Effect on hospital incentive payments and quality performance of a hospital pay for performance (P4P) programme in Belgium.

BACKGROUND: Belgium initiated a hospital pay for performance (P4P) programme after a decade of fixed bonus budgets for "quality and safety contracts". This study examined the effect of P4P on hospital incentive payments, performance on quality measures, and the association between changes in quality performance and incentive payments over time. METHODS: The Belgian government provided information on fixed bonus budgets in 2013-2017 and hospital incentive payments as well as hospital performance on quality measures for the P4P programmes in 2018-2020. Descriptive analyses were conducted to map the financial repercussion between the two systems. A difference-in-difference analysis evaluated the association between quality indicator performance and received incentive payments over time. RESULTS: Data from 87 acute-care hospitals were analyzed. In the transition to a P4P programme, 29% of hospitals received lower incentive payments per bed. During the P4P years, quality performance scores increased yearly for 55% of hospitals and decreased yearly for 5% of hospitals. There was a significant larger drop in incentive payments for hospitals that scored above median with the start of the P4P programme. CONCLUSIONS: The transition from fixed bonus budgets for quality efforts to a new incentive payment in a P4P programme has led to more hospitals being financially impacted, although the effect is marginal given the small P4P budget. Quality indicators seem to improve over the years, but this does not correlate with an increase in reward per bed for all hospitals due to the closed nature of the budget.

Rapid diagnostic tests for dengue would reduce hospitalizations, healthcare costs and antibiotic prescriptions in Spain: A cost-effectiveness analysis / Los tests de diagnóstico rápido para dengue reducirían las hospitalizaciones, los costes sanitarios y la prescripción de antibióticos en España: un análisis de coste-efectividad

Background: Current gold standard diagnostic techniques for dengue are expensive and time-consuming. Rapid diagnostic tests (RDTs) have been proposed as alternatives, although data about their potential impact in non-endemic areas is scarce. Methods: We performed a cost-effectiveness analysis comparing the costs of dengue RDTs to the current standard of care for the management of febrile returning travelers in Spain. Effectiveness was measured in terms of potential averted hospital admissions and reduction of empirical antibiotics, based on 2015–2020 dengue admissions at Hospital Clinic Barcelona (Spain). Results: Dengue RDTs were associated with 53.6% (95% CI: 33.9–72.5) reduction of hospital admissions and were estimated to save 289.08–389.31€ per traveler tested. Moreover, RDTs would have avoided the use of antibiotics in 46.4% (95% CI: 27.5–66.1) of dengue patients. Discussion: Implementation of dengue RDTs for the management of febrile travelers is a cost-saving strategy that would lead to a reduction of half of dengue admissions and a reduction of inappropriate antibiotics in Spain.(AU)

Introducción: El actual gold standard para el diagnóstico de dengue se basa en técnicas caras y que requieren tiempo. Los tests de diagnóstico rápido (TDR) se han propuesto como una posible alternativa, aunque los datos sobre su posible impacto en áreas no endémicas son escasos. Métodos: Realizamos un análisis de coste-efectividad comparando los costes del uso de TDR para dengue con el manejo habitual de viajeros con fiebre en España. Para medir la efectividad se estimaron las hospitalizaciones potencialmente evitables y la reducción de antibióticos empíricos de acuerdo con las hospitalizaciones por dengue entre 2015-2020 en el Hospital Clínic Barcelona (España). Resultados: El uso de TDR para dengue se asoció con una reducción de 53.6% (IC 95%: 33.9–72.5) de las hospitalizaciones y un ahorro de 289.08-389.31€ por viajero testado. Además, el uso de TDR hubiese evitado el tratamiento de antibióticos en 46.4% (IC 95%: 27.5–66.1) de los casos de dengue. Discusión: La implementación de TDR de dengue para el manejo de viajeros con fiebre es una medida de reducción de gastos que disminuiría a la mitad los ingresos hospitalarios por dengue y supondría una reducción del uso inapropiado de antibióticos en España.(AU)

Rapid diagnostic tests for dengue would reduce hospitalizations, healthcare costs and antibiotic prescriptions in Spain: A cost-effectiveness analysis.

BACKGROUND: Current gold standard diagnostic techniques for dengue are expensive and time-consuming. Rapid diagnostic tests (RDTs) have been proposed as alternatives, although data about their potential impact in non-endemic areas is scarce. METHODS: We performed a cost-effectiveness analysis comparing the costs of dengue RDTs to the current standard of care for the management of febrile returning travelers in Spain. Effectiveness was measured in terms of potential averted hospital admissions and reduction of empirical antibiotics, based on 2015-2020 dengue admissions at Hospital Clinic Barcelona (Spain). RESULTS: Dengue RDTs were associated with 53.6% (95% CI: 33.9-72.5) reduction of hospital admissions and were estimated to save 289.08-389.31€ per traveler tested. Moreover, RDTs would have avoided the use of antibiotics in 46.4% (95% CI: 27.5-66.1) of dengue patients. DISCUSSION: Implementation of dengue RDTs for the management of febrile travelers is a cost-saving strategy that would lead to a reduction of half of dengue admissions and a reduction of inappropriate antibiotics in Spain.

Impacto de las fracturas por fragilidad en mujeres españolas con osteoporosis posmenopáusica / Impact of fragility fractures in postmenopausal Spanish women with osteoporosis

Objetivo: dada la repercusión que tienen las fracturas por fragilidad y sus secuelas en la vida de las mujeres con osteoporosis posmenopáusica (OPM), el objetivo de este estudio es describir y analizar su impacto en esta población. Material y métodos: se realizó una encuesta a mujeres posmenopáusicas con fractura por fragilidad en un diseño observacional transversal. Se recogieron variables sociodemográficas, impacto de la fractura (necesidad de cuidados, productividad laboral), calidad de vida relacionada con la salud (CVRS, mediante cuestionario QUALEFFO-31) y disposición a pagar (DAP) por recuperarla. Resultados: participaron 120 mujeres, promedio de edad 62 ± 7 años. Las fracturas más frecuentes fueron las de radio distal (29,9 %) y las vertebrales (21,3 %). Un 53,3 % necesitó cuidados durante su recuperación (76,5 % informales; 24,9 % formales) y un 4,2 % tuvo que ingresar en un centro/residencia sociosanitaria. De aquellas que trabajaban cuando se produjo la fractura (62,5 %), el 56 % vio su vida laboral afectada (69,3 % incapacidad temporal; 17,3 % incapacidad permanente; 10,7 % reducción de jornada; 10,7 % abandono laboral; 5,3 % permiso/excedencia; 3,6 % prejubilación). El impacto de la fractura se debió principalmente al dolor (71,7 %), dificultad para realizar actividades cotidianas (48,3 %), problemas de movilidad (46,7 %) y estado emocional (41,7 %). La mayor DAP se ofreció por recuperar la capacidad para realizar actividades cotidianas y el estado emocional. La puntuación total QUALEFFO-31 (0-100) fue 49,9 ± 10,8 (función mental: 68,3 ± 7,3; dolor: 56 ± 22,6; función física: 39,3 ± 15,5). Conclusiones: las fracturas por fragilidad tienen un alto impacto en la calidad de vida de las mujeres con OPM. Resulta fundamental poner en valor aquellos aspectos que más les preocupan para optimizar su abordaje. (AU)

Objective: Given the impact of fragility fractures and their consequences on the lives of women with postmenopausal osteoporosis (PMO), the objective of this study is to describe and analyze the impact of this kind of fractures on this population. Materials and methods: A survey was conducted among postmenopausal women with fragility fractures in a cross-sectional observational design. Sociodemographic variables, fracture impact (need for care, work productivity), and data on health-related quality of life (HRQoL, assessed using the QUALEFFO-31 questionnaire), and willingness to pay (WTP) to regain HRQoL were collected. Results: A total of 120 women participated, with a mean age of 62 ± 7 years. The most frequent fractures described were distal radius fractures (29.9 %), followed by vertebral fractures (21.3 %). A total of 53.3 % required care during their recovery (76.5 %, informal; 24.9 %, formal), and 4.2 % had to be admitted to a health care or nursing home. Among those who were working when the fracture occurred (62.5 %), 56 % had their working life affected (69.3 %, temporary disability; 17.3 %, permanent disability; 10.7 %, reduced working hours; 10.7 %, quit their jobs; 5.3 %, leave of absence; and 3.6 %, early retirement). The impact of the fracture was primarily due to pain (71.7 %), difficulty performing activities of daily living (48.3 %), mobility problems (46.7 %), and emotional state (41.7 %). The highest WTP was offered to regain the ability to perform activities of daily living and improve the emotional state. The overall QUALEFFO-31 score (0-100) was 49.9 ± 10.8 (mental function, 68.3 ± 7.3; pain, 56 ± 22.6; physical function, 39.3 ± 15.5). Conclusions: Fragility fractures play a significant role on the quality of life of women with PMO. It is of paramount importance to value the aspects that concern them the most to optimize their management. (AU)

Feridas complexas: abordagem por equipa multidisciplinar. Uma scoping review. / Complex wounds: approach by a multidisciplinary team. A scoping review

Objetivos: - reconhecer a importância da equipa multidisciplinar na abordagem à pessoa com ferida complexa na cicatrização de feridas; - mapear a evidência/conhecimento sobre a temática em estudo. Método: Scoping review realizada entre 04 de janeiro e 01 de fevereiro de 2020, nas bases de dados Repositório Científico de Acesso Aberto de Portugal (RCAAP), EBSCO host (CINAHL e Medline) e Web of Science, utilizando estratégias de pesquisa adaptadas a cada base de dados. Resultados e discussão: A evidência científica demonstra a importância das equipas multidisciplinares na abordagem à pessoa com ferida complexa. Conclusão: Tratando-se de um processo complexo, é fundamental ter em consideração todos os elementos que influenciam e atrasam a cicatrização, para se conseguir melhorar os resultados no tratamento e nos custos associados.(AU)

Objectives: - to recognize the importance of the multidisciplinary team in the approach to the person with a complex wound in wound healing; - to map the evidence/knowledge on the subject under study. Method: Scoping review carried out between January 4 and February 1, 2020, in the databases Repositório Científico de Acesso Aberto de Portugal (RCAAP), EBSCO host (CINAHL and Medline) and Web of Science, using search strategies adapted to each database. Results and discussion: The scientific evidence demonstrates the importance of multidisciplinary teams in dealing with people with complex wounds. Conclusion: As this is a complex process, it is essential to take into account all the elements that influence and delay healing, in order to improve treatment results and associated costs. (AU)

Objetivos: - reconocer la importancia del equipo multidisciplinar en el abordaje de la persona con herida compleja en la cicatrización de heridas; - mapear la evidencia/conocimiento sobre el tema objeto de estudio. Método: Revisión de alcance realizada entre el 04 de enero y el 01 de febrero de 2020, en las bases de datos Repositório Científico de Acesso Aberto de Portugal (RCAAP), EBSCO host (CINAHL y Medline) y Web of Science, utilizando estrategias de búsqueda adaptadas a cada base de datos. Resultados y discusión: La evidencia científica demuestra la importancia de los equipos multidisciplinares en el abordaje de las personas con heridas complejas. Conclusión: Al tratarse de un proceso complejo, es fundamental tener en cuenta todos los elementos que influyen y retrasan la cicatrización para mejorar los resultados del tratamiento y los costes asociados.(AU)

Actualización del coste de vacunar a lo largo de toda la vida en España para el año 2023 / Updated cost of vaccinating throughout life in Spain in 2023

Fundamentos: en el calendario de vacunación a lo largo de toda la vida del consejo interterritorial del sistema nacional de Salud (cisns) se introdujeron cuatro modificaciones importantes en 2023. El objetivo de este estudio fue estimar el coste de la vacuNación a lo largo de toda la vida a una persona sana y a ciertos grupos de riesgo tomando como referencia el calendario de 2023 yCompararlo con una estimación previa de 2019. Métodos: se realizo un estudio descriptivo del coste de administrar las vacunas incluidas en el calendario de vacunación a lo Largo de toda la vida para el año 2023 y en el calendario para grupos de riesgo.Resultados: el coste estimado de vacunar a una persona sana a lo largo de toda la vida en 2023 es de 1.541,56 euros en mujeres Y 1.498,18 euros en hombres, lo que supondría un incremento del 125% con respecto al coste en 2019. Las condiciones de riesgo con El coste más alto son asplenia además de déficit del complemento e inmunodeficiencias primarias, suponiendo 3.159.82 euros y 2.566Euros, respectivamente, de media. Vacunar a toda la población sana en españa en un año costaría unos 565 millones de euros y Vacunar a la cohorte de recién nacidos de 2023 a lo largo de toda la vida unos 500 millones de euros.Conclusiones: a pesar del incremento en el coste en 2023, considerando el impacto económico de las enfermedades prevenibles por vacunación en la sociedad, la vacunación sigue siendo una intervención barata que aporta múltiples beneficios.(AU)

Background: four modifications were introduced in the lifetime vaccination schedule of the interterritorial council of the National health system (cisns) in 2023. the aim of this study was to estimate the cost of vaccinating a healthy person and people with Certain risk conditions throughout life in spain and to compare with a previous estimation from 2019.Methods: a descriptive study of the cost of administering the vaccines included in the lifetime vaccination schedule for the year 2023 and in the schedule for risk groups was carried out. Results: the estimated cost to immunize a healthy person throughout life in 2023 is 1,541.56€ for a woman and 1,498.18€ for a Men, which corresponds to an increase of 125% compared to the cost in 2019. The risk conditions with the highest cost are asplenia And complement deficiency and primary immunodeficiencies, with a cost of 3,159.82 euros and 2,566 euros respectively on average. The cost of vaccinating the whole healthy population in spain in a year is around 565m€. Moreover, the cost of vaccinating the New-borns cohort of 2023 was estimated at 500m€. Conclusions: despite the cost increase in 2023, immunization is still a very cheap intervention, considering the economic Impact of immunopreventable diseases in the society. The relative low cost of immunization throughout life makes this health inter-vention useful and worthwhile.(AU)

Impacto de la fracción de eyección del ventrículo izquierdo en el consumo de recursos, los costes y el pronóstico en pacientes con insuficiencia cardiaca / Differences in clinical outcomes, health care resource utilization and costs in heart failure patients according to left ventricular ejection fraction

Introducción y objetivos: No se conoce bien el impacto de la fracción de eyección del ventrículo izquierdo (FEVI) en el coste y la utilización de recursos sanitarios (URS) en la insuficiencia cardiaca (IC). El objetivo de nuestro trabajo es comparar el consumo de costes, la URS y el pronóstico según grupos de FEVI. Métodos: Estudio observacional retrospectivo que incluyó a todos los pacientes con diagnóstico principal de IC en urgencias o en una hospitalización en un centro terciario español durante 2018. Se excluyó la IC de nuevo diagnóstico. Se compararon los resultados clínicos, los costes y la URS según la FEVI (reducida [IC-FEr], ligeramente reducida [IC-FElr] y conservada [IC-FEc]) a 1 año. Resultados: De 1.287 pacientes con diagnóstico de IC en urgencias, 365 (28,4%) fueron dados de alta (grupo de urgencias [GU]) y 919 (71,4%), hospitalizados (GH). En total, 190 pacientes (14,7%) tenían IC-FEr; 146 (11,4%), IC-FElr y 951 (73,9%), IC-FEc. La media de edad fue 80,1±10,7 años, y el 57,1% eran mujeres. La mediana [intervalo intercuartílico] del coste por paciente-año fue de 1.889 [259-6.269] euros en el GU y 5.008 [2.747-9.589] euros en el GH (p <0,001). Los pacientes con IC-FEr del GU sufrieron más hospitalizaciones. El coste de la IC-FEr por paciente-año fue superior en ambos grupos: en el GU, 4.763 [2.076-17.155] euros con IC-FEr frente a 3.900 [590-8.013] euros con IC-FElr frente a 3.812 [259-5.486] euros con IC-FEc; en el GH, 6.321 [3.335-796] frente a 6.170 [3.189-10.484] frente a 4.636 [2.609-8.977] euros respectivamente; todos, p <0,001). Esta diferencia se debió a que los pacientes con IC-FEr ingresaron con mayor frecuencia en unidades de cuidados críticos y recibieron más pruebas diagnóstico-terapéuticas. Conclusiones: La FEVI influye significativamente en los costes y URS en la IC. Los pacientes con IC-FEr, especialmente los hospitalizados, concentran un mayor coste que aquellos con IC-FEc.(AU)

Introduction and objectives: The impact of left ventricular ejection fraction (LVEF) on health care resource utilization (HCRU) and cost in heart failure (HF) patients is not well known. We aimed to compare outcomes, HCRUs and costs according to LVEF groups. Methods: Retrospective, observational study of all patients with an emergency department (ED) visit or admission to a tertiary hospital in Spain 2018 with a primary HF diagnosis. We excluded patients with newly diagnosed heart failure. One-year clinical outcomes, costs and HCRUs were compared according to LVEF (reduced [HFrEF], mildly reduced [HFmrEF], and preserved [HFpEF]). Results: Among 1287 patients with a primary diagnosis of HF in the ED, 365 (28.4%) were discharged to home (ED group), and 919 (71.4%) were hospitalized (hospital group [HG]). In total, 190 patients (14.7%) had HFrEF, 146 (11.4%) HFmrEF, and 951 (73.9%) HFpEF. The mean age was 80.1±10.7 years; 57.1% were female. The median [interquartile range] of costs per patient/y was €1889 [259-6269] in the ED group and €5008 [2747-9589] in the HG (P <.001). Hospitalization rates were higher in patients with HFrEF in the ED group. The median costs of HFrEF per patient/y were higher in patients in both groups: €4763 [2076-17 155] vs €3900 [590-8013] for HFmrEF vs €3812 [259-5486] for HFpEF in the ED group, and €6321 [3335-796] vs €6170 [3189-10484] vs €4636 [2609-8977], respectively, in the hospital group (all P <.001). This difference was driven by the more frequent admission to intensive care units, and greater use of diagnostic and therapeutic tests among HFrEF patients. Conclusions: In HF, LVEF significantly impacts costs and HCRU. Costs were higher in patients with HFrEF, especially those requiring hospitalization, than in those with HFpEF.(AU)

Differences in clinical outcomes, health care resource utilization and costs in heart failure patients according to left ventricular ejection fraction.

INTRODUCTION AND OBJECTIVES: The impact of left ventricular ejection fraction (LVEF) on health care resource utilization (HCRU) and cost in heart failure (HF) patients is not well known. We aimed to compare outcomes, HCRUs and costs according to LVEF groups. METHODS: Retrospective, observational study of all patients with an emergency department (ED) visit or admission to a tertiary hospital in Spain 2018 with a primary HF diagnosis. We excluded patients with newly diagnosed heart failure. One-year clinical outcomes, costs and HCRUs were compared according to LVEF (reduced [HFrEF], mildly reduced [HFmrEF], and preserved [HFpEF]). RESULTS: Among 1287 patients with a primary diagnosis of HF in the ED, 365 (28.4%) were discharged to home (ED group), and 919 (71.4%) were hospitalized (hospital group [HG]). In total, 190 patients (14.7%) had HFrEF, 146 (11.4%) HFmrEF, and 951 (73.9%) HFpEF. The mean age was 80.1±10.7 years; 57.1% were female. The median [interquartile range] of costs per patient/y was €1889 [259-6269] in the ED group and €5008 [2747-9589] in the HG (P <.001). Hospitalization rates were higher in patients with HFrEF in the ED group. The median costs of HFrEF per patient/y were higher in patients in both groups: €4763 [2076-17 155] vs €3900 [590-8013] for HFmrEF vs €3812 [259-5486] for HFpEF in the ED group, and €6321 [3335-796] vs €6170 [3189-10484] vs €4636 [2609-8977], respectively, in the hospital group (all P <.001). This difference was driven by the more frequent admission to intensive care units, and greater use of diagnostic and therapeutic tests among HFrEF patients. CONCLUSIONS: In HF, LVEF significantly impacts costs and HCRU. Costs were higher in patients with HFrEF, especially those requiring hospitalization, than in those with HFpEF.

Economic burden of skin and skin structure infections due to Gram-positive bacteria in patients on hospital at home-based outpatient parenteral antibiotic therapy (OPAT) / Carga económica de la infección de piel y partes blandas por microorganismos grampositivos en pacientes en unidades de hospitalización a domicilio con tratamiento antimicrobiano domiciliario endovenoso (TADE)

Objective: To describe and quantify resource use and direct health costs associated with skin and skin structure infections (SSSIs) caused by Gram-positive bacteria in adults receiving outpatient parenteral antimicrobial therapy (OPAT), administered by Hospital at Home units (HaH) in Spain. Material and method: Observational, multicenter, retrospective study. We included patients of both sexes included in the HaH-based OPAT Registry during 2011 to 2017 who were hospitalized due to SSSIs caused by Gram-positive bacteria. Resource use included home visits (nurses and physician), emergency room visits, conventional hospitalization stay, HaH stay and antibiotic treatment. Costs were quantified by multiplying the natural units of the resources by the corresponding unit cost. All costs were updated to 2019 euros. Results: We included 194 episodes in 189 patients from 24 Spanish hospitals. The most frequent main diagnoses were cellulitis (26.8%) and surgical wound infection (24.2%), and 94% of episodes resulted in clinical improvement or cure after treatment. The median HaH stay was 13 days (interquartile range [IR]:8-22.7), and the conventional hospitalization stay was 5 days (IR: 1-10.7). The mean total cost attributable to the complete infectious process was €7,326 (95% confidence interval: €6,316-€8,416). Conclusions: Our results suggest that OPAT administered by HaH is a safe and efficient alternative for the management of these infections and could lead to lower costs compared with hospital admission. (AU)

Objetivo: Describir y cuantificar el uso de recursos y costes directos sanitarios asociados con las infecciones de piel y tejidos blandos (IPPB) causadas por microorganismos grampositivos en adultos que recibieron tratamiento antimicrobiano domiciliario endovenoso (TADE), administrado en unidades de hospitalización a domicilio (HaD) en España. Material y métodos: Estudio observacional, multicéntrico, retrospectivo. Se incluyeron pacientes adultos de ambos sexos, incluidos en el Registro TADE en el periodo 2011 a 2017y cuyo motivo de ingreso fue una IPPB causada por un microorganismo Grampositivo. El uso de recursos incluyó las visitas a domicilio (enfermería y médico), visitas a urgencias, estancia en hospitalización convencional, estancia en HaD y tratamiento antibiótico. Los costes se cuantificaron multiplicando las unidades naturales de los recursos por el coste unitario correspondiente. Todos los costes fueron actualizados a euros de 2019. Resultados: Se incluyeron 194 episodios (189 pacientes) procedentes de 24 centros españoles. Los diagnósticos principales más frecuentes fueron celulitis (26,8%) e infección por herida quirúrgica (24,2%). El 94% de los episodios resultaron en una mejoría o curación clínica al finalizar el tratamiento. La mediana de la estancia en HaD fue de 13 días (rango intercuartílico [RI]:8-22,7), con una estancia previa en hospitalización convencional de 5 días (RI: 1-10,7). El coste total promedio atribuible al proceso infecciosos completo fue de 7.326€ (intervalo de confianza del 95%: 6.316€-8.416€). Conclusiones: Este estudio sugiere que el TADE administrado en HaD es una alternativa segura y eficiente para el manejo de estas infecciones y podría conducir a menores costes en comparación con el ingreso hospitalario. (AU)

Impacto Laboral, Económico, y Clínico Funcional en la Artrodesis Lumbar / Labor, economic, and clinical functional impact of lumbar arthrodesis

Introducción: El dolor lumbar, constituye un grave problema de salud, en España ocupa el primer puesto como causa de Incapacidad Temporal (IT). Diversos estudios han intentado responder a la cuestión de si compensa realizar intervenciones más intensivas. El objetivo del proyecto es analizar el gasto sanitario ocasionado, valorando los costes de IT al emplear el tratamiento conservador y con tratamiento quirúrgico. Material y Métodos: Estudio prospectivo comparativo entre pacientes con patología degenerativa lumbar tratados quirúrgicamente, y de manera conservadora. Se recogieron la edad y sexo, hábitos tóxicos, tratamiento farmacológico, actividad laboral, los segmentos afectados, y el número de días en situación de IT, con un seguimiento de 3 años. Resultados: Un total de 94 pacientes fueron incluidos en el estudio (55 pertenecían al grupo control, y 39 al grupo artrodesis). Los pacientes que fueron operados llevaban más días de IT, y entrañaban más costes de IT (p=0,018). Comparando los costes de la intervención quirúrgica para el grupo artrodesis vemos que no existen diferencias entre los pacientes jubilados/ en situación de incapacidad permanente. Después de tres años de seguimiento, el 89,1% del grupo control y el 52,6% del grupo artrodesis recibieron el alta. Conclusión: Los costes de incapacidad transitoria fueron mayores en los pacientes sometidos a tratamiento quirúrgico. Los pacientes que no recibieron el alta supusieron mayores costes de IT. En los pacientes que recibieron el alta no hubo diferencias en los costes, descontando el coste del proceso quirúrgico. (AU)

Introduction: Low back pain is a serious health problem, and in Spain it occupies first place as a cause of Temporary Disability (TD). Several studies have tried to answer the question of whether it is worthwhile to carry out more intensive interventions. The project aims to analyze the health care costs incurred, assessing the costs of TD when conservative treatment and surgical treatment are used. Material and methods: Prospective comparative study between patients with lumbar degenerative pathology treated surgically and conservatively. Age and sex, toxic habits, pharmacological treatment, work activity, affected segments, and the number of days on TI were recorded, with a follow-up of 3 years. Results: A total of 94 patients were included in the study (55 belonged to the control group and 39 to the arthrodesis group). Patients who underwent surgery had more days of TD and more TD costs (p=0.018). Comparing the costs of surgery for the arthrodesis group, we see that there are no differences between retired/permanently disabled patients. After three years of follow-up, 89.1% of the control group and 52.6% of the arthrodesis group were discharged. Conclusion: Transitional disability costs were higher in patients who underwent surgical treatment. Patients who were not discharged had higher TD costs. In patients who were discharged, there were no differences in costs, discounting the cost of the surgical process. (AU)

Organización y costes de la atención extrahospitalaria del ictus. Revisión sistemática de la literatura / Organization and costs of stroke care in outpatient settings: Systematic review

Objetivo: Revisar la bibliografía sobre costes del ictus (ICD-10 código I63) en el ámbito de la atención primaria. Diseño: Revisión sistemática. Fuentes de datos: PubMed/Medline, ClinicalTrials.gov, Cochrane Reviews, EconLit y Ovid/Embase entre el 1 de enero de 2012 y el 31 de diciembre de 2021 con descriptores incluidos en Medical Subject Heading (MeSH). Selección de estudios: Aquellos con descripción de costes de actividades realizadas en el ámbito extrahospitalario. Se incluyeron revisiones sistemáticas; estudios observacionales prospectivos y retrospectivos; análisis de bases de datos y de costes totales o parciales del ictus como enfermedad (COI). Se agregaron artículos utilizando el método de «bola de nieve». Se excluyeron los estudios: a) no relacionados concretamente con el ictus; b) en formato de editoriales o comentarios; c) irrelevantes después de examinar el título y el resumen; d) literatura gris y estudios no académicos. Extracción de datos: A los estudios se les asignó un nivel de evidencia según los niveles GRADE. Se recogieron datos de costes directos e indirectos. Resultados y conclusiones: Treinta estudios, de los que 14 (46,6%) eran relativos a costes postictus y 12 (40%) a costes en prevención cardiovascular. Los resultados muestran que la mayoría son análisis retrospectivos de diferentes bases de datos de atención hospitalaria a corto plazo, y no permiten realizar un análisis detallado de los costes por diferentes segmentos de servicios. Las posibilidades de mejora aparecen centradas en la prevención primaria y secundaria, selección y traslado prehospitalario, el alta precoz con soporte y la atención sociosanitaria.(AU)

Objective: To review the bibliography on stroke costs (ICD-10 code I63) in the field of primary care. Design: Systematic review. Data sources: PubMed/Medline, ClinicalTrials.gov, Cochrane Reviews, EconLit, and Ovid/Embase between 01/01/2012–12/31/2021 with descriptors included in Medical Subject Heading (MeSH). Selection of studies: Those with a description of the costs of activities carried out in the out-of-hospital setting. Systematic reviews were included; prospective and retrospective observational studies; analysis of databases and total or partial costs of stroke as a disease (COI). Articles were added using the snowball method. The studies were excluded because: a) not specifically related to stroke; b) in editorial or commentary format; c) irrelevant after review of the title and abstract; and d) gray literature and non-academic studies were excluded. Data extraction: They were assigned a level of evidence according to the GRADE levels. Direct and indirect cost data were collected. Results and conclusions: Thirty studies, of which 14 (46.6%) were related to post-stroke costs and 12 (40%) to cardiovascular prevention costs. The results show that most of them are retrospective analyzes of different databases of short-term hospital care, and do not allow a detailed analysis of the costs by different segments of services. The possibilities for improvement are centered on primary and secondary prevention, selection and pre-hospital transfer, early discharge with support, and social and health care.(AU)

Análisis de minimización de costes de brolucizumab en el tratamiento de la degeneración macular asociada a la edad neovascular / Cost minimization analysis of brolucizumab in the treatment of neovascular age-related macular degeneration

Introducción Brolucizumab es un nuevo fármaco antifactor de crecimiento endotelial vascular (anti-VEGF) administrado con una pauta fija de ocho o 12 semanas que en los estudios HAWK y HARRIER demostró ser no inferior a aflibercept con respecto a la mejor agudeza visual corregida, bajo una menor carga de administración. El objetivo del análisis fue comparar los costes directos sanitarios de ambos anti-VEGF como tratamiento en pacientes con degeneración macular asociada a la edad neovascular. Material y métodos Se realizó un análisis de minimización de costes bajo un horizonte temporal de 25 años y considerando el coste farmacológico, de administración, de pruebas de seguimiento y del manejo de eventos adversos. El uso de recursos fue obtenido de literatura relacionada y validada por expertos clínicos. Se llevaron a cabo diversos análisis de escenarios para comprobar la robustez de los resultados. Resultados Brolucizumab resultó con un menor coste por paciente en comparación con aflibercept, considerando el número de inyecciones derivadas de los estudios HAWK y HARRIER. Este resultado se mantuvo en los diferentes escenarios analizados, excepto frente al número de inyecciones de la pauta flexible de aflibercept del estudio ARIES, ya que la menor discontinuación de tratamiento con brolucizumab conlleva mantener el tratamiento de más pacientes. Al considerar la misma discontinuación, brolucizumab mantuvo los resultados observados en el caso base del análisis. Conclusiones El presente estudio muestra como la pauta de administración fija de brolucizumab puede ayudar a disminuir la carga asistencial para los centros sanitarios y los pacientes (AU)

Introduction Brolucizumab is a novel anti-vascular endothelial growth factor (anti-VEGF) drug administered in a fixed regimen of 8 or 12 weeks which, in the HAWK and HARRIER studies, was shown not to be inferior to aflibercept with respect to the best corrected visual acuity, with a less burdensome treatment regimen. The aim of the analysis was to compare the direct healthcare costs of both anti-VEGF as a treatment in patients with neovascular age-related macular degeneration.Material and methods A cost minimization analysis was performed under a 25-year time horizon and considering the drug costs, administration, follow-up tests, and management of adverse events. Resource use was obtained from the related literature and validated by clinical experts. Various scenario analysis were carried out to check the robustness of the results. Results Brolucizumab resulted in a lower cost per patient compared with aflibercept, considering the number of injections derived from the HAWK and HARRIER studies. This result was maintained in the different scenarios analysed, except for the number of injections of the flexible aflibercept regimen of the ARIES study, since the lower discontinuation of treatment with brolucizumab implies maintaining the treatment of more patients. Considering the same discontinuation, brolucizumab maintained the results observed in the base case of the analysis. Conclusions This study shows how the fixed administration regimen of brolucizumab can help reduce both healthcare and patients’ burden (AU)

Use of hospital resources in ICU inpatients with infections caused by carbapenem-resistant Gram-negative bacteria: A real clinical practice-based study in Spain / Uso de recursos hospitalarios en pacientes hospitalizados en UCI debido a infecciones causadas por bacterias gramnegativas resistentes a carbapenémicos: un estudio basado en la práctica clínica real en España

Introduction: Carbapenem-resistant Gram-negative bacteria (CRGN) are an urgent public health threat because of the limited treatment options, its rapid spreading and high clinical impact and mortality rates. However, the burden and the use of resources of these infections have not been investigated. The aim of the current study is to understand the use of resources associated to the clinical management of CRGN infections in real clinical practice conditions. Methods: An observational retrospective chart review study was performed. Data regarding patient demographics, clinical management and use of resources associated to hospitalization were retrieved from clinical charts of ICU inpatients with a confirmed CRGN infection. Three reference Spanish hospitals were selected according to their patient volume and geographical coverage. Descriptive analyses of the clinical management and the use of resources and its cost were performed and then total costs by type of resource were calculated. Results: A total of 130 patients were included in the study. The higher number of patients (n=43; 33%) were between 61 and 70 years old. Ninety-four (72%) patients were male and 115 (88%) suffered from comorbidities. The mean total cost associated to the resources used in patients with CRGN infections hospitalized in ICU was 96,878€ per patient. These total costs included 84,140€ of total hospital stay, 11,021€ of treatments (558€ of antibiotics; 10,463€ of other treatments) and 1717€ costs of diagnostic tests. Conclusions: CRGN infection causes a high use of hospital resources, being the length of stay either in hospital wards or ICU the driver of the total costs. Diagnostic tests and treatments, including antibiotics, represent the lowest part of the use of resources and costs (13% of total costs).(AU)

Introducción: Las bacterias gramnegativas resistentes a carbapenémicos (CRGN) son una amenaza urgente de salud pública por las limitadas opciones de tratamiento, su rápida dispersión y el alto impacto clínico y tasas de mortalidad. Sin embargo, la carga y el uso de recursos de estas infecciones no han sido investigadas. El objetivo de este estudio es comprender el uso de recursos asociado al manejo clínico de las infecciones por CRGN en condiciones de práctica clínica real. Métodos: Se llevó a cabo un estudio observacional retrospectivo de revisión de historias clínicas. Se recogieron datos demográficos, del manejo clínico y del uso de recursos asociado a la hospitalización de historias clínicas de pacientes hospitalizados en UCI con una infección confirmada por CRGN. Se seleccionaron tres hospitales españoles de referencia por su cobertura geográfica. Se realizaron análisis descriptivos del manejo clínico y el uso de recursos y sus costes en episodios de infecciones por CRGN, y se calcularon los costes totales para cada tipo de recurso. Resultados: Se incluyeron en el estudio un total de 130 pacientes. La mayoría de los pacientes (n=43;33%) tenían entre 61-70 años. Noventa y cuatro pacientes (72%) eran hombres y 115 (88%) presentaron comorbilidades. El coste medio total asociado a los recursos usados durante el episodio de infección por CRGN por paciente fue de 96.878€. Este coste total incluye 84.140€ de la estancia en el hospital, 11.021€ de los tratamientos (558€ de antibióticos y 10.463€ de otros tratamientos) y 1.717€ del coste de test diagnósticos. Conclusiones: El episodio de infección por CRGN causa un alto uso de recursos hospitalarios, siendo la duración de la estancia tanto en planta hospitalaria como en UCI el factor con mayor peso de los costes totales. Los test diagnósticos clínicos y los tratamientos, incluyendo los antibióticos, representan la parte más pequeña del uso de recursos y sus costes (13% del coste total).(AU)

Disease burden and costs for patients with hip and knee osteoarthritis and chronic moderate-to-severe refractory pain on treatment with strong opioids in Spain.

INTRODUCTION AND OBJECTIVES: To determine the disease burden and costs in patients with hip or knee OA and chronic moderate-to-severe refractory pain, receiving strong opioids in Spain. MATERIALS AND METHODS: This was a 36-month longitudinal secondary analysis of the real-word OPIOIDS study. Patients aged ≥18 years with hip or knee OA and chronic moderate-to-severe refractory pain receiving strong opioids were considered. The disease burden included analgesia assessments (NRS scale), cognitive functioning (MMSE scale), basic activities of daily living (Barthel index), and comorbidities (severity and frequency). Costs due to the use of healthcare resources and productivity loss were estimated. RESULTS: 2832 patients were analyzed; age was 72.0 years (SD=14.3), 76.8% were women. Patients had mainly been treated with fentanyl (n=979; 37.6%), tapentadol (n=625; 24.0%), oxycodone (n=572; 22.0%), and buprenorphine (n=425; 16.3%). Pain intensity decreased by 1 point (13.7%), with a 2.6-point decline in the cognitive scale (14.3%, with a 5.3%-increase in patients with cognitive deficit) over a mean treatment period of 384.6 days (SD: 378.8). Barthel scores decreased significantly yielding to a slightly increase in proportion of patients with severe-to-total dependency; 1.2%-2.9%. In the first year of treatment, average healthcare costs were €2013/patient, whereas the average productivity loss cost was €12,227/working-active patient. DISCUSSION AND CONCLUSIONS: Strong opioids resulted in high healthcare costs with a limited reduction in pain, an increase in cognitive deficit, and a slight increase of patients with severe to total dependency over 36 months of treatment.

[Organization and costs of stroke care in outpatient settings: Systematic review]. / Organización y costes de la atención extrahospitalaria del ictus. Revisión sistemática de la literatura.

OBJECTIVE: To review the bibliography on stroke costs (ICD-10 code I63) in the field of primary care. DESIGN: Systematic review. DATA SOURCES: PubMed/Medline, ClinicalTrials.gov, Cochrane Reviews, EconLit, and Ovid/Embase between 01/01/2012-12/31/2021 with descriptors included in Medical Subject Heading (MeSH). SELECTION OF STUDIES: Those with a description of the costs of activities carried out in the out-of-hospital setting. Systematic reviews were included; prospective and retrospective observational studies; analysis of databases and total or partial costs of stroke as a disease (COI). Articles were added using the snowball method. The studies were excluded because: a) not specifically related to stroke; b) in editorial or commentary format; c) irrelevant after review of the title and abstract; and d) gray literature and non-academic studies were excluded. DATA EXTRACTION: They were assigned a level of evidence according to the GRADE levels. Direct and indirect cost data were collected. RESULTS AND CONCLUSIONS: Thirty studies, of which 14 (46.6%) were related to post-stroke costs and 12 (40%) to cardiovascular prevention costs. The results show that most of them are retrospective analyzes of different databases of short-term hospital care, and do not allow a detailed analysis of the costs by different segments of services. The possibilities for improvement are centered on primary and secondary prevention, selection and pre-hospital transfer, early discharge with support, and social and health care.

Disease burden and costs for patients with hip and knee osteoarthritis and chronic moderate-to-severe refractory pain on treatment with strong opioids in Spain / Carga de la enfermedad y costes en pacientes con osteoartritis de cadera y rodilla con dolor crónico refractario moderado-severo tratados con opioides mayores en España

Introduction and objectives: To determine the disease burden and costs in patients with hip or knee OA and chronic moderate-to-severe refractory pain, receiving strong opioids in Spain. Materials and methods: This was a 36-month longitudinal secondary analysis of the real-word OPIOIDS study. Patients aged ≥18 years with hip or knee OA and chronic moderate-to-severe refractory pain receiving strong opioids were considered. The disease burden included analgesia assessments (NRS scale), cognitive functioning (MMSE scale), basic activities of daily living (Barthel index), and comorbidities (severity and frequency). Costs due to the use of healthcare resources and productivity loss were estimated. Results: 2832 patients were analyzed; age was 72.0 years (SD=14.3), 76.8% were women. Patients had mainly been treated with fentanyl (n=979; 37.6%), tapentadol (n=625; 24.0%), oxycodone (n=572; 22.0%), and buprenorphine (n=425; 16.3%). Pain intensity decreased by 1 point (13.7%), with a 2.6-point decline in the cognitive scale (14.3%, with a 5.3%-increase in patients with cognitive deficit) over a mean treatment period of 384.6 days (SD: 378.8). Barthel scores decreased significantly yielding to a slightly increase in proportion of patients with severe-to-total dependency; 1.2%–2.9%. In the first year of treatment, average healthcare costs were €2013/patient, whereas the average productivity loss cost was €12,227/working-active patient. Discussion and conclusions: Strong opioids resulted in high healthcare costs with a limited reduction in pain, an increase in cognitive deficit, and a slight increase of patients with severe to total dependency over 36 months of treatment.(AU)

Introducción y objetivos: Determinar la carga de la enfermedad y los costes en pacientes con osteoartritis de cadera y rodilla y dolor crónico refractario moderado-severo, en tratamiento con opioides mayores en España. Materiales y métodos: Se trata de un subanálisis de 36 meses de duración, procedente del estudio observacional OPIOIDS. Participaron pacientes con una edad ≥18 años, diagnosticados con osteoartritis de cadera y rodilla y dolor crónico refractario moderado-severo, en tratamiento con opioides mayores. La carga de la enfermedad incluyó la evaluación de la analgesia (escala NRS), del funcionamiento cognitivo (escala MMSE), de la capacidad para realizar las actividades de la vida diaria (índice de Barthel) y de las comorbilidades (gravedad y frecuencia). También se estimaron los costes asociados al uso de recursos sanitarios y a la productividad laboral. Resultados: Se analizaron 2.832 pacientes (edad: 72,0 años [DE: 14,3]; mujeres: 76,8%), que habían sido principalmente tratados con fentanilo (n=979; 37,6%), tapentadol (n=625; 24,0%), oxicodona (n=572; 22,0%) y buprenorfina (n=425; 16,3%). La intensidad del dolor disminuyó una unidad (13,7%), con una reducción de 2,6 unidades en la escala cognitiva (14,3% y aumento del 5,3% en los pacientes con déficit cognitivo) durante una media de 384,6 días (DE: 378,8). Las puntuaciones en la escala de Barthel disminuyeron significativamente, con un ligero aumento en la proporción de pacientes con dependencia grave/total, entre 1,2% y 2,9%. En el primer año, los costes sanitarios medios fueron 2.013€/paciente, mientras que los costes medios de pérdida de productividad fueron 12.227€/trabajador. Discusión y conclusiones: El tratamiento con opioides mayores durante 36 meses implicó elevados costes sanitarios, con una eficacia analgésica limitada, un aumento del déficit cognitivo y un ligero aumento de los pacientes con dependencia grave/total.(AU)

[Approximation to the budgetary cost of universalizing oral health in Spain]. / Una aproximación al coste presupuestario de universalizar la salud bucodental en España.

OBJECTIVE: To make an approximation to an estimate of the impact that an increase in the portfolio of oral health benefits would have on public health spending, which would at least cover most of the therapeutic treatments that households currently pay for privately. METHOD: This estimate is based on the level of expenditure on dental services of the Health Accounts System for the year 2020. The data of increased demand is extracted from a RAND's study on universalization of services. Then we carry out various linear projections of increased spending by introducing several linear co-payment assumptions to explore the impact of different mixed financing mechanisms. RESULTS: The increase in the demand for treatment would be 47.54% with respect to the current level of spending and that, under the starting assumptions, the increase in public spending would reach some 5345 million euros. Various co-pay scenarios could reduce budget impact. CONCLUSIONS: Despite the improvement in the oral health of the Spanish population, there are still problems derived from the existence of a socioeconomic gradient that promotes the concentration of the presence and prevalence of diseases in the lowest socioeconomic levels. Extending the services of the oral-dental portfolio to attend to the entire population would increase public health spending by 0.48 points over GDP and, even so, Spanish public health spending would continue to be below the EU-27 average.

Use of hospital resources in ICU inpatients with infections caused by carbapenem-resistant Gram-negative bacteria: A real clinical practice-based study in Spain.

INTRODUCTION: Carbapenem-resistant Gram-negative bacteria (CRGN) are an urgent public health threat because of the limited treatment options, its rapid spreading and high clinical impact and mortality rates. However, the burden and the use of resources of these infections have not been investigated. The aim of the current study is to understand the use of resources associated to the clinical management of CRGN infections in real clinical practice conditions. METHODS: An observational retrospective chart review study was performed. Data regarding patient demographics, clinical management and use of resources associated to hospitalization were retrieved from clinical charts of ICU inpatients with a confirmed CRGN infection. Three reference Spanish hospitals were selected according to their patient volume and geographical coverage. Descriptive analyses of the clinical management and the use of resources and its cost were performed and then total costs by type of resource were calculated. RESULTS: A total of 130 patients were included in the study. The higher number of patients (n=43; 33%) were between 61 and 70 years old. Ninety-four (72%) patients were male and 115 (88%) suffered from comorbidities. The mean total cost associated to the resources used in patients with CRGN infections hospitalized in ICU was 96,878€ per patient. These total costs included 84,140€ of total hospital stay, 11,021€ of treatments (558€ of antibiotics; 10,463€ of other treatments) and 1717€ costs of diagnostic tests. CONCLUSIONS: CRGN infection causes a high use of hospital resources, being the length of stay either in hospital wards or ICU the driver of the total costs. Diagnostic tests and treatments, including antibiotics, represent the lowest part of the use of resources and costs (13% of total costs).

Real-World Treatment Patterns, Resource Use and Costs in Adult Patients With Atopic Dermatitis Receiving Systemic Treatment: Derma-Atopic Study in Spain.

BACKGROUND: Moderate-severe atopic dermatitis (AD) has a significant impact on patients' lives, with many requiring systemic treatment to manage symptoms (e.g., pruritus). Several drugs are used off-label to treat AD. This study describes sociodemographic/clinical characteristics, treatment patterns, health resource use (HRU) and costs in adults with AD who initiated systemic treatment or phototherapy in routine practice. METHODS: This retrospective observational study of electronic medical records in the BIG-PAC database identified adults with prior diagnosis of AD (ICD-9: 691.8 or 692.9) starting oral corticosteroids, immunosuppressants, biologics or phototherapy between 01/01/2012 and 31/12/2016. Patients were followed for 3 years from treatment initiation, up to 31/12/2019. Data on patient characteristics, treatment patterns, HRU and costs were analyzed descriptively. RESULTS: Patients (N=1995) had a mean age of 60 years, 64% were female, with a mean time of 23 years since diagnosis (84% were ≥18 years at AD onset). Main comorbidities were anxiety (38%), arterial hypertension (36%) and dyslipidemia (35%). Most patients used oral corticosteroids as first systemic (84%; median duration 29 days) and immunosuppressants in 13% of patients (median duration 117 days, 5% cyclosporine and 4% methotrexate). Half of patients required a second line systemic and 12% a third line. The use of immunosuppressants and biologics increased with treatment lines. About 13% of patients received systemic treatments continuously over the 3-year follow-up. The average 3-year per patient cost was 3835 euros, with an average annual cost of 1278 euros. CONCLUSIONS: Results suggest a high comorbidity and economic burden in this real-world adult population with AD, and the need for systemic treatments indicated for use in AD.

Real-World Treatment Patterns, Resource Use and Costs in Adult Patients With Atopic Dermatitis Receiving Systemic Treatment: Derma-Atopic Study in Spain. / [Artículo traducido] Características de los pacientes, patrones de tratamiento, uso de recursos y costes en adultos con dermatitis atópica moderada-grave en la práctica habitual en España: Estudio Derma-Atopic.

BACKGROUND: Moderate-severe atopic dermatitis (AD) has a significant impact on patients' lives, with many requiring systemic treatment to manage symptoms (e.g., pruritus). Several drugs are used off-label to treat AD. This study describes sociodemographic/clinical characteristics, treatment patterns, health resource use (HRU) and costs in adults with AD who initiated systemic treatment or phototherapy in routine practice. METHODS: This retrospective observational study of electronic medical records in the BIG-PAC database identified adults with prior diagnosis of AD (ICD-9: 691.8 or 692.9) starting oral corticosteroids, immunosuppressants, biologics or phototherapy between 01/01/2012 and 31/12/2016. Patients were followed for 3 years from treatment initiation, up to 31/12/2019. Data on patient characteristics, treatment patterns, HRU and costs were analyzed descriptively. RESULTS: Patients (N = 1995) had a mean age of 60 years, 64% were female, with a mean time of 23 years since diagnosis (84% were ≥18 years at AD onset). Main comorbidities were anxiety (38%), arterial hypertension (36%) and dyslipidemia (35%). Most patients used oral corticosteroids as first systemic (84%; median duration 29 days) and immunosuppressants in 13% of patients (median duration 117 days, 5% cyclosporine and 4% methotrexate). Half of patients required a second line systemic and 12% a third line. The use of immunosuppressants and biologics increased with treatment lines. About 13% of patients received systemic treatments continuously over the 3-year follow-up. The average 3-year per patient cost was 3835 euros, with an average annual cost of 1278 euros. CONCLUSIONS: Results suggest a high comorbidity and economic burden in this real-world adult population with AD, and the need for systemic treatments indicated for use in AD.