Can we afford to offer pre-exposure prophylaxis to MSM in Catalonia? Cost-effectiveness analysis and budget impact assessment.

Pre-exposure prophylaxis (PrEP) effectiveness has been well established. This study aims to assess the cost-effectiveness of providing PrEP, estimate the number of eligible MSM, and its budget impact in Catalonia. Cost-effectiveness analysis compared costs of on daily basis and "on demand" PrEP to prevent one infection with lifetime costs of one HIV infection. We estimated the total cost of providing PrEP by estimating number of eligible MSM, and included in the budget impact assessment antiretroviral and laboratory costs. Costs were lower for the on-demand PrEP group by €64015.1 and the incremental benefit was nearly 15 life-years and 17 quality-adjusted life-years gained. The incremental cost-effectiveness ratio (ICER) was cost-effective at €6281.62 when undiscounted PrEP was given daily. On-demand PrEP can be considered cost-saving in 20 years if the price is reduced by 90%. The number of eligible MSM in Catalonia ranges from 5,989 to 10,972. At current antiretroviral costs, the annual cost would range between €25.3-46.7 million/year (on demand PrEP), and €42.9-78.7 million/year (daily basis PrEP). PrEP is most cost-effective if targeted towards groups with high incidence rates of over 3%/year. Beneficial ICER depends on reducing the current price of Truvada® and ensuring that effectiveness is maintained at high levels.

Health policies for the reduction of obstetric interventions in singleton full-term births in Catalonia.

AIM: To explore the effect of hospital's characteristics in the proportion of obstetric interventions (OI) performed in singleton fullterm births (SFTB) in Catalonia (2010-2014), while incentives were employed to reduce C-sections. METHODS: Data about SFTB assisted at 42 public hospitals were extracted from the dataset of hospital discharges. Hospitals were classified according to the level of complexity, the volume of births attended, and the adoption of a non-medicalized delivery (NMD) strategy. The annual average change in the percentage for OI was calculated based on Poisson regression models. RESULTS: The rate of OI (35% of all SFTB) including C-sections (20.6%) remained stable through the period. Hospitals attending less complex cases had a lower average of OI, while hospitals attending lower volumes had the highest average. Higher levels of complexity increased the use of C-sections (+4% yearly) and forceps (+16%). The adoption of the NMD strategy decreased the rate of C-sections. CONCLUSIONS: The proportion of OI, including C-sections, remained stable in spite of public incentives to reduce them. The adoption of the NMD strategy could help in decreasing the rate of OI. To reduce the OI rate, new strategies should be launched as the development of low-risk pregnancies units, alignment of incentives and hospital payment, increased value of incentives and encouragement of a cultural shift towards non-medicalized births.

Widening social inequalities in mortality: the case of Barcelona, a southern European city.

OBJECTIVE: To analyse trends in mortality inequalities in Barcelona between 1983 and 1994 by comparing rates in those electoral wards with a low socioeconomic level and rates in the remaining wards. DESIGN: Mortality trends study. SETTING: The city of Barcelona (Spain). SUBJECTS: The study included all deaths among residents of the two groups of city wards. Details were obtained from death certificates. MAIN OUTCOME MEASURES: Age standardised mortality rates, age standardised rates of years of potential life lost, and age specific mortality rates in relation to cause of death, sex, and year were computed as well as the comparative mortality figure and the ratio of standardised rates of years of potential life lost. RESULTS: Rates of premature mortality increased from 5691.2 years of potential life lost per 100,000 inhabitants aged 1 to 70 years in 1983 to 7606.2 in 1994 in the low socioeconomic level wards, and from 3731.2 to 4236.9 in the other wards, showing an increase in inequalities over the 12 years, mostly due to AIDS and drug overdose as causes of death. Conversely, cerebrovascular disease showed a reduction in inequality over the same period. Overall mortality in the 15-44 age group widened the gap between both groups of wards. CONCLUSION: AIDS and drug overdose are emerging as the causes of death that are contributing to a substantial increase in social inequality in terms of premature mortality, an unreported observation in European urban areas.

[Knowledge, values and politics in health economics]. / Conocimientos, valores y políticas en economía de la salud.

OBJECTIVE: To assess the level of agreement in positive questions, and policy-value questions in Health Economics of the members of the Spanish Health Economics Association (AES). METHODS: A survey was made among the members of the AES (42 academic health economists, 196 health managers, and 34 practising physicians). The survey included 20 positive questions, 11 policy questions, 4 value questions, and 5 socio-demographic questions. An analysis of the average absolute differences between percentage agreeing and percentage disagreeing by type of question was performed. RESULTS: Two main results can be identified. First, there are no significant differences in the level of agreement between health economists, health care managers and practising physicians with respect to positive and policy-value questions. Second, there is no significant difference in the level of agreement in the three identified groups between type of questions (positive versus policy-value questions). CONCLUSION: There are no significant differences in the agreement about the positive questions between the three identified groups in the AES (academic health economists, health care managers and practising physicians.

Ranking Spain's medical schools by their performance in the national residency examination.

BACKGROUND: Medical school graduates in Spain must take a uniform national exam (called "examen MIR") in order to enter postgraduate training in a specialty. Its results offer a unique opportunity to rank medical schools according to this exam. OBJECTIVES: We measured differences in the MIR exam results among Spanish medical schools and assessed the stability of the MIR-based rankings for the period 2003-2011. RESULTS: In the year 2011 a total of 6873 residency positions nationwide were offered by the Spanish Ministry of Health, Social Services and Equality. These positions covered 47 specialties distributed over 231 training centers. A total of 11,550 medical graduates (including 1997 foreign graduates) took the MIR examination. Marked differences among medical schools were evident. The median graduate from medical school #1 and #29 occupied the positions 1477 and 5383, respectively. These figures correspond to a standardized ranking of 21 out of 100 for medical school #1 (that is, 1477/6873; half of medical school #1 obtained better [below position 21%] and half worse [over position 21%] results) and a standardized ranking of 70 out of 100 for medical school #29. While 81% of the medical school #1 graduates were amongst the best 3000 MIR exams and only 5% above the 5000 position the corresponding figures for medical school #29 graduates were 21% and 44%, respectively. The ranking position of the 29 medical schools was very stable between the years 2003 and 2011. CONCLUSION: There are marked differences in medical schools in Spain and these differences are very consistent over the years 2003-2011.

A population-based study of the costs of care for community-acquired pneumonia.

In a population-based study, the consumption of resources for treating adult patients with community-acquired pneumonia was determined. During a 2-yr period, all cases with a clinical and radiological suspicion of community-acquired pneumonia that occurred in patients aged > 14 yrs in a community of 74,610 inhabitants were investigated prospectively. Of 292 cases with a suspicion of community-acquired pneumonia, 224 were included (18.5% misdiagnoses). The mean number of visits per patient was 4.5 (72% in the primary care setting). Inpatient care was recommended in 59.8% of cases; after discharge, 44% of patients were managed in outpatient clinics. The mean direct cost of pneumonia treated in the hospital setting was [symbol: see text] (euros) 1,553, whereas the mean cost of cases treated as outpatients was [symbol: see text] 196. A total of 15.7% of admissions were considered inappropriate and the length of stay could have been reduced by 3.5 days in the most severe cases. A reduction in inappropriate admissions and lengths of hospital stay would result in a decrease in cost of 17.4%. Community-acquired pneumonia in Maresme, Spain, occurs at a low incidence, although with a high percentage of hospitalisations (in part inappropriate), resulting in considerable costs.

Ranking Spain's Medical Schools by their performance in the national residency examination

Antecedentes. En España, los graduados de las Facultades de Medicina deben tomar someterse a nacional uniforme (llamado «MIR») con el fin de ingresar a la formación de posgrado en una especialidad médica. Sus resultados ofrecen una oportunidad única para clasificar las Facultades en términos de calidad. Objetivos. Medir la presencia y la significación de las diferencias en los resultados del MIR entre las facultades de medicina españolas, y evaluar la estabilidad de las clasificaciones basadas en los resultados de la prueba MIR para el período 2003–2011. Resultados. Se observaron diferencias significativas, persistentes y consistentes en los rankings basados en los resultados de la prueba MIR. El graduado promedio de la Facultad con mejores resultados queda clasificado en el percentil 21 en todo el país, mientras que el graduado promedio de la Facultad con peores resultados queda clasificado en el percentil 70. Conclusión. Existen marcadas diferencias en las Facultades de Medicina en España, y estas diferencias son muy consistentes durante los años 2003 a 2011 (AU)

Background. Medical school graduates in Spain must take a uniform national exam (called “examen MIR”) in order to enter postgraduate training in a specialty. Its results offer a unique opportunity to rank medical schools according to this exam. Objectives. We measured differences in the MIR exam results among Spanish medical schools and assessed the stability of the MIR-based rankings for the period 2003–2011. Results. In the year 2011 a total of 6873 residency positions nationwide were offered by the Spanish Ministry of Health, Social Services and Equality. These positions covered 47 specialties distributed over 231 training centers. A total of 11,550 medical graduates (including 1997 foreign graduates) took the MIR examination. Marked differences among medical schools were evident. The median graduate from medical school #1 and #29 occupied the positions 1477 and 5383, respectively. These figures correspond to a standardized ranking of 21 out of 100 for medical school #1 (that is, 1477/6873; half of medical school #1 obtained better [below position 21%] and half worse [over position 21%] results) and a standardized ranking of 70 out of 100 for medical school #29. While 81% of the medical school #1 graduates were amongst the best 3000 MIR exams and only 5% above the 5000 position the corresponding figures for medical school #29 graduates were 21% and 44%, respectively. The ranking position of the 29 medical schools was very stable between the years 2003 and 2011. Conclusion. There are marked differences in medical schools in Spain and these differences are very consistent over the years 2003–2011 (AU)

Posibles problemas de falta de objetividad, transparencia, doble publicación y autoría en el análisis coste-efectividad de celecoxib / Possible problems of lack of objectivity, transparency, duplicate publication and authorship in the cost-effectiveness analysis of celecoxib

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Conocimientos, valores y políticas en economía de la salud / Knowledge, Values and Policies in Health Economics

Objetivo: Se pretende en este estudio valorar el grado de consenso respecto de los conocimientos, valores y políticas en Economía de la Salud de los tres grupos identificables (académicos, gestores y clínicos) en el seno de la Asociación de Economía de la Salud (AES). Métodos: A partir de la lista de los socios de la Asociación de Economía de la Salud se seleccionó una muestra de 42 académicos, 196 gestores y 34 clínicos, a los cuales se les mandó por vía postal un cuestionario que constaba de 20 preguntas sobre conocimientos, 11 sobre elecciones de política sanitaria, cuatro sobre valores y cinco con características individuales. El análisis estadístico de las relaciones entre los distintos bloques de preguntas se realizó mediante la comparación de las diferencias en la proporción de respuestas que manifiestan acuerdo o desacuerdo. Resultados: Se recibieron 106 respuestas válidas (tasa de respuesta del 39 por ciento). Los principales resultados se pueden resumir en dos. En primer lugar, no se encuentran diferencias significativas en el grado de consenso entre los grupos de economistas de la salud académicos, gestores y profesionales clínicos en materia de conocimiento, políticas y valores. En segundo lugar, en esta encuesta a economistas de la salud, gestores y clínicos no se observa diferencia significativa entre el grado de consenso según el tipo de pregunta (conocimientos versus políticas y valores). Conclusión: No existen diferencias en el grado de consenso sobre conocimientos en economía de la salud entre los distintos grupos identificables en AES (economistas académicos, clínicos y gestores) (AU)