[Sociosanitary impact on patients with rare diseases (ERES study)]. / Impacto sociosanitario en pacientes con enfermedades raras (estudio ERES).

BACKGROUND AND OBJECTIVE: The impact and burden of disease of the rare diseases (RD) is not known, also the type of disability that entail. The objective of the work is to analyze the socio-sanitary impact of the RD in Spain. PATIENTS AND METHOD: This is a nationwide study. The dimensions used were mobility, personal care and daily activities of the EUROQoL-5D questionnaire to analyze the degree of dependency of the patient with RD. RESULTS: 714 surveys were analyzed. 51.2% were men; 21.1% were children and 78.9% adults. The more frequent laboral status were: retired/pensioner, active and student (35.3%; 29.2%, and 17.1% respectively). In the last quarterly 8.4% of the patients were in situation of transitory labor incapacity: 5.7% men and 11.9% women (p < 0.005). The patients referred disability (slight or moderate degree) in the areas: physical (87.7%), emotional (83.6%), social (75.6%) and sensorial (53%). They presented severe mixed disability (sensorial and physic) in 6.4%. Patient organisations, physicians and Internet (80.1%; 48.2% and 47.3% respectively) were the used sources of information. The patients were more satisfied with doctor's care than social worker's (47% and 2.4% respectively), considering doctors more accessible than social workers (32.4% and 13.1% respectively). CONCLUSIONS: RD present a high percentage of disability and dependency, being both more severe in children. The patient organisations are the main source of information. Patients are more satisfied and consider the doctor more accessible than the social worker. This work might serve to make decisions in the socio-sanitary assistance for RD.

[Impact of psoriasis on health-related quality of life]. / Impacto de la psoriasis en la calidad de vida relacionada con la salud.

BACKGROUND AND OBJECTIVE: Different studies have reported of physical, social and psychological disadvantages in patients with psoriasis. Nevertheless, its impact on the health-related quality of life is not clarified sufficiently. Our objective is to know the repercussion of the moderate-severe psoriasis on the health-related quality of life with the Psoriasis Disability Index (PDI). PATIENTS AND METHOD: An observational, cross-sectional, international study developed in dermatology practices in Spain and Portugal. During a period of 9 months, 332 participating dermatologist included a minimum of 10 consecutive patients with moderate to severe psoriasis. The date report form includes information about the health-related quality of life (PDI), as well as objective variables of severity as body surface area and PASI (Psoriasis Area and Severity Index), pruritus, costs and willingness to pay. RESULTS: A total of 3,320 patients were assessed. The majority of cases were males (57%) and the mean age at study inclusion time was 47 years. The mean value of the PDI was 8.93 (95% confidence interval, 7.83-9.21), which represents a percentage of global disability lower than 20%. The floor effect varies between 8.3% and 61.2%, and the ceiling effect varies between 0% and 3%. The correlations between the PDI and objective variables of severity (PASI and body surface area) were weak though statistically significant (p < 0.001) They all indicate that to higher severity of the psoriasis, upper negative impact in the health-related quality of life. CONCLUSIONS: Psoriasis causes a negative impact in the health-related quality of life, though the magnitudes are weak and suggest some problems with the questionnaire. Possibly, the PDI reflects more the disability that the form in which the patients perceive and react to their state of health, and, several items seem to have a scanty applicability in the Spanish and Portuguese population. The PDI doesn't seem the appropriate instrument for this type of patients in our environment.

[Non mydriatic retinal camera: cost-effectiveness study for early detection of diabetic retinopathy]. / Cámara de retina no midriática: estudio de coste-efectividad en la detección temprana de la retinopatía diabética.

BACKGROUND AND OBJECTIVE: Cost-effectiveness analysis (ACE) for application of fundoscopic photograph with non mydriatic retinal camera (Ffo-CNM) in early diagnostic of diabetic retinopathy (RD) compared with ophthalmoscopic view by pupillary dilation. PATIENTS AND METHOD: diabetic patients, older than 14 years, attended on three Health Primary Care Areas (n=1495). Effectiveness measurement: predictive value of a positive test (VPD) and correctly diagnosed cases. Cost measurement: total cost by patient. ACE: defined as expected cost by VPD case and as expected cost by correctly diagnosed case. The results were submitted to an analysis of sensitivity for the study main variables. RESULTS: Ffo-CNM presented 90.91% of sensitivity [95% CI, 69.4-98.4%], 78.21% of specificity [95% CI, 67.1-86.4%], 54.05% positive predictive value [95% CI, 37.1-70.2%] and 96.83% of negative predictive value [95% CI, 88-99.4%]. Effectiveness, defined as VPD case, was 15.4% for ophthalmoscopic view and 19.5% for Ffo-CNM, and defined as correctly diagnosed case, was 70% and 79.8%, respectively. Cost-effectiveness ratio: a) for health care system, the cost by VPD case was 52.62 euros for ophthalmoscopic view and 28.44 euros for Ffo-CNM and cost by correctly diagnosed case was 11.58 euros and 6.95 euros, respectively, and b) for the society, cost by VPD case was 100.13 euros for ophtalmoscopic view and 34.54 for Ffo-CNM and the cost by correctly diagnosed case was 22.03 euros and 8.44 euros respectively. CONCLUSIONS: If an introduction of a early detection of RD program for the entire diabetic population was decided the option to make it using Ffo-CNM would be the most efficient.

[Initial treatment of patients with subjective memory complaints and/or cognitive impairment in primary care: ISSEA Study]. / Tratamiento inicial de los pacientes con quejas subjetivas de memoria y/o deterioro cognitivo en atención primaria: estudio ISSEA.

OBJECTIVE: To describe the initial treatment of patients >60 years who had subjective memory complaints and/or cognitive impairment for at least 6 months. DESIGN: Observational, longitudinal, multicentre, and naturalistic study, with a follow-up period of 12 months. SETTING: A total of 105 primary care centres. PARTICIPANTS: The study included 921 patients who attended a clinic. MAIN MEASUREMENTS: In the baseline visit, the social demographic characteristics, diagnosis, treatment, and the health care referrals were recorded, and in the next 2 (6 and 12 months) the diagnostic change, treatment, and referrals. RESULTS: The majority of subjects were female (66.9%) and the mean age was 74.3+/-6.8 years. In the initial visit, 50.5% (95% confidence interval [CI], 47.3-53.7) of the diagnoses were classed as syndromic and 33.3% (95% CI, 30.3-36.3), aetiological. The primary care doctor modified an unconfirmed initial diagnosis in 22% (95% CI, 19.3-24.7) of the patients during the 12 months follow-up study. A diagnosis was made in 63.8% (95% CI, 60.7-66.9) of patients by anamnesis, physical examination, the screening test, and laboratory data. In the initial visit, el 52.6% (95% CI, 49.4-55.8) received treatment of mainly nootropics and neuroprotectors, and later, the percentage of patients on cholinesterase inhibitors increased. The primary care doctor referred 54.9% (95% CI, 51.7-58.1) of the patients during the 12 months of the study. CONCLUSIONS: The primary care doctor diagnoses the majority of patients with the means available, mainly based on anamnesis, examination, the screening test, and laboratory data. They prescribe drugs that lack efficacy for this disease and few of those that have been shown to be effective.

[Study of flu costs]. / Estudio de costes de la gripe.

OBJECTIVE: To evaluate the costs of influenza epidemics in Spanish society. DESIGN: Observational, longitudinal, and multi-centre study of healthcare and non-healthcare resource use associated with flu. SETTING: Two primary care centres, 3 hospital emergency services, and the medical service at an old people's home. PARTICIPANTS: A total of 662 individuals diagnosed with flu who attended MAIN MEASUREMENTS: Direct and indirect costs of flu in Spanish society. RESULTS: The 60.7% of diagnosed cases of flu included in the study came from hospital emergency services, 36.9% from primary health care centres, and 2.4% from an old people's home. During the epidemic period, flu in Spain costs about 1036.9 million euros, taking incidence at 7.9%. Flu-derived costs are higher in over-65 and chronic patients. CONCLUSIONS: Influenza costs fall mainly on hospitals and work through time off. The cost of flu is higher among patients considered to be risk groups.

Impacto sociosanitario en pacientes con enfermedades raras (estudio ERES) / Sociosanitary impact on patients with rare diseases (ERES study)

Fundamento y objetivo: Se desconoce el impacto y la carga de enfermedad en las enfermedades raras (ER), así como el tipo de discapacidades que conllevan. El objetivo de este trabajo ha sido analizar el impacto sociosanitario de las ER en España. Pacientes y método: Se trata de un estudio de ámbito nacional. Se utilizaron las dimensiones movilidad, cuidado personal y actividades cotidianas del cuestionario EUROQoL-5D para analizar el grado de dependencia del paciente con ER. Resultados: Se analizaron 714 encuestas. Un 51,2% de los encuestados eran varones; el 21,1%, niños, y el 78,9%, adultos. Los grupos laborales más frecuentes fueron: jubilado/pensionista, activo y estudiante (un 35,3, un 29,2 y un 17,1%, respectivamente). En el último trimestre el 8,4% de los pacientes estaba en situación de incapacidad laboral transitoria; de ellos, un 5,7% eran varones y el 11,9%, mujeres (p < 0,005). Los pacientes refirieron discapacidad (grado leve o moderado) en las áreas física (87,7%), emocional (83,6%), social (75,6%) y sensorial (53%). Presentaba discapacidad mixta (sensorial más física) de carácter grave el 6,4%. Las asociaciones de afectados, el médico e internet (un 80,1, un 48,2 y un 47,3%, respectivamente) eran las fuentes de información utilizadas por los pacientes. Éstos estaban más satisfechos con la atención del médico que con la del trabajador social (el 47 y el 2,4%, respectivamente) y consideraban más accesible al primero que al segundo (el 32,4 y el 13,1%, respectivamente). Conclusiones: Las ER se acompañan de un elevado porcentaje de discapacidad y dependencia, y ambas son más graves en niños. Las asociaciones de afectados constituyen la principal fuente de información. Los pacientes están más satisfechos y consideran más accesible al médico que al trabajador social. Este trabajo puede servir para tomar decisiones en la asistencia sociosanitaria de las ER

Background and objective: The impact and burden of disease of the rare diseases (RD) is not known, also the type of disability that entail. The objective of the work is to analyze the socio-sanitary impact of the RD in Spain. Patients and method: This is a nationwide study. The dimensions used were mobility, personal care and daily activities of the EUROQoL-5D questionnaire to analyze the degree of dependency of the patient with RD. Results: 714 surveys were analyzed. 51.2% were men; 21.1% were children and 78.9% adults. The more frequent laboral status were: retired/pensioner, active and student (35.3%; 29.2%, and 17.1% respectively). In the last quarterly 8.4% of the patients were in situation of transitory labor incapacity: 5.7% men and 11.9% women (p < 0.005). The patients referred disability (slight or moderate degree) in the areas: physical (87.7%), emotional (83.6%), social (75.6%) and sensorial (53%). They presented severe mixed disability (sensorial and physic) in 6.4%. Patient organisations, physicians and Internet (80.1%; 48.2% and 47.3% respectively) were the used sources of information. The patients were more satisfied with doctor's care than social worker's (47% and 2.4% respectively), considering doctors more accessible than social workers (32.4% and 13.1% respectively). Conclusions: RD present a high percentage of disability and dependency, being both more severe in children. The patient organisations are the main source of information. Patients are more satisfied and consider the doctor more accessible than the social worker. This work might serve to make decisions in the socio-sanitary assistance for RD

Impacto de la psoriasis en la calidad de vida relacionada con la salud / Impact of psoriasis in health-related quality of life

Fundamento y objetivo: Diversos estudios han informado de las desventajas físicas, sociales y psicológicas que presentan los pacientes con psoriasis. El objetivo del presente estudio es conocer la repercusión de la psoriasis moderada-grave en la calidad de vida relacionada con la salud, evaluada por medio del Índice de Discapacidad de la Psoriasis (Psoriasis Disability Index, PDI). Pacientes y método: Se ha realizado un estudio observacional, transversal e internacional en consultas de dermatología de España y Portugal. Participaron 332 investigadores, cada uno de los cuales incluyó a 10 pacientes consecutivos diagnosticados de psoriasis moderada-grave. Se recogieron, entre otras, las siguientes variables: calidad de vida relacionada con la salud, medida por el PDI, variables objetivas de gravedad como la superficie corporal afectada (body surface area, BSA) y el índice de gravedad y de área de la psoriasis ­PASI (Psoriasis Area and Severity Index)­, prurito, costes y disposición a pagar. Resultados: Se incluyó a un total de 3.320 pacientes. La mayoría eran varones (57%) y la edad media era de 47 años. El PDI presentó un valor medio de 8,93 (intervalo de confianza del 95%, 7,83-9,21), lo que representa un porcentaje de discapacidad global inferior al 20%. El efecto suelo osciló entre el 8,3 y el 61,2% y el efecto techo, entre el 0 y el 3%. Las correlaciones entre el PDI y las variables objetivas de gravedad (PASI y superficie corporal afectada) fueron débiles, aunque estadísticamente significativas (p < 0,001). Todas indican que cuanto mayor es la afección o la gravedad de la psoriasis, mayor es el impacto negativo en la calidad de vida relacionada con la salud. Conclusiones: La psoriasis tiene un impacto negativo en la calidad de vida relacionada con la salud, aunque las magnitudes halladas son débiles e indican algunos problemas con el cuestionario. Posiblemente el PDI refleje más la discapacidad que la forma en que los individuos perciben y reaccionan ante su estado de salud, y algunos ítems parecen tener una escasa aplicabilidad a la población española y portuguesa. El PDI no parece el instrumento idóneo para este tipo de pacientes en nuestro entorno sociocultural

Background and objective: Different studies have reported of physical, social and psychological disadvantages in patients with psoriasis. Nevertheless, its impact on the health-related quality of life is not clarified sufficiently. Our objective is to know the repercussion of the moderate-severe psoriasis on the health-related quality of life with the Psoriasis Disability Index (PDI). Patients and method: An observational, cross-sectional, international study developed in dermatology practices in Spain and Portugal. During a period of 9 months, 332 participating dermatologist included a minimum of 10 consecutive patients with moderate to severe psoriasis. The date report form includes information about the health-related quality of life (PDI), as well as objective variables of severity as body surface area and PASI (Psoriasis Area and Severity Index), pruritus, costs and willingness to pay. Results: A total of 3,320 patients were assessed. The majority of cases were males (57%) and the mean age at study inclusion time was 47 years. The mean value of the PDI was 8.93 (95% confidence interval, 7.83-9.21), which represents a percentage of global disability lower than 20%. The floor effect varies between 8.3% and 61.2%, and the ceiling effect varies between 0% and 3%. The correlations between the PDI and objective variables of severity (PASI and body surface area) were weak though statistically significant (p < 0.001) They all indicate that to higher severity of the psoriasis, upper negative impact in the health-related quality of life. Conclusions: The psoriasis causes a negative impact in the health-related quality of life, though the magnitudes are weak and suggest some problems with the questionnaire. Possibly, the PDI reflects more the disability that the form in which the patients perceive and react to its health's state and, several items seem to have a scanty applicability in the Spanish and Portuguese population. The PDI doesn't seem the appropriate instrument for this type of patients in our environment

Tratamiento inicial de los pacientes con quejas subjetivas de memoria y/o deterioro cognitivo en atención primaria: estudio ISSEA / Initial treatment of patients with subjective memory complaints and/or cognitive impairment in primary care: ISSEA study

Objetivo. Describir el tratamiento inicial de pacientes > 60 años con quejas subjetivas de memoria y/o deterioro cognitivo de al menos 6 meses de evolución. Diseño. Estudio observacional, longitudinal, multicéntrico y naturalístico, con un período de seguimiento de 12 meses. Emplazamiento. Un total de 105 centros de atención primaria. Participantes. Participaron 921 pacientes que acudieron a consulta. Mediciones principales. En la visita basal se recogieron las características sociodemográficas, el diagnóstico, el tratamiento y las derivaciones asistenciales, y en las 2 siguientes (6 y 12 meses), el cambio de diagnóstico, el tratamiento y las derivaciones. Resultados. El 66,9% de los sujetos eran mujeres y la edad media fue de 74,3 ± 6,8 años. En la visita inicial, el 50,5% (intervalo de confianza [IC] del 95%, 47,3-53,7) de los diagnósticos fue de tipo sindrómico y el 33,3% (IC del 95%, 30,3-36,3), etiológico. El médico de atención primaria modificó el diagnóstico de sospecha inicial en el 22% (IC del 95%, 19,3-24,7) de los pacientes durante el año de seguimiento del estudio. El 63,8% (IC del 95%, 60,7-66,9) de los pacientes fue diagnosticado a través de la anamnesis, la exploración física, el test de cribado y los datos de laboratorio. En la visita inicial, el 52,6% (IC del 95%, 49,4-55,8) de los pacientes recibían tratamiento, principalmente nootropos y neuroprotectores, y más tarde aumentó el porcentaje de pacientes con inhibidores de la colinesterasa. Durante los 12 meses de estudio, el médico de atención primaria remitió a un 54,9% (IC del 95%, 51,7-58,1) de los pacientes. Conclusiones. El médico de atención primaria diagnostica a la mayoría de los pacientes con los medios disponibles, basándose fundamentalmente en la anamnesis, la exploración, el test de cribado y los datos de laboratorio. Se prescriben fármacos que carecen de eficacia en esta enfermedad y pocos de los que han demostrado eficacia

Objective. To describe the initial treatment of patients >60 years who had subjective memory complaints and/or cognitive impairment for at least 6 months. Design. Observational, longitudinal, multicentre, and naturalistic study, with a follow-up period of 12 months. Setting. A total of 105 primary care centres. Participants. The study included 921 patients who attended a clinic. Main measurements. In the baseline visit, the social demographic characteristics, diagnosis, treatment, and the health care referrals were recorded, and in the next 2 (6 and 12 months) the diagnostic change, treatment, and referrals. Results. The majority of subjects were female (66.9%) and the mean age was 74.3±6.8 years. In the initial visit, 50.5% (95% confidence interval [CI], 47.3-53.7) of the diagnoses were classed as syndromic and 33.3% (95% CI, 30.3-36.3), aetiological. The primary care doctor modified an unconfirmed initial diagnosis in 22% (95% CI, 19.3-24.7) of the patients during the 12 months follow-up study. A diagnosis was made in 63.8% (95% CI, 60.7-66.9) of patients by anamnesis, physical examination, the screening test, and laboratory data. In the initial visit, el 52.6% (95% CI, 49.4-55.8) received treatment of mainly nootropics and neuroprotectors, and later, the percentage of patients on cholinesterase inhibitors increased. The primary care doctor referred 54.9% (95% CI, 51.7-58.1) of the patients during the 12 months of the study. Conclusions. The primary care doctor diagnoses the majority of patients with the means available, mainly based on anamnesis, examination, the screening test, and laboratory data. They prescribe drugs that lack efficacy for this disease and few of those that have been shown to be effective

Estudio de costes de la gripe / Study of flu costs

Objetivo. Evaluar los costes que representa la epidemia de la gripe para la sociedad en España. Diseño. Estudio observacional, longitudinal y multicéntrico sobre la utilización de recursos sanitarios y no sanitarios asociados a la gripe. Emplazamiento. Dos centros de atención primaria, servicios de urgencias de 3 hospitales y una residencia de ancianos. Participantes. Un total de 662 individuos diagnosticados de gripe que acudieron a las consultas. Mediciones principales. Costes directos e indirectos de la gripe en la sociedad española. Resultados. El 60,7% de los casos diagnosticados de gripe incluidos en el estudio procedía de los servicios de urgencias de los hospitales, el 36,9% de los centros de asistencia primaria y el 2,4% de una residencia de ancianos. La gripe representa en España durante la epidemia gripal un coste total de aproximadamente 1.036,9 millones de euros, asumiendo en dicho período una incidencia del 7,9%. Los costes debidos a la gripe son superiores en los pacientes mayores de 65 años y los pacientes crónicos. Conclusiones. Los costes de la gripe recaen principalmente en costes hospitalarios y costes de absentismo laboral. El coste de la gripe es superior entre los pacientes considerados como grupos de riesgo

Objective. To evaluate the costs of influenza epidemics in Spanish society. Design. Observational, longitudinal, and multi-centre study of healthcare and non­healthcare resource use associated with flu. Setting. Two primary care centres, 3 hospital emergency services, and the medical service at an old people's home. Participants. A total of 662 individuals diagnosed with flu who attended Main measurements. Direct and indirect costs of flu in Spanish society. Results. The 60.7% of diagnosed cases of flu included in the study came from hospital emergency services, 36.9% from primary health care centres, and 2.4% from an old people's home. During the epidemic period, flu in Spain costs about 1036.9 million euros, taking incidence at 7.9%. Flu-derived costs are higher in over-65 and chronic patients. Conclusions. Influenza costs fall mainly on hospitals and work through time off. The cost of flu is higher among patients considered to be risk groups

Validez del cuestionario king's health para la evaluación de la calidad de vida en pacientes con incontinencia urinaria / Validity of the king's Health Questionnaire in the assessment of quality of life in patients with urinary incontinence

Fundamento: Evaluar la validez de la versión española del cuestionario de calidad de vida King's Health Questionnaire (KHQ) en mujeres con diferentes tipos de incontinencia urinaria (IU). Pacientes y métodos: Se seleccionó consecutivamente a 77 mujeres diagnosticadas por prueba urodinámica de incontinencia urinaria de esfuerzo (IUE), 51 de urgencia (IUU) y 34 mixta (IUM). Las pacientes completaron los cuestionarios KHQ y el SF-36 en el momento de la inclusión en el estudio, a los 15 días y al mes. Resultados: No se observaron diferencias significativas en las características sociodemográficas ni en la calidad de vida entre los diferentes tipos de IU. Las pacientes con IUU e IUM tenían una mayor frecuencia urinaria y urgencia miccional que las que presentaban IUE, y las pacientes con IUE e IUM tenían mayor número de escapes que las de IUU. Las correlaciones entre las dimensiones de los cuestionarios KHQ y SF-36 fueron moderadas a altas. Las mujeres con mayor frecuencia urinaria, más urgencia miccional, más episodios de incontinencia a la semana y uso de compresas y pañales percibían una peor calidad de vida. Los cambios en estas variables clínicas se correlacionaron con los cambios en la calidad de vida relacionada con la salud (CVRS). La consistencia interna de las dimensiones fue buena (0,65-0,92), así como la fiabilidad test-retest (0,68-0,88). Las dimensiones más sensibles al cambio después de un mes de tratamiento fueron el impacto de la IU, la gravedad de la IU y la escala de síntomas (tamaño del efecto superior a 0,6). Conclusión: El KHQ es un instrumento válido para evaluar la calidad de vida en pacientes con distintos tipos de IU. La mejoría en la frecuencia urinaria, urgencia miccional, número de escapes y el cambio en el tipo de material protector producen un aumento de la CVRS. (AU)

Cámara de retina no midriática: estudio de coste-efectividad en la detección temprana de la retinopatía diabética / Non mydriatic retinal camera: cost-effectiveness study for early detection of diabetic retinopathy

FUNDAMENTO Y OBJETIVO: Realizar un análisis de coste-efectividad (ACE) de la aplicación de la fotografía de fondo de ojo con cámara de retina no midriática (Ffo-CNM) en el diagnóstico temprano de la retinopatía diabética, comparado con la oftalmoscopia con dilatación pupilar. PACIENTES Y MÉTODO: Se incluyó a los pacientes diabéticos mayores de 14 años atendidos en tres áreas básicas de salud (n = 1.495). Para la medida de efectividad se utilizaron los casos verdaderos positivos detectados (VPD) y casos correctamente diagnosticados. La medida de coste fue el coste total por paciente. El ACE se definió como coste esperado por caso VPD y como coste esperado por caso correctamente diagnosticado. Los resultados se sometieron a un análisis de sensibilidad de las variables clave del estudio. RESULTADOS: La Ffo-CNM presentó una sensibilidad del 90,91 por ciento (intervalo de confianza [IC del 95 por ciento] 69,4-98,4 por ciento), una especificidad del 78,21 por ciento (IC del 95 por ciento, 67,1-86,4 por ciento), un valor predictivo positivo del 54,05 por ciento (IC del 95 por ciento, 37,1-70,2 por ciento) y un valor predictivo negativo del 96,83 por ciento (IC del 95 por ciento, 88,0-99,4 por ciento). La efectividad, definida como caso VPD, fue del 15,4 por ciento para la oftalmoscopia y del 19,5 por ciento para la Ffo-CNM y, definida como caso correctamente diagnosticado, fue del 70 y el 79,8 por ciento, respectivamente. En cuanto a la razón coste-efectividad, para el sistema sanitario, el coste por caso VPD fue de 52,62 euros para la oftalmoscopia y de 28,44 euros para la FfoCNM, y el coste por caso correctamente diagnosticado fue de 11,58 y 6,95 euros, respectivamente; para la sociedad el coste por caso VPD fue de 100,13 euros para la oftalmoscopia y de 34,54 euros para la Ffo-CNM, y el coste por caso correctamente diagnosticado fue de 22,03 y de 8,44 euros, respectivamente. CONCLUSIONES: Si se decidiese la implantación de un programa de detección temprana de retinopatía diabética dirigido a toda la población diabética, la opción de hacerlo utilizando la FfoCNM sería la más eficiente (AU)