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Objective: The increase in traffic accidents depends on multiple factors; it generates an economic and public health problem that must be analyzed jointly by agents involved in road safety. The aim of the work was to quantify the effect of various factors in the cost savings due to traffic accidents on interurban roads in Spain., Methods: It was analyzed, through a lineal regression with panel data model and in the period 2000-2017, how different factors affected cost savings due to the risk of mortality or injury avoided on Spanish interurban roads., Results: A 1% increase in traffic volume led to a reduction in costs per MVKT (million vehiclekilometres travelled) of €162.46 referring to the risk of mortality, €115.32 for serious injuries and €10.10 for mild injuries. This increase in unemployment caused a cost reduction of €31.43, €10.76 and €0.98, respectively. The same increase in the investment in replacement implied a reduction of these costs of €11 for any risk. A 1% increase in the ageing index led to an increase in costs of €276.83 in terms of mortality risk and €257.49 in terms of injury. Foreign tourism generated a cost of more than €40 for any risk. A 1% increase in GDP per capita led to an increase in costs of €155.50, €138.09 and €8.21 for defined risks. The points driving license led to an increase in costs of €785.50 per MVKR when referring to mortality risks., Conclusions: Determining factors for cost savings: motorization rate, unemployment rate and investment in replacement interurban roads. Determining factors that increased costs: expiry of the effect of the penalty - points driving licence, ageing index of the population, increase in GDP or proportion of foreign travelers., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Introduction and Objectives: DRM is a highly prevalent condition in Spanish hospitals and is associated to increased healthcare costs. Costs associated to DRM were calculated using the methods of the PREDyCES study. The potential savings derived from specialized nutritional treatment were calculated by extrapolating the results of the SNAQ strategy., Results: Median cost per procedure in patients with DRM was €9,679.85, with a final cost of €28,700,775.2. The cost of each patient with DRM was 2.63 times higher than the cost of patients with no DRM. The potential cost saving associated to specialized nutritional treatment was estimated at €1,682,317.28 (5.86% of total cost associated to DRM)., Conclusions: Patients with DRM showed a higher consumption of financial resources as compared to well-nourished patients. Specialized nutritional treatment is a potential cost-saving procedure., (Copyright © 2017 SEEN. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: To be able to treat prolonged epileptic crises practical, safe and effective rescue medication is needed. Today, the standard treatment in community healthcare is rectal diazepam. The introduction of a buccal solution of midazolam opens up a new perspective in their treatment., Aims: To evaluate the cost-effectiveness of buccal midazolam with respect to rectal diazepam for children diagnosed with epilepsy who present prolonged convulsive seizures in the community setting in Spain., Materials and Methods: The study produces a model of its cost-effectiveness from the perspective of the Spanish National Health System (SNS), with the outcomes presented in terms of cost-quality adjusted life years. Data were collected from different sources, including estimations regarding the clinical effectiveness from a clinical trial, from a Delphi panel in Spain and from a national survey carried out on parents of children with epilepsy in order to determine the current practices., Results: Treatment with buccal midazolam produces a saving in costs in comparison to rectal diazepam. The amount saved by the Spanish SNS comes to 5,484 euros per patient per year. Treatment with buccal midazolam offers an improved health-related quality of life. This, together with the savings in costs, means that there is a dominance of buccal midazolam over rectal diazepam in all the settings that have been examined., Conclusions: The results obtained with the model show that buccal midazolam is more cost-effective than rectal diazepam due to a reduction in the need to call out ambulances and for stays in hospital, as well as an improved health-related quality of life.

Objectives: To analyze the clinical utility and economic impact of conventional transbronchial needle aspiration (TBNA) in patients with diagnosis of bronchogenic carcinoma (BC) and mediastinal lymphadenopathies in thoracic computed tomography (CT). To assess the predictive factors of valid aspirations., Patients and Methods: Retrospective observational study between 2006 and 2011 of all TBNA performed in patients with final diagnosis of BC and accessible hilar or mediastinal lymphadenopathies on thoracic CT., Results: We performed TBNA on 267 lymphadenopathies of 192 patients. In 34.9% of patients, two or more lymph nodes were biopsied. Valid aspirations were obtained in 153 patients (79.7%) that were diagnostic in 124 (64.6%). Multivariate analysis showed that factors associated with valid or diagnostic results are the diameter of the lymph node and the number of lymph nodes explored. TBNA was the only endoscopic technique that provided the diagnosis of BC in 54 patients (28.1%). Staging mediastinoscopy was avoided in 67.6% of patients. The prevalence of mediastinal lymph node involvement was 74.4%, sensitivity of TBNA was 86.2% and negative predictive value was 63.6%. Including mediastinoscopy and other avoided diagnostic techniques, TBNA saved 451.57 € per patient., Conclusions: TBNA is a clinically useful, cost-effective technique in patients with BC and mediastinal or hilar lymphadenopathies. It should therefore be performed on a regular basis during diagnostic bronchoscopy of these patients., (Copyright © 2012 SEPAR. Published by Elsevier Espana. All rights reserved.)

Background: Day hospital units specialized in pulmonology are a relatively new instrument for providing care to complex respiratory patients. However, the number of studies focused on the efficacy and efficiency of day hospitals is scarce., Aim: Therefore, the aim of the present study was to analyze the effects of implementing a specialized respiratory day hospital in a standard teaching hospital with 500 beds., Methods: An analysis of efficacy, efficiency and quality care., Results: Throughout the study period (2 years) the day hospital progressively increased its activity. Although patient pressure on the emergency department remained constant, this was associated with a parallel increase in the overall medical activity of the Pulmonology Department and a reduction in the number of discharges from the hospital. There was a reduction in the number of admissions, and consequently in the need for beds in the Pulmonology Department. The complexity of the hospitalized patients increased, although the efficiency (standard functioning ratio) and quality (readmissions and mortality) of patient care remained stable., Conclusion: Day hospital pulmonology units are a useful tool in the management of respiratory patient care. They reduce the need for hospitalizations, while maintaining healthcare quality and complementing other care management instruments., (Copyright © 2012 SEPAR. Published by Elsevier Espana. All rights reserved.)

Objective: Determine the economic impact of avoided cost in hospital stays by preventing drug-related problems., Method: Prospective observational study of six months in the emergency department. We included patients admitted for observation and pre-admission beds. A pharmacist was integrated into the healthcare team to validate / reconcile pharmacotherapy. Severity was associated DRPs detected / resolved with the risk increasing the stay of patients admitted to a clinical unit, estimating the potential cost avoided., Results: El 32,5% of patients required intervention and were intercepted 444 drug-related problems, resolving 85.5%. Serious problems serious / significant unresolved affected 130 patients who were admitted, with an estimated avoided cost about 60,000 €. It was noted that serious problems and oral cytostatics, insulin and diabetes were the groups associated with a higher average cost avoided (p <0.05)., Conclusion: The integration of the pharmacist in the emergency team to intercept medication problems, reducing the risk of stay and increase healthcare costs., (Copyright © 2013 SEFH. Published by AULA MEDICA. All rights reserved.)

Objective: To compare the adaptation of medical prescriptions according to the dosage guides in patients with renal disease, before and after applying a pharmaceutical intervention programme. The secondary objectives were to prepare a guide to dosing in renal disease and to measure the prevalence of prescription of drugs with renal risk., Method: Non-randomised, experimental interventional study (before/after) conducted in a general hospital with 800 beds, including hospitalised patients, over the age of 18, with kidney disease and drugs with renal risk prescribed in their pharmacotherapeutic profile. The study was designed to be carried out in two descriptive cross-cutting phases (control group) and a prospective interventional cohort study (intervention group). The primary variable was the percentage non-adaptation according to the stage of renal disease., Results: The study included 185 patients, 88 in the control group and 97 in the intervention group. In the intervention group, the prevalence of non-compliance before and after the intervention was 18.7 % and 2.1 %, representing a statistically significant reduction in non-adaptation of the dose. The costs saved with the pharmaceutical intervention programme were 1,939.63 euro over two months, the average saving per medication intervened amounting to 62.57 euro (CI 95 %, 23.99-101.14 euro; p = 0.02)., Conclusions: The results of the study indicate that the application of a pharmaceutical care model based on the prospective validation of drugs with renal risk, very significantly improved the adaptation of dosing regimens in kidney disease.

Objective: To know the evolution of the introduction of generic drugs (GDs) in Galicia. Secondarily, to evaluate its potential impact on pharmaceutical expenditure., Design: Descriptive study of GDs utilization. Cost-minimization analysis., Setting: Galician autonomous region, year 1998., Measurements and Results: Using data from the prescription billing registry of Social Security we have selected the active ingredients corresponding to GDs with prescriptions in Galicia in 1997. We have analyzed the data for their oral single substance preparations by quarters. Consumption in DHDs of allopurinol, atenolol, captopril, naproxen and ranitidine remained stable during 1998. The market share for their GDs in quantitative terms relative to both total consumption of the active ingredients and to their pharmaceutical equivalents, showed an overall growing trend. The maximum observed value was seen for ranitidine at last quarter. Total expenditure (in final customer prices) during 1998 on the selected active substances was higher than 1864 million pesetas. Potential savings afforded by substitution for the lowest price GD prescribed in Galicia would reach 427 million pesetas., Conclusions: GDs market penetration in Galicia during 1998 was limited but increasing. Its utilization may afford estimated savings of 21-28% of the cost for the selected drugs. However, the expenditure on the above drugs was just 2.7% of total pharmaceutical expenditure.

Objective: To evaluate whether the introduction of out-patient blood pressure monitoring (OBPM) to follow up patients diagnosed with light hypertension (HT) decreases the use of medicines and so saves money., Design: An observational study., Setting: Urban health centre., Patients and Other Participants: Patients with light HT not being treated with medication, with two or less cardiovascular risk factors and who had type 0 or 1 curves in OBPM and a mean daily blood pressure < 135/85 mm Hg., Measurements and Main Results: OBPM over 24 hours with a Spacelabs 90202 oscillometer. 23 patients (15 women), average age 38.6 +/- 8, were studied. Savings generated ranged from 153,628 pesetas, when the cheapest thiazide diuretic was prescribed, to 5,208,258 pesetas, when the dearest ACEI was chosen., Conclusions: Monitoring HT with OBPM led to a decrease in the use of medicines to combat hypertension, with considerable savings. These findings cannot be generalised. We believe that Primary Care must have access to OBPM in order to manage hypertension, apart from the savings involved.