Search

Introdução: A carga da doença tem sido empregada em estimativas do impacto das neoplasias, mas a perda de produtividade em razão dessas enfermidades ainda não foi tão explorada. Objetivo: Estimar os anos de vida produtiva perdidos (AVPP) e a perda de produtividade por conta da mortalidade prematura relacionada ao câncer em países da América do Sul em 2019. Método: Dados de mortalidade disponíveis no Global Burden of Disease (GBD) Study 2019 foram usados para estimar a carga de doença atribuível a neoplasias. A perda de produtividade em termos monetários foi calculada usando um proxy da abordagem do capital humano (ACH). Os cálculos foram realizados por sexo, nas faixas etárias de trabalho. Resultados: O total de óbitos foi de 192.240 e o de AVPP, 2.463.155. A perda total de produtividade permanente foi de US$ 4,4 bilhões e US$ 9,4 bilhões em purchasing power parity (PPP) – 0,13% do produto interno bruto (PIB) da região. O custo total por morte foi de US$ 23.617. Houve diferenças significativas entre os países, mas a variação dos cenários mostra robustez das estimativas. Conclusão: O câncer impõe um ônus econômico significativo à América do Sul tanto em termos de saúde quanto de produtividade. Sua caracterização pode subsidiar os governos na alocação de recursos destinados ao planejamento de políticas e execução de intervenções de saúde.

Introduction: Respiratory diseases (RD) are an important public health problem. Their burden has not been comprehensively evaluated in South America (SA). This study describes the burden of acute respiratory infections (ARIs) in SA in 2019. Methodology: This is an exploratory, population-based study with a quantitative approach to incidence, mortality, and Disability-adjusted life years (DALYs) by standardized age group among the 12 countries. Measurements were captured through the Institute for Health Metrics and Evaluation (IHME) website. It used the Burden Study Global Disease, Injury and Risk Factors (GBD) 2019 assessment. Correlation analyses were performed. Results: The age-standardized incidence rate per 1,00,000 people for lower respiratory infections (LRIs) is lowest in Chile (3,902) and highest in Peru (9,997). For upper respiratory infections (URIs), Bolivia (2,25,826) had the lowest rates, while Brazil (3,16,667) and Colombia (3,06,302) had the highest. Standardized mortality rates for LRI were lowest in Colombia (15.10) and highest in Bolivia (80.53). Bolivia had the highest standardized DALY rate (2,083), while Uruguay had the lowest (468). Upper ARI had lower incidence rates than lower ARI. The lowest DALY rates were in Suriname (82) and the highest were in Brazil (111). There is a correlation between sociodemographic and economic health indicators and the standardized rates of incidence and DALY in the upper ARIs. Conclusions: The present paper provides comprehensive ARI burden estimates for the region. The substantial incidence and considerable mortality and DALYs are noteworthy and lead to reflections on preventive measures such as rational use of antibiotics and deeper epidemiological investigations.

Objective: The introduction of biosimilar medicines in markets can bring savings to health systems, expanding the population’s access to various treatments. This study aims to analyze the price competition of biological agents and their biosimilars in Brazil within the scope of rheumatoid arthritis. Methods: Prices for 14 presentations of original and biosimilar medicines were analyzed from January 2003 to October 2019 in Brazil. Prices were taken from official lists and were noted since launch and during the later trading period. Prices were converted to United States dollars and adjusted for inflation for the 2003 base year. Results: In Brazil, during this review period, prices of biopharmaceuticals decreased in real values, reaching up to a 50% reduction. The introduction of biosimilars did not affect the price sharing of biological medicines. Conclusion: Biosimilar antirheumatics do not yet have a significant impact on the price of biologics marketed in Brazil. A change in this scenario is expected in the medium and long term.

Objectives. To estimate the burden of permanent productivity losses caused by acute respiratory infections in South American countries in 2019. Methods. Mortality data from the Global Burden of Disease Study 2019 were analyzed to estimate the burden of disease attributable to acute respiratory infections. An approach based on the human capital method was used to estimate the cost of permanent productivity losses associated with respiratory diseases. To calculate this cost, the sum of the years of productive life lost for each death was multiplied by the proportion in the workforce and the employment rate, and then by the annual minimum wage or purchasing power parity in United States dollars (US$) for each country in the economically active age groups. Separate calculations were done for men and women. Results. The total number of deaths from acute respiratory infections in 2019 was 30 684 and the years of productive life lost were 465 211 years. The total cost of permanent productivity loss was about US$ 835 million based on annual minimum wage and US$ 2 billion in purchasing power parity, representing 0.024% of the region’s gross domestic product. The cost per death was US$ 33 226. The cost of productivity losses differed substantially between countries and by sex. Conclusion. Acute respiratory infections impose a significant economic burden on South America in terms of health and productivity. Characterization of the economic costs of these infections can support governments in the allocation of resources to develop policies and interventions to reduce the burden of acute respiratory infections.

Study Group of clinical LA-MRSA, [Background] Tetracycline resistance (TetR) is a marker of livestock-associated MRSA of lineage CC398., [Objectives] To determine the MRSA CC398 prevalence among TetR-MRSA recovered in Spanish hospitals located in regions with different pig-farming densities, and the influence of pig density as a key risk factor for its acquisition., [Methods] TetR-MRSA isolates (n = 232) recovered from clinical and epidemiological samples during January–June 2016 in 20 hospitals in 13 regions with different pig-farming densities were analysed. MRSA CC398 identification, detection of spa types, methicillin resistance genes and immune evasion cluster (IEC) genes were performed by PCR/sequencing. Statistical analyses were performed to establish the relationships between MRSA CC398 prevalence and pig density., [Results] The global MRSA prevalence was 29.7% (6.9% TetR-MRSA/MRSA), with 137 CC398 isolates recovered, representing 4.1% of total MRSA and 59.1% of TetR-MRSA. Among MRSA CC398, 16 different spa types were recorded (t011: 72.3%), and all but two strains were IEC negative. Higher pig-density regions were associated with significant MRSA CC398 increases in hospitals located in adjacent regions (P, [Conclusions] High pig density leads to a significant increase in MRSA CC398 in hospitals in Spain, and its combination with a high human population could help its dissemination. In Spain, the prevalence of the zoonotic CC398 lineage is closely related to pig-farming density; therefore, specific tools could be implemented in order to detect its dissemination., This work was supported by the Sociedad de Enfermedades Infecciosas del Norte (SEINORTE) and by the Agencia Estatal de Investigación (AEI) of Spain (project SAF2016-76571-R) and by the Fondo Europeo de Desarrollo Regional (FEDER). Sara Ceballos and Laura Ruiz-Ripa have predoctoral fellowships of the University of La Rioja, Spain.

Background: The most recommended treatment for a Helicobacter pylori infection is high doses of combined antibiotics. The objective of this article is to perform a systematic review of the economic evaluation studies applied to assess the efficiency of diagnostic testing for H. pylori infections, so that their main characteristics can be identified and to learn from the literature how the antimicrobial resistance (AMR) issue is incorporated into these economic evaluations. Methods: We conducted a systematic review to compare the costs and clinical effectiveness of diagnostic strategies for H. pylori infections. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and extracted the items from the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Results: We found thirteen articles that were of good quality according to CHEERS: six studies focused on diagnostics of Helicobacter pylori infections associated with dyspepsia and four on duodenal ulcers. Testing was found to be the most cost-effective strategy in eight articles. Four studies considered AMR. Conclusions: Testing was more cost-effective than empirical treatment, except in cases of high prevalence (as with developing countries) or when patients could be stratified according to their comorbidities. The introduction of AMR into the model may change the efficiency of the testing strategy.

Background In many healthcare systems, affordability concerns can lead to restrictions on the use of expensive efficacious therapies. However, there does not appear to be any consensus as to the terminology used to describe affordability, or the thresholds used to determine whether new drugs are affordable. Objectives The aim of this systematic review was to investigate how affordability is defined and measured in healthcare. Methods MEDLINE, EMBASE and EconLit databases (2005-July 2016) were searched using terms covering affordability and budget impact, combined with definitions, thresholds and restrictions, to identify articles describing a definition of affordability with respect to new medicines. Additional definitions were identified through citation searching, and through manual searches of European health technology assessment body websites. Results In total, 27 definitions were included in the review. Of these, five definitions described affordability in terms of the value of a product; seven considered affordability within the context of healthcare system budgets; and 15 addressed whether products are affordable in a given country based on economic factors. However, there was little in the literature to indicate that the price of medicines is considered alongside both their value to individual patients and their budget impact at a population level. Conclusions Current methods of assessing affordability in healthcare may be limited by their focus on budget impact. A more effective approach may involve a broader perspective than is currently described in the literature, to consider the long-term benefits of a therapy and cost savings elsewhere in the healthcare system, as well as cooperation between healthcare payers and the pharmaceutical industry to develop financing models that support sustainability as well as innovation.

In 2013, a change in copayment rate was introduced in the Basque Country (one year later than in the other regions in Spain), and improvements were made to drug packaging. In 2014, a National Program Against Bacterial Resistance (Spanish abbreviation: PRAN) was approved. The aim of this study is to analyze the impact of change to the copayment rate, the adjustment of drug packaging, and the approval of PRAN on the consumption of antibiotics. Raw monthly data on the consumption of antibiotics (costs, packages, and daily defined doses per thousand people (DID)) were collected from January 2009 to December 2018 in the Basque Country. Counterfactual and intervention analysis (Autoregressive integrated moving average (ARIMA) model) was performed for the total series, disaggregated by group of antibiotics (2019 WHO Access, Watch, and Reserve (AWaRe) Classification) and active substances with the highest cost per prescription (cefditoren and moxifloxacin), the lowest cost per prescription (doxycycline and cloxacillin), and the most prescribed active ingredients (amoxicillin, azithromycin, and levofloxacin). Introduction of copayment led to a &lsquo, stockpiling effect&rsquo, one month before its implementation, equal to 8% in the three consumption series analyzed. Only the adjustment of drug packaging significantly reduced the number of packages dispensed (&minus, 12.19%). PRAN approval reduced consumption by 0.779 DID (&minus, 4.51%), representing a significant decrease for both &rsquo, access&rsquo, and &rsquo, watch&rsquo, group antibiotics. Despite the delay in implementing changes to copayment, there was a &lsquo, With the adjustment of packaging, fewer packs were prescribed but with a higher drug load and price. PRAN approval reduced both the consumption of &rsquo, access group antibiotics&rsquo, (first-line treatment) and &rsquo, watch group antibiotics&rsquo, (second-line treatment).

The aim of this review is to provide a summary of the literature on risk-sharing agreements, including conceptual, theoretical and empirical (number of agreements and their achievements) perspectives, and stakeholders’ perceptions. We conducted a systematic literature search in MEDLINE from 2000 to April 2019, following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology, and completed it with a manual search of other publications (mainly grey literature). The search was restricted to publications with English abstracts; the initial identification of articles was restricted to the title, abstract and key words fields. The geographical scope was not restricted. Over 20 studies proposed different taxonomies of risk-sharing contracts, which can be summarised as financial and paying-for-performance agreements. Theoretical studies modelling the incentives to implement risk-sharing agreements are scarce; they addressed different types of contracts and regulatory contexts, characterizing the drug prices and the optimal strategies of the involved agents. Empirical studies describing specific agreements are abundant and referred to different geographical contexts; however, few articles showed the economic results and assessed the value of such contracts. Stakeholders’ perceptions of risk-sharing contracting were favourable, but little is known about the economic and clinical advantages of specific agreements. Whether risk-sharing contracts have yielded the desired results for healthcare systems remains uncertain. Risk-sharing contracts are increasingly used, although the lack of transparency and aggregated registries makes it difficult to learn from these experiences and assess their impact on healthcare systems.

In this article, we model the relationship between a health authority and a pharmaceutical firm when the real efficacy of the drug manufactured by the firm is uncertain. The ex-ante information on the efficacy of the new drug is provided by the outcomes of a clinical trial. We focus on two types of contracts. On the one hand, the health authority can set a unit price regardless of the ex-post real effectiveness of the drug (traditional contract, i.e. no risk sharing). Alternatively, the health authority can make the payments contingent upon the observed ex-post effectiveness (risksharing contract). The optimal contract depends on the trade-off between the monitoring costs, the marginal production cost and the health cost derived from treatment failure. When the efficacy of the drug in the clinical trial is relatively high, a traditional contract is optimal for relatively low marginal costs. When the efficacy in the clinical trial is relatively low, the health authority always prefers to condition the payments upon the effectiveness outcomes.

In this article, we model the behavior of a pharmaceutical firm that has marketing authorization for a new therapy believed to be a candidate for personalized use in a subset of patients, but that lacks information as to why a response is seen only in some patients. We characterize the optimal outcome-based reimbursement policy a health authority should follow to encourage the pharmaceutical firm to undertake research and development activities to generate the information needed to effectively stratify patients. Consistent with the literature, we find that for a pharmaceutical firm that does not undertake research and development activities, when the treatment fails, the total price of the drug must be returned to the healthcare system (full penalization). By contrast, if the firm undertakes research and development activities that make the implementation of personalized medicine possible, treatment failure should not be fully penalized. Surprisingly, in some cases, particularly for high-efficacy drugs and small target populations, the optimal policy may not require any penalty for treatment failure. To illustrate the main results of the analysis, we provide a numerical simulation and a graphical analysis.

Risk-sharing contracts (RSC) present a novel management tool, which link the payment to the pharmaceutical company to health outcomes. The objective of this work was to know the perception of health professionals about the utility of these agreements in the Spanish National Health System.A questionnaire was designed to conduct a series of semi-structured interviews with hospital pharmacy, laboratory and oncology professionals from Spanish hospitals in Madrid, Aragón, Castilla-La Mancha, Castilla y León, Cataluña, La Rioja, País Vasco and Navarra. The selection criteria was for convenience. The interview period was from April to November 2017. A qualitative analysis was performed based on the responses from 14 interviews.All the surveyed affirmed that the CRCs allow to improve the economic and administrative management of the hospital, emphasizing as main advantages the budgetary control, the obtaining of funding and the savings possibilities. CRCs are perceived (13 of 14 respondents) as agreements with positive health implications because they increased the portfolio of treatments and had greater efficacy. The need for CRCs to register patients, involved monitoring and control, also contributed to the improvement of their health. In addition, CRCs were believed (8 out of 14 respondents) to facilitate the introduction of personalized medicine (MP) as both depend on diagnostic tests, one for screening reasons (MP) and the other for obtain clinical evidences that improve economic outcomes (CRC). However, it was considered that signing the CRCs entails the need to modify certain regulations (5 out of 14 respondents) as well as to increase the number of staff to handle bureaucratic tasks and to increase laboratory tests, which can complicate health management.Qualitative social research techniques have proven to be useful for gathering information on a new topic and understanding the perception of the advantages and disadvantages of CRCs, as well as their association with the MP. In addition, synergies were detected between the CRCs and the MP. Respondents had positive opinions on CRCs about its application, although work must be done in order to improve the normative and organizational context so that the additional complexity that they incorporate does not constitute an obstacle to extend its use.Los contratos de riesgo compartido (CRC) presentan un novedoso instrumento de gestión sanitaria que condiciona el pago a la compañía farmacéutica dependiendi de si el paciente tratado con su fármaco es curado con éxito. El objetivo de este trabajo fue conocer la percepción de los profesionales sanitarios acerca de la utilidad de dichos acuerdos en el Sistema Nacional de Salud español.Se diseñó un cuestionario para realizar una serie de entrevistas semiestructuradas con profesionales de farmacia hospitalaria, laboratorio y oncología de hospitales españoles de Madrid, Aragón, Castilla-La Mancha, Castilla y León, Cataluña, La Rioja, País Vasco y Navarra. El criterio de selección fue de conveniencia. El periodo de realización de las entrevistas fue de abril a noviembre de 2017. Se efectuó un análisis cualitativo a partir de las respuestas de 14 entrevistas.Todos los encuestados afirmaron que los CRC permiten mejorar la gestión económica y administrativa del hospital, destacando el control presupuestario, la obtención de financiación y la posibilidad de ahorro como ventajas principales. Los CRC son percibidos (13 de 14 entrevistados) como acuerdos con implicaciones positivas para la salud porque aumentaban el portfolio de tratamientos disponibles y porque los tratamientos introducidos contaban con una mayor eficacia. La necesidad de los CRC de registrar a los pacientes implicaba un seguimiento y control que también se entendió contribuía a la mejora de su salud. Además, los CRC se creyó (8 de 14 entrevistados) que favorecían la introducción de la medicina personalizada (MP) ya que tanto la MP como los CRC dependen e impulsan la elaboración de pruebas diagnósticas, ya sea por motivos de cribado (MP) o de aumentar las evidencias clínicas para mejorar los resultados económicos (CRC). No obstante, se consideró que la firma de los CRC conlleva la necesidad de modificar ciertas normativas (5 de 14 entrevistados), de aumentar las plantillas para encargarse de tareas burocráticas, como la elaboración de registros, y también de incrementar las pruebas de laboratorio, lo cual puede complicar la gestión sanitaria.En general, los CRC contaron con opiniones positivas acerca de su aplicación aunque deba trabajarse para mejorar el contexto normativo y organizativo de modo que la complejidad adicional que incorporan no constituya una traba para extender su uso. Además, se detectaron sinergias entre los CRC y la MP.

Objective: To provide recommendations for addressing previously identified key challenges in health economic evaluations of Gene Replacement Therapies (GRTs), including: 1) the assessment of clinical effectiveness; 2) the valuation of health outcomes; 3) the time horizon and extrapolation of effects beyond trial duration; 4) the estimation of costs; 5) the selection of appropriate discount rates; 6) the incorporation of broader elements of value; and 7) affordability. Methods: A literature review on economic evaluations of GRT was performed. Interviews were conducted with 8 European and US health economic experts with experience in evaluations of GRT. Targeted literature reviews were conducted to investigate further potential solutions to specific challenges. Recommendations: Experts agreed on factors to be considered to ensure the acceptability of historical cohorts by HTA bodies. Existing prospective registries or, if not available, retrospective registries, may be used to analyse different disease trajectories and inform extrapolations. The importance of expert opinion due to limited data was acknowledged. Expert opinion should be obtained using structured elicitation techniques. Broader elements of value, beyond health gains directly related to treatment, can be considered through the application of a factor to inflate the quality-adjusted life years (QALYs) or a higher cost-effectiveness threshold. Additionally, the use of cost-benefit analysis and saved young life equivalents (SAVE) were proposed as alternatives to QALYs for the valuations of outcomes of GRT as they can incorporate broader elements of value and avoid problems of eliciting utilities for paediatric diseases. Conclusions: While some of the limitations of economic evaluations of GRT are inherent to limited clinical data and lack of experience with these treatments, others may be addressed by methodological research to be conducted by health economists. ispartof: J Mark Access Health Policy vol:8 issue:1 pages:1822666- ispartof: location:United States status: Published online

This paper analyses and updates the economic information regarding methicillin-resistant Staphylococcus aureus (MRSA), including information that has been previously reviewed by other authors, and new information, for the purpose of facilitating health management and clinical decisions. The analysed articles reveal great disparity in the economic burden on MRSA patients; this is mainly due to the diversity of the designs of the studies, as well as the variability of the patients and the differences in health care systems. Regarding prophylactic strategies, the studies do not provide conclusive results that could unambiguously orientate health management. The studies addressing treatments noted that linezolid seems to be a cost-effective treatment for MRSA, mostly because it is associated with a shorter length of stay (LOS) in hospital. However, important variables such as antimicrobial susceptibility, infection type and resistance emergence should be included in these analyses before a conclusion is reached regarding which treatment is the best (most efficient). The reviewed studies found that rapid MRSA detection, using molecular techniques, is an efficient technique to control MRSA. As a general conclusion, the management of MRSA infections implicates important economic costs for hospitals, as they result in higher direct costs and longer LOS than those related to methicillin-susceptible S. aureus (MSSA) patients or MRSA-free patients; there is wide variability in those increased costs, depending on different variables. Moreover, the research reveals a lack of studies on other related topics, such as the economic implications of changes in MRSA epidemiology (community patients and lineages associated with farm animals).

This paper acknowledges the difficulties of providing access to innovative drugs in some jurisdictions under the patent system and it contributes to the current debate on mechanisms aimed at facilitating such access. We employ a highly stylized static model of two markets (North and South) to analyse the conditions under which a new system based on royalty payments would be preferred to a patent system for pharmaceuticals. In the welfare calculations we have considered explicitly the influence of marketing activities by the patent owner as well as the shadow price of public funds needed to finance the royalties. The bargaining power of the firm in terms of obtaining higher compensation is also considered. The result: are not unambiguously conclusive being heavily dependent on the relevant values of the parameters. Nevertheless, it seems that for realistic parameter values, the new system could be preferred by all the parties involved.

Objective A review of existing economic models in major depressive disorder (MDD) highlighted the need for models with longer time horizons that also account for heterogeneity in treatment pathways between patients. A core discrete event simulation model was developed to estimate health and cost outcomes associated with alternative treatment strategies. Methods This model simulated short- and long-term clinical events (partial response, remission, relapse, recovery, and recurrence), adverse events, and treatment changes (titration, switch, addition, and discontinuation) over up to 5 years. Several treatment pathways were defined on the basis of fictitious antidepressants with three levels of efficacy, tolerability, and price (low, medium, and high) from first line to third line. The model was populated with input data from the literature for the UK setting. Model outputs include time in different health states, quality-adjusted life-years (QALYs), and costs from National Health Service and societal perspectives. The codes are open source. Results Predicted costs and QALYs from this model are within the range of results from previous economic evaluations. The largest cost components from the payer perspective were physician visits and hospitalizations. Key parameters driving the predicted costs and QALYs were utility values, effectiveness, and frequency of physician visits. Differences in QALYs and costs between two strategies with different effectiveness increased approximately twofold when the time horizon increased from 1 to 5 years. Conclusion The discrete event simulation model can provide a more comprehensive evaluation of different therapeutic options in MDD, compared with existing Markov models, and can be used to compare a wide range of health care technologies in various groups of patients with MDD. © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc.

Objectives: Antimicrobial resistance (AMR) is a public health threat; infections with resistant organisms are estimated to cause over 650.000 infections and over 30.000 deaths in Europe. AMR is associated with antibiotic consumption: appropriate prescribing of antibiotics is key in combating AMR. To fight this threat, it has been suggested that point-of-care diagnostics to inform antibiotics prescribing are an important tool in reducing antibiotics prescriptions. With the objective of knowing the state of the art, we reviewed diagnostic cost-effectiveness analyses (CEAs) for infectious disease, focussing on model types, effects on prescriptions and AMR. Methods: We searched the literature comprehensively through the PUBMED, Web of Science and EMBASE databases, as well as grey literature for the period 2000-2018. We included economic evaluations for diagnostic strategies for infectious disease in all geographic areas. Data extraction was based on the Consolidated Health Economic Evaluation Reporting Standards statement, with an additional focus on the modelling type and inclusion of AMR. Results: In general, CEAs of diagnostics for infectious disease fall in two categories: trial-based cost-effectiveness, focusing on short-term outcomes, and long-term models, focusing on outcomes extrapolated beyond the trial. Outcomes measured are for example prescriptions saved or hospitalizations saved. Cost-utility analyses seem to be difficult, as QALY differences between various diagnostic strategies are minor. Antimicrobial resistance is considered indirectly: as an ICER with prescriptions saved as an outcome; by calculating the threshold cost of resistance that would change the conclusion of cost-effectiveness; or as a point estimate; often, it is not considered at all. Conclusions: CEAs of diagnostic strategies for infectious disease are relatively scarce and it can be challenging to prove the cost-effectiveness of diagnostic strategies, especially in the context of relatively inexpensive treatments, such as antibiotics. However, there is an important opportunity of including the societal costs of AMR in future CEAs.

An increasing number of published studies of economic evaluations of health technologies have been reviewed and summarized with different purposes, among them to facilitate decision-making processes. These reviews have covered different aspects of economic evaluations, using a variety of methodological approaches. The aim of this study is to analyze the methodological characteristics of the reviews of economic evaluations in health care, published during the period 1990–2010, to identify their main features and the potential missing elements. This may help to develop a common procedure for elaborating these kinds of reviews. We performed systematic searches in electronic databases (Scopus, Medline and PubMed) of methodological reviews published in English, period 1990–2010. We selected the articles whose main purpose was to review and assess the methodology applied in the economic evaluation studies. We classified the data according to the study objectives, period of the review, number of reviewed studies, methodological and non-methodological items assessed, medical specialty, type of disease and technology, databases used for the review and their main conclusions. We performed a descriptive statistical analysis and checked how generalizability issues were considered in the reviews. We identified 76 methodological reviews, 42 published in the period 1990–2001 and 34 during 2002–2010. The items assessed most frequently (by 70 % of the reviews) were perspective, type of economic study, uncertainty and discounting. The reviews also described the type of intervention and disease, funding sources, country in which the evaluation took place, type of journal and author’s characteristics. Regarding the intertemporal comparison, higher frequencies were found in the second period for two key methodological items: the source of effectiveness data and the models used in the studies. However, the generalizability issues that apparently are creating a growing interest in the economic evaluation literature did not receive as much attention in the reviews of the second period. The remaining items showed similar frequencies in both periods. Increasingly more reviews of economic evaluation studies aim to analyze the application of methodological principles, and offer summaries of papers classified by either diseases or health technologies. These reviews are useful for finding literature trends, aims of studies and possible deficiencies in the implementation of methods of specific health interventions. As no significant methodological improvement was clearly detected in the two periods analyzed, it would be convenient to pay more attention to the methodological aspects of the reviews.

Assisted reproduction is one of the health services currently being considered for possible limitation or exclusion from the public health services portfolio in Spain. One of the main reasons claimed for this is the impact on the budget for pharmaceutical expenditure.The objective of this study was to assess the significance of the pharmaceutical costs of assisted reproduction in Spain.This study focused on medical practice in Spain, and is based on the opinions of experts in assisted reproduction and the results provided by professional societies' publications. The reference year is 2012 and the setting was secondary care. We have included all existing pharmaceutical modalities for assisted reproduction, as well as the most common drug for each modality. We have considered the pharmaceutical cost per cycle for artificial insemination, in vitro fertilisation with or without intracytoplasmic sperm injection (IVF_ICSI), and cryotransfer and donated fresh oocytes reception.In Spain, artificial insemination has a pharmaceutical cost per cycle of between €69.36 and €873.79. This amounts to an average cycle cost of €364.87 for partner's sperm and €327.10 for donor sperm. The pharmaceutical cost of IVF_ICSI ranges between €278.16 and €1,902.66, giving an average cost per cycle of €1,139.65. In the case of cryotransfer and donated fresh oocytes reception, the pharmaceutical cost per cycle is between €22.61 and €58.73, yielding an average cost of €40.67. The budgetary impact of pharmaceutical expenditure for assisted reproduction in Spain for the year 2012 was estimated at €98.7 million.In Spain, the total pharmaceutical cost of assisted reproduction is substantial. According to our results, we can say that about 29% of the total pharmaceutical expenditure for assisted reproduction techniques is funded by the National Health System and the rest represents 2.4% of the total annual out-of-pocket family expenditure on drugs.

In this paper we carry out a vertical differentiation duopoly model applied to pharmaceutical markets to analyze how endogenous and exogenous generic reference pricing influence competition between generic and branded drugs producers. Unlike the literature, we characterize for the exogenous case the equilibrium prices for all feasible relevant reference prices. Competition is enhanced after the introduction of a reference pricing system. We also compare both reference pricing systems on welfare grounds, assuming two different objective functions for health authorities: (i) standard social welfare and (ii) gross consumer surplus net of total pharmaceutical expenditures. We show that regardless of the objective function, health authorities will never choose endogenous reference pricing. When health authorities are paternalistic, the exogenous reference price that maximizes standard social welfare is such that the price of the generic drug is the reference price while the price of the branded drug is higher than the reference price. When health authorities are not paternalistic, the optimal exogenous reference price is such that the price of the branded drug is the reference price while the price of the generic drug is lower than the reference price. © 2017 Springer Science+Business Media New York

Health Technology Assessment is increasingly used to evaluate the value of healthcare products and to prioritize resources; however, defining exactly what value is and how it should be measured remains a challenge. In this article, we report the results of a literature review, focusing on nine European countries, with the aim of investigating how value is defined from the perspective of different stakeholders, how definitions of value are used, and how value is incorporated into decision making. Only three articles were identified that presented definitions of value, and there was no single shared definition of value in healthcare, which appears to be a highly subjective concept. The majority of the countries investigated combine clinical assessment with economic evaluation to make reimbursement recommendations; the quality-adjusted life-year is the most commonly used measure of value but does not capture broader aspects of value that may be important to patients and healthcare systems. We describe the use of value-based pricing and multi-criteria decision analysis, two approaches to the incorporation of broader aspects of value into decision making. Overall, we have identified considerable variation in how a product's value is defined by different stakeholders. Although a universal understanding of value in healthcare is important, it is clear that current definitions are insufficient, potentially leading to inconsistent reimbursement decisions. Ultimately, the establishment of clearer policies for defining and measuring value in healthcare is needed, and is likely to lead to improvements in the consistency of decision making.

Objetivos:Comparar la eficiencia del tratamiento de inicio con la combinacion de tamsulosina y dutasterida (TAM+DUT) frente a la pauta habitual de tratamiento consistente en iniciar con TAM y a los 6 meses anadir DUT (retraso de inicio), en pacientes con hiperplasia benigna de prostata (HBP) moderada-grave con riesgo de progresion. Material y metodos: Se diseno un modelo de Markov con un horizonte temporal a 4 anos desde la perspectiva del Sistema Nacional de Salud (SNS) a partir del estudio CombAT y de los resultados del estudio de Naslund y cols. Los resultados en salud se expresaron en porcentaje de complicaciones (retencion aguda de orina y cirugia). El uso de recursos sanitarios se obtuvo de un panel de expertos. Los costes unitarios (€ de 2010) proceden de las tarifas publicadas por las Comunidades Autonomas. El coste del tratamiento farmacologico se expresa en PVP-IVA. Resultados: El inicio del tratamiento con TAM+DUT es un tratamiento eficiente y dominante respecto al retraso en el inicio de la combinacion al disminuir en un 15% la probabilidad de sufrir una complicacion y reducir los costes sanitarios directos asociados a los 4 anos. Conclusiones: El tratamiento de inicio con la combinacion TAM+DUT resulta ser una alternativa de tratamiento mas eficiente para el SNS que la pauta habitual de retrasar el inicio de la combinacion. La adopcion de tratamientos mas eficientes ayudaria a aumentar la eficiencia del SNS.

Uncertainty is present in most human decisions. The introduction of health technologies in publicly funded systems is no exception. Sources of uncertainty in this domain come from different grounds, and a variety of means and tools have been developed to cope with unknown parameters and uncertain variables. Clinical trials were established more formally back in the 1950s and 1960s of the last century in most developed countries as a requirement to reduce uncertainties in general and primarily to guarantee safety and, later, efficacy. The outcomes of such clinical trials allowed us to understand the features of a given agent under certain controlled specific conditions, usually by comparing its medical performance versus a placebo. They have provided basic knowledge for registration, and to fix the price and reimbursement conditions for the majority of new drugs for several decades. However, in order to use this information on drugs, health authorities and physicians had to assume that the biological response of individuals to pharmaceutical agents and the clinical management of patients were similar across jurisdictions so that health outcomes held generally. That is to say, the basic and implicit assumption was that health outcomes from clinical trials were fully transferable to other health systems where decisions on the utilization of that drug had to be adopted. Needless to say, this basic assumption was subject to strong criticism and raised many questions with regard to whether similar health outcomes in different medical environments could be achieved. As a result of this debate, efficacy outcomes needed to be supplemented with real world data from other studies, i.e., data on effectiveness. In this sense, databases such as the Cochrane library—constituting a world reference since 1988—provide the medical community with real practice data. Additionally, once therapeutic areas became crowded with several similar agents, relative efficacy data started to be demanded by health authorities and physicians so that uncertainties about which drug would be more appropriate for each patients subgroup could be clarified. Although an old concern, this information requirement was considered more intensively during the 1980s and demand continues to grow. Furthermore, most current comparisons of the efficacy and safety of a new treatment with existing ones are still carried out using indirect methods, with the results again being subject to uncertainty (the already cited Cochrane library offers a collection of evidence that is easy to access but still many questions remain open to research). These uncertainties come from a variety of sources, such as differences in recruitment criteria, clinical management of patients in each trial, study duration, the statistical design of the trial, and so on. In this context, comparative efficacy studies (whose outcomes come from face-to-face clinical trials) began to be designed in response to requests from many health bodies to some rather reluctant pharmaceutical companies, who were unwilling to compare their new molecules with other, well-established treatments. This new route towards the reduction of uncertainty is still clearly under development and has a long way to go.

Background Chronic pain is known to be a significant and common health problem. Tapentadol, a recently developed centrally active, oral analgesic agent is used to treat adults with severe chronic pain that can be adequately managed only with opioid analgesics. Tapentadol has been reported to provide an improved adverse-events (AE) profile compared with other potent opioid analgesics at similar levels of analgesia. Objectives The aim of this study was to compare the cost-effectiveness of tapentadol to that of opioids commonly used as first-line treatment of severe, chronic, nonmalignant pain from the perspective of the health care payer in Spain. Methods A Markov state-transition model was developed to compare the cost-effectiveness of first-line treatment with tapentadol to that of oxycodone, morphine, and transdermal fentanyl (TDF) over a 1-year time horizon. Four health states were defined: (1) treatment discontinuation due to a severe AE; (2) treatment discontinuation due to a lack of efficacy; (3) occurrence of an AE that required medical treatment; and (4) no discontinuation and no AE. If a patient discontinued a treatment, he or she was switched to an alternative, second-line opioid. Data regarding efficacy, tolerability, and utility values (EQ-5D) were derived from randomized clinical trials. Clinical experts estimated the rates of switching to other opioids and the health care resource utilization associated with the treatment of severe chronic pain. Unit costs were derived from public price lists/tariff works and were calculated from the perspective of the National Spanish Health System. The robustness of the model results was tested in extensive sensitivity analyses in which event probabilities, costs, utilities, and treatment-switching rates were altered. Results Data from 3 studies (1981 patients) were included in the model. Overall, the model predicted that initiating first-line treatment with tapentadol in patients with severe, chronic, nonmalignant pain was associated with lower costs and greater efficacy versus first-line treatment with oxycodone. Compared with morphine and TDF, tapentadol yielded incremental cost-effectiveness ratios of €2656 and €2069 per quality-adjusted life-year gained, respectively. On extensive 1-way and scenario analyses, findings on the cost-effectiveness of tapentadol were consistent. The probability that tapentadol would be cost-effective compared with each comparator at the willingness-to-pay threshold of €20,000 to €30,000/QALY gained exceeded 90%. Conclusions Based on the findings from the present model, tapentadol is likely to be a cost-effective first-line treatment in patients with severe, chronic, nonmalignant pain in Spain according to the commonly accepted willingness-to-pay thresholds. Compared with morphine and TDF, the incremental cost-effectiveness ratios were low; compared with oxycodone, tapentadol dominated, showing better quality-of-life outcomes at lower costs.

Objetivos: Los estudios de evaluacion economica de tecnologias sanitarias ofrecen informacion util para la adopcion de decisiones y cada vez se publican mas articulos referidos a esta materia. Sin embargo, los estudios estan referidos a un contexto determinado por lo que no es inmediato aprovechar los resultados sin antes efectuar algunas comprobaciones. Es decir, no es directa su transferencia a otros contextos.

Resumen Objetivos evaluar el coste-efectividad incremental (CEI) de la combinacion dutasterida y tamsulosina (DUT + TAM) de inicio frente al tratamiento mas utilizado, tamsulosina (TAM), en pacientes con hiperplasia benigna de prostata (HBP) moderada-grave con riesgo de progresion. Material y metodos se diseno un modelo semi-Markov con un horizonte temporal a 4 y a 35 anos desde la perspectiva del Sistema Nacional de Salud espanol a partir del estudio CombAT. La efectividad de los tratamientos se midio en anos de vida ajustados por calidad (AVAC). El uso de recursos sanitarios se obtuvo de un panel de expertos. Los costes unitarios proceden de tarifas publicadas por las Comunidades Autonomas. El coste del tratamiento farmacologico se expresa en PVP-IVA; en el caso de TAM se utilizo el precio del generico y en el de DUT + TAM el de la combinacion a dosis fija. Todos los costes se expresan en euros de 2010. Resultados DUT + TAM produce una mejoria incremental respecto a TAM de 0,06 AVAC a los 4 anos y de 0,4 AVAC a los 35 anos. El coste incremental de DUT + TAM es de 810,53 € a los 4 anos y 3.443,62 € a los 35 anos. Por tanto, El CEI de TAM + DUT respecto a TAM es 14.023,32 €/ AVAC y 8.750,15 €/ AVAC a los 4 y 35 anos respectivamente. Conclusiones el tratamiento de inicio con la combinacion DUT + TAM es un tratamiento coste-efectivo frente TAM, el tratamiento mas habitual en la practica clinica espanola, al encontrase el ratio CEI por debajo del umbral que usualmente se considera para clasificar las tecnologias como coste-efectivas.

Objetivos: evaluar el coste-efectividad incremental (CEI) de la combinación dutasterida y tamsulosina (DUT+TAM) de inicio frente al tratamiento más utilizado, tamsulosina (TAM), en pacientes con hiperplasia benigna de próstata (HBP) moderada-grave con riesgo de progresión. Material y métodos: se diseñó un modelo semi-Markov con un horizonte temporal a 4 y a 35 años desde la perspectiva del Sistema Nacional de Salud español a partir del estudio CombAT. La efectividad de los tratamientos se midió en años de vida ajustados por calidad (AVAC). El uso de recursos sanitarios se obtuvo de un panel de expertos. Los costes unitarios proceden de tarifas publicadas por las Comunidades Autónomas. El coste del tratamiento farmacológico se expresa en PVP-IVA; en el caso de TAM se utilizó el precio del genérico y en el de DUT+TAM el de la combinación a dosis fija. Todos los costes se expresan en euros de 2010. Resultados: DUT+TAM produce una mejoría incremental respecto a TAM de 0,06 AVAC a los 4 años y de 0,4 AVAC a los 35 años. El coste incremental de DUT+TAM es de 810,53 € a los 4 años y 3.443,62 € a los 35 años. Por tanto, El CEI de TAM+DUT respecto a TAM es 14.023,32 €/ AVAC y 8.750,15 €/ AVAC a los 4 y 35 años respectivamente. Conclusiones: el tratamiento de inicio con la combinación DUT+TAM es un tratamiento coste-efectivo frente TAM, el tratamiento más habitual en la práctica clínica española, al encontrase el ratio CEI por debajo del umbral que usualmente se considera para clasificar las tecnologías como coste-efectivas. Objectives: to evaluate the incremental cost-effectiveness ratio (ICER) of the combination therapy with dutasteride and tamsulosin (DUT+TAM) as initiation treatment versus the most used drug in Spain, tamsulosin (TAM), in the treatment of moderate to severe benign prostatic hyperplasia (BPH) with risk of progression. Methods: a semi-Markov model was developed using 4-year and 35-year time horizons and from the Spanish National Healthcare Service perspective. Data were obtained from the CombAT trial. Effectiveness was measured in terms of quality adjusted life years (QALYs). Health care resources were defined by an experts' panel, and unitary costs were obtained from published Spanish sources. Pharmacologic cost is expressed in PTP WAT; in the case of TAM, the generic price is used, in the case of DUT+TAM the price of a fixed dose combination is used. Costs are expressed in 2010 Euros. Results: combination therapy with DUT+TAM produces an incremental effectiveness of 0.06QALY at year 4 and 0.4QALY at year 35. DUT+TAM represents an incremental cost of € 810.53 at 4 years and € 3,443.62 at 35 years. Therefore, the ICER for DUT+TAM versus TAM is € 14,023.32/QALY at year 4 and € 8,750.15/QALY at year 35. Conclusions: initiation treatment with DUT+TAM represents a cost-effective treatment versus TAM, the most used treatment in Spain, due to the fact the ICER is below the threshold that usually allows a technology to be considered as cost-effective.

A review was performed of the key methodological elements of all the published economic evaluations (EEs), available in the European Network of Health Economics Evaluation Database (EURONHEED), of healthcare technologies conducted in Europe over the past 10 years in order to identify and compare the methodological patterns of EEs conducted in different countries.

A review was performed of the key methodological elements of all the published economic evaluations (EEs), available in the European Network of Health Economics Evaluation Database (EURONHEED), of healthcare technologies conducted in Europe over the past 10 years in order to identify and compare the methodological patterns of EEs conducted in different countries. Selected for analysis were summaries of EEs of interventions for bacterial and viral infections, and diseases of the digestive and respiratory tracts. The summaries were obtained from the EURONHEED. There were 346 studies that fulfilled the selection criteria. The statistical analyses consisted of a descriptive analysis and a bivariate inference analysis to assess associations between the different variables, essentially between the variables of country, year of publication and methodology applied. Of the summaries examined, approximately 50% focused on pharmacological interventions. The most frequent type of analysis was that of cost effectiveness. The technologies most evaluated referred to treatments (versus diagnosis or prevention technologies). The perspective was mostly that of the health service. The sensitivity analysis most applied was univariate and the model type mostly used was the decision-tree. Over the period assessed, there were significant differences between countries in the types of EE, the perspective from which the studies were performed and in the practice of discounting costs and health effects. Although there has been an improvement in methodologies since the year 2000, there are studies that still fail to take into account key elements of EE necessary for a study to be considered of high quality. For better appreciation of the potential capacity for the transfer of results of EEs between jurisdictions, the methodologies used in health EE studies in the different European countries need to be known in greater detail.

La evaluacion economica de medicamentos (EEM) ha experimentado un fuerte crecimiento en los ultimos anos, debido a la progresiva aplicacion de la eficiencia como criterio de priorizacion en un entorno en el que los recursos

To evaluate the economic efficiency of influenza vaccination using both dynamic and static modelling approaches.The Spanish National Health System.We modelled the progress of an influenza epidemic in Spain according to the epidemiological pattern of susceptible--infective--resistant, employing a non-linear system of ordinary differential equations that enables the measurement of epidemiological effects of an anti-influenza vaccination. We used a decision tree to represent the repercussion on healthcare resources use and on financial resources. The same analyses were conducted using a static approach, and the results were compared. Healthcare costs were valued in euro, year 2005 values.For the base case, the impact of the healthcare intervention (vaccination) was not efficient from the perspective of the healthcare payer when using a static approach (return rate 0.28 per euro invested in vaccination). Nevertheless, it was efficient when employing a dynamic approach (return rate 1.22 per euro). Furthermore, a considerable freeing of healthcare resources would have been produced over the entire influenza season.The indirect effect of vaccination on the non-vaccinated individuals (the 'herd immunity effect') can be greater than the direct effect on individuals vaccinated. This implies that the herd immunity effect needs to be taken into consideration in the economic evaluations of prophylactic measures employed against infectious diseases.

Background Patients with chronic obstructive pulmonary disease (COPD) are at elevated risk of pneumococcal infection. A 13-valent pneumococcal conjugate vaccine (PCV13) was approved for protection against invasive disease and pneumonia caused by Streptococcus pneumoniae in adults. This study estimated the incremental cost-effectiveness ratio (ICER) of vaccinating COPD patients >= 50 years old with PCV13 compared with current vaccination policy (CVP) with 23-valent pneumococcal polysaccharide vaccine. Methods A Markov model accounting for the risks and costs for all-cause non-bacteremic pneumonia (NBP) and invasive pneumococcal disease (IPD) was developed. All parameters, such as disease incidence and costs ((sic); 2015 values), were based on published data. The perspective of the analysis was that of the Spanish National Healthcare System, and the horizon of evaluation was lifetime in the base case. Vaccine effectiveness considered waning effect over time. Outcomes and costs were both discounted by 3 % annually. Results Over a lifetime horizon and for a 629,747 COPD total population, PCV13 would prevent 2224 cases of inpatient NBP, 3134 cases of outpatient NBP, and 210 IPD extra cases in comparison with CVP. Additionally, 398 related deaths would be averted. The ICER was (sic)1518 per quality-adjusted life-year (QALY) gained for PCV13 versus CVP. PCV13 was found to be cost effective versus CVP from a 5-year modelling horizon (1302 inpatient NBP and 1835 outpatient NBP cases together with 182 deaths would be prevented [ICER (sic)25,573/QALY]). Univariate and probabilistic sensitivity analyses confirmed the robustness of the model. Conclusions At the commonly accepted willingness-to-pay threshold of (sic)30,000/QALY gained, PCV13 vaccination in COPD patients aged >= 50 years was a cost-effective strategy compared with CVP from 5 years to lifetime horizon in Spain.

To estimate the 5-year clinical and economic impact of a pneumococcal vaccination program on immunocompetent population aged 65-year-old in Spain.A 5 year dynamic model based on differential equations was built for the conceptualization of the burden of pneumococcal disease (PD) on a 65 year-old cohort. A 36.5% of the cohort was vaccinated with an expected efficacy rate of 52.5% as observed in the CAPITA study. The serotype vaccination coverage used was 63.4% (CAPA study), the incidence of pneumococcal disease was 162.2 per 100,000 cases per year (CMBD 2010-2013) and a rate of vaccinated subjects previously from the start of the model of 0.99%. The study used the perspective of The National Health System, and included the costs associated to PD and the conjugate vaccine laboratory selling price.In a 5 years-period, the vaccination with 13-valent pneumococcal conjugate vaccine is expected to avoid 10,360 cases of pneumococcal disease (7,411 in-patient pneumonias) and 699 deaths (14,736 Life Years Gained) in the 65 year old cohort. Vaccination costs of 36.5 million euros would be completely offset by medical cost reduction of 41.5 million euros, yielding to a net saving of 3.8 million constant euros (4.9 million undiscounted).PCV13 vaccination targeting the cohort of 65 year-old immunocompetent Spanish adults is expected to result in net savings for the National Health System, while decreasing disease burden and averting a substantial number of related deaths.Analizar el impacto económico y sanitario en 5 años de la vacunación de la cohorte española de 65 años inmunocompetente con la vacuna antineumocócica conjugada 13-valente.Mediante un modelo de transmisión dinámica basado en ecuaciones diferenciales se analizó la carga de la enfermedad neumocócica (EN) en sujetos de 65 años en 5 años, siendo vacunada anualmente el 36,5% de la cohorte. Se aplicó la eficacia de la vacuna del 52,5% observada en el estudio CAPITA en pacientes de 65 años inmunocompetentes, cobertura de serotipos vacunales del 63,4% (estudio CAPA), incidencia de infección neumocócica de 162,2/100.000 casos año (CMBD 2010-2013) y proporción de vacunados previamente al arranque del modelo del 0,99%. La perspectiva fue la del Sistema Nacional de Salud (SNS). Costes de casos de EN según CMBD y precio de venta de laboratorio de la vacuna conjugada.En 5 años la vacunación con vacuna conjugada 13-valente espera evitar 10.360 casos de EN (7.411 hospitalizaciones por neumonías) y 699 muertes (14.736 años de vida ganados -AVG-), en una cohorte de 65 a 69 años de edad. El coste de vacunación esperado de 36,5 millones de euros se compensaría completamente por la reducción de 41,5 millones de costes médicos evitados, con un ahorro neto acumulado de 3,8 millones de euros a precios constantes (4,9 a precios corrientes).La vacunación con vacuna conjugada 13-valente en adultos de 65 años inmunocompetentes resulta eficiente para el Sistema Nacional de Salud, reduciendo la carga de enfermedad y evitando un número importante de muertes.

Introduction and objectives. This article examines the cost impact associated with the utilization of the Taxus drug eluting stent versus a conventional bare-metal stent for percutaneous coronary interventions in a Spanish hospital setting. Methods. A decision analysis model has been developed to compare the intervention and re-hospitalization costs at 12 and 24 months post-intervention. The analysis considers the general patient population and a high-risk subpopulation (diabetes, small vessel, long lesion). The analysis simulates the results of the TAXUS-IV clinical trial, in a population with similar risks, with appropriate costs, and including budget impact analyses with alternative utilization scenarios. Results. The expected average per patient hospital cost at 12 months was €6934 with Taxus and €6756 with baremetal stent (and increase of 2.6%). At 24 months, per patient hospital cost was €6991 for Taxus and €6887 for bare-metal stent (an increase of 1.5%). In the high-risk subpopulation, Taxus was overall cost saving as compared to bare-metal stent both at 12 months (decrease of 3.0%) and 24 months (decrease of 4.7%). Conclusions. Use of Taxus in the overall population slightly raises treatment costs, while in patients with greater risk of restenosis the treatment cost is reduced. Given the decrease in the number of repeat revascularizations with this stent, the cost-effectiveness relationship could be acceptable in the general patient population and is dominant in the high-risk subpopulation.

Objetivo: Realizar un analisis de coste-efectividad comparando escitalopram y citalopram en el tratamiento de la depresion mayor grave. Metodologia: Se ha adaptado un modelo de arbol de decision, que representa el tratamiento de la depresion mayor grave, al contexto espanol. El modelo representa las opciones terapeuticas habituales, en el contexto sanitario espanol, para la poblacion del estudio. El horizonte temporal del modelo es de 6 meses y calcula el cociente de coste-efectividad por paciente con remision. Los datos de eficacia del modelo provienen de un ensayo clinico aleatorizado. Las pautas de tratamiento habituales en Espana han sido indicadas por varios especialistas medicos. La perspectiva del analisis es la del sistema sanitario y el ano del analisis, 2005. Resultados: El coste por paciente con remision es de 951 € con escitalopram y de 992 € con citalopram. El coste por conseguir una remision adicional mediante escitalopram respecto a citalopram se ha estimado en 353 €. Conclusiones: El tratamiento con escitalopram, ademas de ser mas eficaz que citalopram, presenta un perfil de eficiencia cuyos costes adicionales respecto de los costes de los tratamientos medios por remision con citalopram son menores, por lo que su empleo estaria respaldado desde la perspectiva economica.

Las revistas clinicas publican a menudo estudios de evaluacion economica de tecnologias y programas sanitarios. A fin de mejorar el proceso de revision y, promover la calidad y validez de los estudios publicados, el British Medical Journal (BMJ) establecio unas directrices para la publicacion de estudios de evaluacion economica dirigidas a autores, revisores y editores. Este articulo analiza la justificacion y efectividad de este tipo de directrices y, mas concretamente, la oportunidad de que Medicina Clinica adopte las directrices del BMJ u otras similares. Se concluye que dicha adopcion seria probablemente positiva, aunque se sugiere que seria preferible actualizar y revisar las directrices del BMJ y adaptarlas al contexto espanol mediante un proceso de consenso entre las partes implicadas. Finalmente, se pone de relieve las limitaciones del sistema de revision por expertos para garantizar la validez y calidad de los estudios de evaluacion economica y se sugieren medidas complementarias, tomando en consideracion algunas experiencias relevantes del campo de la investigacion clinica.

Objetivo. Realizar un analisis coste-efectividad de samario [153Sm-EDTMP] (Quadramet®) respecto a la terapia convencional, para el tratamiento del dolor causado por metastasis oseas en pacientes con cancer de prostata.

Objetivo: Conocer los beneficios sanitarios en forma de ahorro de recursos sanitarios (consultas y tratamientos) y financieros (euros) que supondria la implantacion de la vacunacion antigripal, financiada a cargo del empleador, en la poblacion ocupada espanola.

Objetivo: Conocer si la vacunacion sistematica de la poblacion infantil sana frente al virus de la varicela-zoster resulta eficiente frente a la ausencia de vacunacion y seleccionar la estrategia de inmunizacion mas adecuada.

El objetivo fundamental de cualquier sistema sanitario esmaximizar el nivel de salud de la poblacion a la que da co-bertura. Desgraciadamente, los recursos economicos dispo-nibles para tal fin no suelen ser suficientes para cubrir todaslas necesidades que en este ambito se presentan. Por estarazon, los agentes que toman las decisiones deben estable-cer que acciones resultan prioritarias para poder maximizarel beneficio producido con los recursos disponibles

la evaluacion economica de las intervenciones sanita-rias es un termino generico que engloba varias tecnicas oprocedimientos que pueden emplearse para comparar in-formacion sobre la relacion que existe entre el coste y losresultados de las intervenciones destinadas a la mejora dela salud de los individuos. El analisis coste-efectividad (ACE) es, en la actualidad, laforma mas comun de llevar a cabo cualquier evaluacioneconomica de las intervenciones sanitarias destinada a de-terminar que intervenciones resultan prioritarias para maxi-mizar el beneficio producido por los recursos economicosdisponibles

Durante los ultimos anos, varios paises han incorporado la evaluacion economica de intervenciones sanitarias (EEIS) como criterio para establecer prioridades en salud. Desde su creacion en 1999, el modelo ingles del National Institute for Health and Clinical Excellence (NICE) se ha convertido en la principal referencia sobre como puede utilizarse el criterio de eficiencia en la seleccion de medicamentos y otras tecnologias. La idea de priorizar el uso de las nuevas intervenciones sanitarias en funcion de su eficiencia resulta enormemente atractiva, aunque no esta exenta de dificultades. Aparte del coste politico que supone racionar en funcion de criterios explicitos, se han senalado diversos problemas metodologicos y eticos, entre los que cabe destacar la determinacion del valor de los anos de vida ajustados por calidad (AVAC), el limite de eficiencia utilizado y si dicho limite deberia aplicarse o no de forma flexible. En la practica, la mayoria de los paises que utilizan la EEIS reconocen la existencia de diversos factores que influyen en las decisiones, tales como la gravedad de la enfermedad, la disponibilidad de otras alternativas, el impacto presupuestario, o la presencia de enfermedades que afectan a determinados colectivos. A pesar de estos problemas, cada vez existe mas consenso sobre las ventajas de utilizar el criterio de coste-efectividad si se pretende hacer un mejor uso de los recursos disponibles. Por ello, resulta sorprendente que, recientemente, varios paises hayan optando por priorizar en funcion de un criterio diferente, el de efectividad. En este trabajo se expondran algunos ejemplos que ilustran este cambio, sus posibles razones y algunos de los retos que plantea este nuevo sistema.