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Background and Aim: Costs for the treatment of diabetes and its comorbidities are a major international issue. A recent randomized clinical trial showed that the introduction of color range indicator (CRI)-based glucose meters (GMs) positively affects the HbA1c of patients with type 1 and type 2 diabetes, when compared to GMs without a CRI. This budget impact analysis aimed to translate this beneficial effect of CRI-based GMs, OneTouch Verio Flex and OneTouch Verio, into potential monetary impact for the healthcare systems of five European countries, Germany, Spain, Italy, France, and the United Kingdom., Material and Methods: Data from a randomized controlled trial, evaluating the effect of CRI-based GMs, were used to estimate the ten-year risk of patients for fatal myocardial infarction (MI) as calculated by the UK Prospective Diabetes Study (UKPDS) risk engine. On the basis of assessed risks for MI, the potential monetary impact for the healthcare systems in five European countries was modeled., Results: Based on a mean HbA1c reduction of 0.36%, as demonstrated in a randomized controlled trial, the UKPDS risk engine estimated a reduction of 2.4% of the ten-year risk of patients for fatal MI. When applied to our economic model, substantial potential cost savings for the healthcare systems of five European countries were calculated: €547 472 (France), €9.0 million (Germany), €6.0 million (Italy), €841 799 (Spain), and €421 069 (United Kingdom) per year., Conclusion: Improving metabolic control in patients with diabetes by the utilization of CRI-based GMs may have substantial positive effects on the expenditure of the healthcare systems of several European countries.

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.

Objective: To assess the monetary savings resulting from a pharmacist intervention on the appropriateness of prescribed drugs in community-dwelling polymedicated (≥8 drugs) elderly people (≥70 years)., Method: An evaluation of pharmaceutical expenditure reduction was performed within a randomised, multicentre clinical trial. The study intervention consisted of a pharmacist evaluation of all drugs prescribed to each patient using the "Good Palliative-Geriatric Practice" algorithm and the "Screening Tool of Older Persons Prescriptions/Screening Tool to Alert doctors to Right Treatment" criteria (STOPP/START). The control group followed the routine standard of care. A time horizon of one year was considered and cost elements included human resources and drug expenditure., Results: 490 patients (245 in each group) were analysed. Both groups experienced a decrease in drug expenditure 12 months after the study started, but this decrease was significantly higher in the intervention group than in the control group (-14.3% vs.-7.7%; p=0.041). Total annual drug expenditure decreased 233.75 €/patient (95% confidence interval [95%CI]: 169.83-297.67) in the intervention group and 169.40 €/patient (95%CI: 103.37-235.43) in the control group over a one-year period, indicating that 64.30 € would be the drug expenditure savings per patient a year attributable to the study intervention. The estimated return per Euro invested in the programme would be 2.38 € per patient a year on average., Conclusions: The study intervention is a cost-effective alternative to standard care that could generate a positive return of investment., (Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

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.)

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.)

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.)

Aim: To analyze the influence of contrast dose adjusted by weight vs. fixed contrast dose in the attenuation and cost of abdominal computed tomography (CT)., Materials and Methods: A randomised, consecutive, parallel group study was conducted in 151 patients (74 men and 77 women, age range 22-67 years), studied with the same CT helical protocol. A dose at 1.75 ml/kg was administered in 101 patients while 50 patients had a fixed dose of 120 ml of same non-ionic contrast material (320 mg/ml). Mean enhancements were measured at right hepatic lobe, superior abdominal aorta and inferior cava vein. Statistical analysis was weight-stratified (<60, 61-70, 71-80 and >81 kg)., Results: Aortic attenuation was significantly superior (p<0.05) in the dose adjusted by weight group than in the fixed dose group. Patients who weighed >61 kg in dose-adjusted group, presented higher hepatic attenuation, being statistically significant in those >81 kg (p<0.01). In dose-adjusted group, there was a savings of euro 4.1 per patient in patients weighing <80 kg. In patients weighing >80 kg, there was an over cost of euro 10.7 per patient., Conclusions: An injection volume of 1.75 ml/kg offers an optimal diagnostic quality with a global savings of euro 1.34 per patient.

Objectives: The objective of this study was to evaluate the intended and unintended impact on pharmaceutical use and sales of three public reimbursement reforms applied to the prescription of statins: a Spanish generic reference pricing system, and two competing policies introduced by the Andalusian Public Health Service., Methods: This study is designed as an interrupted time series analysis with comparison series of 46 monthly drug use and sales figures from January 2001 to October 2004 for each active ingredient., Results: The mean monthly saving for the year after the introduction of reference pricing was 16.7% of total lovastatin sales, representing only 1.1% of total statins sales. Mean monthly savings for the 10 months after reference pricing being applied to simvastatin were 51.8% of simvastatin sales, and 13.9% of statin sales. Over the 46 months of the study, all analysed public interventions resulted in a 2.2% average monthly decrease in statin sales in the rest of Spain and savings non-significantly different from zero in Andalusia., Conclusion: RP has been effective at reducing the volume of sales growth of the off-patent statins, yet its overall impact on sales of all statins has been relatively modest.

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.