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Economic evaluation of health care technologies (EEHT) has become a basic tool in the decision-making process in health. The continuous development of methods and their direct application to reality have placed EEHT as a key item on the agenda of health policy makers across countries. The present article introduces the aims of EEHT and describes the experience of several European countries where economic evaluation studies are currently used to select the health technologies to be implemented. The role played by EEHT in Spain at the present time is then discussed. Finally, pressing tasks are identified and recommendations are made for the consolidation of EEHT as a basic element in the decision-making process of health care technologies.

Mental illness affects a large number of people in the world, seriously impairing their quality of life and resulting in high socioeconomic costs for health care systems and society. Our aim is to estimate the socioeconomic impact of mental illness in Spain for the year 2002, including health care resources, informal care and loss of labour productivity. A prevalence-based approach was used to estimate direct medical costs, direct non-medical costs, and loss of labour productivity. The total costs of mental illness have been estimated at 7,019 million euros. Direct medical costs represented 39.6% of the total costs and 7.3% of total public healthcare expenditure in Spain. Informal care costs represented 17.7% of the total costs. Loss of labour productivity accounted for 42.7% of total costs. In conclusion, the costs of mental illness in Spain make a considerable economic impact from a societal perspective.

En los últimos años estamos asistiendo a cambios en la definición del concepto de salud aplicable a individuos y poblaciones. En el presente trabajo se propone la estimación del stock de capital salud de la población residente en Cataluña. Para ello, en primer lugar, se estima la Esperanza de Vida Ajustados por Calidad de dicha población (ajustada por edad y género), para a continuación proponer una valoración monetaria de los resultados obtenidos. En el análisis descriptivo observamos una marcada evolución negativa de la CVRS en la población femenina durante el periodo considerado. En la segunda parte del trabajo se analiza los principales determinantes de la Calidad de Vida Relacionada con la Salud (CVRS) de la población estudiada, empleando las tres Encuestas de Salud de Cataluña (ESCA) disponibles: año 1994, año 2002 y año 2006. Con tal fin, se plantea un modelo probit ordenado, estimándose los efectos marginales de las variables explicativas utilizadas (sociodemográficas, salud “objetiva” y estilos de vida). La edad, el género, el nivel educativo y las enfermedades diagnosticadas son las principales variables significativas, siendo más complicado determinar el efecto de los hábitos y estilos de vida. El año en que se realiza la encuesta es una variable significativa, lo cual hace pensar en la conveniencia de recalibrar las tarifas del instrumento de calidad de vida relacionado con la salud empleado en el análisis en un medio plazo. Se concluye con una serie de recomendaciones, efectuadas a partir de los resultados encontrados en el análisis, para responsables sanitarios y públicos, en general.

En los últimos años estamos asistiendo a cambios en la definición del concepto de salud aplicable a individuos y poblaciones. En el presente trabajo se propone la estimación del stock de capital salud de la población residente en la Comunidad Canaria. Para ello, en primer lugar, se estiman la Esperanza de Vida Ajustados por Calidad de dicha población (ajustada por edad y género), para a continuación proponer una valoración monetaria de los resultados obtenidos. En la segunda parte del trabajo se analiza los principales determinantes de la Calidad de Vida Relacionada con la Salud de la población estudiada, empleando la Encuesta Canaria de Salud. Con tal fin, se plantea un modelo probit ordenado, estimándose los efectos marginales de las variables explicativas utilizadas (sociodemográficas, salud “objetiva” y estilos de vida). La edad, el género, el nivel educativo y las enfermedades diagnosticadas son las principales variables significativas, siendo más complicado determinar el efecto de los hábitos y estilos de vida. En ambas fases de trabajo se compara los resultados obtenidos con los de un trabajo previo correspondientes a la población residente en Cataluña.

In this article, we provide readers with a summary of the main economic features of the recently approved Spanish law regarding pharmaceutical preparations entitled the Law of Guarantees and Rational Use of Pharmaceuticals and Health Products (Law 29/2006 of July 26th). We review information on pricing, reference pricing, promotion of generic drugs, public reimbursement, patients’ contributions, and penalties. Other aspects of minor economic relevance such as the information on prices shown in the packs and the transparency on the results of clinical trials irrespective of whether these are positive or not, are not addressed in this paper. We conclude with some observations on the new horizons opened up by this new legal framework. We have not included any detailed references to the new law; we merely wish to comment on certain aspects of its application.

Marc Miravitlles,1 Luz María Peña-Longobardo,2 Juan Oliva-Moreno,2 Álvaro Hidalgo-Vega2 1Pneumology Department, University Hospital Vall d’Hebron, Ciber of Respiratory Diseases (CIBERES), Barcelona, Spain; 2Faculty of Law and Social Sciences, University of Castilla-La Mancha, Toledo, Spain Objective: Chronic obstructive pulmonary disease (COPD) is a very prevalent and invalidating disease. The aim of this study was to analyze the burden borne by informal caregivers of patients with COPD. Methods: We used the Survey on Disabilities, Personal Autonomy, and Dependency Situations (Encuesta sobre Discapacidad, Autonomía personal y Situaciones de Dependencia [EDAD]-2008) to obtain information on the characteristics of disabled individuals with COPD and their caregivers in Spain. Additionally, statistical multivariate analyses were performed to analyze the impact that an increase in dependence would have on the problems for which caregivers provide support, in terms of health, professional, and leisure/social dimensions. Results: A total of 461,884 individuals with one or more disabilities and with COPD were identified, and 220,892 informal caregivers were estimated. Results showed that 35% of informal caregivers had health-related problems due to the caregiving provided; 83% had leisure/social-related problems; and among caregivers of working age, 38% recognized having profession-related problems. The probability of a problem arising was significantly associated with the degree of dependence of the patient receiving care. Caregivers of patients with great dependence showed a 39% higher probability of presenting health-related problems, 27% more professional problems, and 23% more leisure problems compared with those with nondependent patients. Conclusion: The results show the large impact on society in terms of the welfare of informal caregivers of patients with COPD. A higher level of dependence was associated with more severe problems in caregivers, in all dimensions. Keyword: informal care, chronic care, disease burden&nbsp

Objectives: To examine the economic burden (direct and indirect costs) of Alzheimer disease (AD) and to analyze the impact on health-related quality of life (HRQOL) for patients with AD and caregivers in 2001 in the Canary Islands, Spain. Methods: Two hundred thirty-seven patients (61% of those contacted) were recruited from the Alzheimer’s Disease Association in the Canary Islands. Demographic, health resources utilization, informal care, indirect costs, and quality of life data were collected from primary caregivers of patients as proxy respondents. HRQOL was measured for patients and caregivers with the generic questionnaire EQ-5D. Results: The average annual cost per patient with AD was �28,198 (US $36,144). The most important categories of costs were for informal care and drugs. Costs increased with cognitive impairment with an average annual cost of �14,956 (US $19,171) for mild, �25,562 (US $32,765) for moderate, and �41,669 (US $53,411) for severe patients. The total cost of patients with AD in Canary Islands was �259 (US $332) million. The HRQOL with the EQ-5D social tariff was 0.29 for patients and 0.67 for caregivers. The EQ-5D VAS (thermometer) score was 42 for patients and 62 for caregivers. Conclusions: Direct health care costs of AD represented 2.4% of the total public health care expenditure in the Canary Islands. Across all severity levels, we estimated a total annual cost of �10 (US $13) billion for AD patients older than 65 years in Spain. The degree of severity of the patients with AD substantially influenced the quality of life of the patients but not that of the caregivers.

The therapeutic advances that have taken place since the mid 1990s have profoundly affected the situation of people living with HIV/AIDS, not only in terms of life expectancy and quality of life but also socio-economically. This has numerous effects on different aspects of the patients’ lives and, especially, on their working lives. We analyze in this paper labour force participation of people living with HIV/AIDS in Spain. Although we first set up our model in a typical neoclassical framework where variables of defence levels, illness stage and patients health related quality of life are added to the normally used demographic and economic variables, we depart from it at several points of the paper. The results point to a high level of labour participation, although lower than the level at the time of the diagnosis, associated with a good health status. Gender, education level, unearned income, clinical indicators and the patients’ own perception of their health are the main variables explaining the probability of participating in the labour market. The results obtained in the study may serve both as a basis for making medium term predictions and for designing integral support policies for these people.

This study estimated the economic impact of schizophrenia-related direct costs (medical and nonmedical costs) in Spain. Direct medical costs (hospitalizations, outpatient consultations, drug costs) and direct nonmedical costs (costs of informal care) were estimated based on prevalence costs for 2002. The total costs of schizophrenia were estimated at euro 1,970.8 million; direct medical costs accounted for 53% and informal care costs 47%. Despite having implemented a conservative approach, the health care costs associated with schizophrenia account for 2.7% of total public health care expenditure in Spain. The sum of medical and nonmedical costs give us a better definition of the magnitude of the problem in Spain as well as contributing to helping make the debate on this issue more transparent.

This study estimated the indirect costs (productivity loss) caused by mortality and morbidity of cervical and breast cancers in Spain. We used two alternative methods: (a) the traditional human capital (HC) approach and (b) the friction cost (FC) method. The annual costs were €43.4 and 288.7 for cervical and breast cancer, respectively, by the HC approach and €1.1 and 11.6 mil lion by the FC approach. Cost-of-ill ness studies help to illustrate the real dimension of health problems and should be a major concern for health policies. Indirect costs are relevant information about diseases. However, the estimated indirect costs depend heavily on the approach adopted. © Springer Medizin Verlag 2005 Publicado

OBJECTIVE—The goal of this study was to estimate the health care resources spent by type 1 and type 2 diabetic patients in Spain during the year 2002. RESEARCH DESIGN AND METHODS—This is a cost-of-illness study focusing on direct health care costs estimated from primary and secondary sources of information. A prevalence of diabetes ranging from 5 to 6% of the adult population was determined. Total cost is composed of six items: insulin and oral hypoglycemic agents, other drugs, disposable and consumable goods (glucose test strips, needles, and syringes), hospitalization, primary care visits, and visits to endocrinologists and dialysis. RESULTS—The estimated direct cost of diabetes in 2002 ranges from €2.4 to 2.67 billion. Hospital costs were the most (€933 million), followed by noninsulin, nonhypoglycemic agent drugs (€777–932 million). Much lower are the costs of insulin and oral hypoglycemic agents (€311 million), primary care visits (€181–272 million), specialized visits (€127–145 million), and disposable elements (€70–81 million). Expenditures for all drugs and consumable goods ranged between €1.16 and 1.3 billion, representing 48–49% of total cost, which is 15% higher than hospital costs. CONCLUSIONS—The direct health care costs of diabetic patients are high (6.3–7.4% of total National Health System expenditure). Their average annual cost is €1,290–1,476. For individuals without diabetes, the average annual cost is €865.

Une des multiples manifestations de la presence des Aventures de Telemaque dans les manuels espagnols du XIXesiecle, est la presentation de textes traduits en guise de modeles. A partir des notes a ces traductions principalement heritees du XVIIIe siecle, des positions generales des auteurs sur la traduction et l’enseignement du francais, mais surtout de l’analyse des « manipulations » que subit le texte, on peut retrouver le reflet des avatars scolaires de Telemaque. Nous nous appuyons egalement pour ce portrait sur les commentaires de differents auteurs de manuels qui ne traduisent pas l’œuvre mais nous informent cependant par leurs critiques sur l’usage habituel de ce livre archifamilier dans les salles de classe.

This paper considers the current perspective of coordinating efforts to stabilize exchange rates in East Asia, viewed as the first and essential stage of monetary integration process. In this context, the effects of asymmetric demand and supply shocks affecting the two countries are considered, with the help of a game-theory model, and the outcomes from cooperative and non-cooperative fiscal policy responses are analyzed. The properties of fixed-exchange rate arrangements are analytically treated and numerically simulated in a situation where fiscal policies are left as the only device to deal with asymmetric shocks, both on the demand side and the supply side. The model prediction is that both asymmetric demand and supply shocks may be contrasted with the help of fiscal policies, without damaging consequences for the fixed-exchange rate arrangement. The model also suggests that the results will prove better when the fiscal response to the asymmetric shocks is coordinated. Not differently than what happened in Europe following the implementation of end stages of monetary integration, asymmetric fiscal policy response to asymmetric supply shocks may bring about the piling up of huge public debt, and pave the way to sovereign debt crises. Arguably, in such a situation joint fiscal responsibility may help reinforcing the process of integration and convergence.

In order to estimate the composition, distribution and abundance of zooplankton in 3 areas off the western Caribbean, samples were collected in 15 stations at South Coast and Chinchorro Bank, Mexico, and Hol-Chan Belize, from April to December 1996. Duplicate samples (2.5 m 3 ) were collected bimonthly using a submersible pump. The pumped water was filtered through a 202 µm mesh net yielding a total of 20 zooplankton groups. Chinchorro Bank had 19 groups, South Coast had 15 groups, and Hol-Chan had 14 groups. The most abundant groups were copepods (43.1%), fish eggs (29.0%), foraminifera (12.0%), decapod larvae (5.7%) and gastropod larvae (4.3%). Twenty-seven species of gastropod larvae were identified with Natica sp. 1, Rissoina sp. 1, Cerithiopsis hero, Cerithium atratum, and Epitonium sp.1 being dominant. Newly hatched veligers of Strombus gigas were collected only at Chinchorro Bank (5.7/10m -3 ). Zooplankton was diverse and showed marked changes during the sampling months. Chinchorro Bank had a higher number of marine zooplankters than South Coast and Hol-Chan, and this may be related to a greater oceanic influence. In spite of the environmental homogeneity, there were differences in the distribution and abundance of Strombus veligers, and this might be related to some water characteristics locally, affecting gastropod reproduction mainly in South Coast and Hol-Chan.

Whether the indirect costs caused by a specific disease should be included in economic analysis of health issues is a continuous matter of study which is far from solved. Throughout the course of this paper, we will try to point out the reasons of recommending their inclusion in economic health analysis and the main techniques for their calculation. Two practical examples about the economic impact caused in our society by some diseases will be analyzed. HIV/AIDS case has been chosen for its social relevance. Migraine was chosen for being a disease which in term of direct costs represents a small burden of illness for the health sector. But, if we have into account the indirect costs, the impact of the whole problems related to the migraine should be reconsidered.

El trabajo consiste en suministrar a los respectivos agentes una información de calidad que permita comparar entre opciones alternativas dentro de un marco de recursos limitados, de ahí la necesidad de que las autoridades sanitarias tengan en cuenta no sólo los estudios clínicos, sino también los socioeconómicos para poseer una visión global del impacto social de los problemas de salud.

Nos encontramos ante una obra que nos narra el origen de los Hurritas como un pueblo establecido desde tiempos remotos en el área norsiro-mesopotámica, distinto a otros pueblos conocidos del Próximo Oriente antiguo: sumerios, semitas (acadios, asirios y babilonios) y semitas occidentales (amoritas, cananeos, arameos), hititas, indo-arios, casitas y elamitas.

Background Diabetes is becoming of increasing concern in Spain due to rising incidence and prevalence, although little information is known with regards to costs and outcomes. The information on cost of diabetes in Spain is fragmented and outdated. Our objective is to update diabetes costs, and to identify outcomes and quality of care of diabetes in Spain. Methods We performed systematic searches from secondary sources, including scientific literature and government data and reports. Results Diabetes Type II prevalence is estimated at 7.8%, and an additional 6% of the population is estimated to be undiagnosed. Four Spanish diabetes cost studies were analyzed to create a projection of direct costs in the NHS and productivity losses, estimating €5.1 billion for direct costs along with €1.5 billion for diabetes-related complications (2009) and labour productivity losses represented €2.8 billion. Glycemic control (glycolysated hemoglobin) is considered acceptable in 59% of adult Type II cases, in addition to 85% with HDL cholesterol ≥40mg/dl and 65% with blood pressure 30), 15% have diabetic retinopathy, 16% with microalbuminuria, and 15% with cardiovascular disease. Conclusions The direct health care costs (8% of the total National Health System expenditure) and the loss of labour productivity are high. The importance of a multi-sectoral approach in prevention and improvements in management of diabetes are discussed, along with policy considerations to help modify the disease course.

This paper analyzes the stability of foreign trade, currency markets and international portfolio balances with the help of a model which captures the interactions between current account balances and the international asset portfolios for domestic and foreign investors. The model is used for policy analysis based on numerical simulations for the interplay between the US and China in terms of exchange rate, foreign exchange reserves and foreign debt. Conditions for the existence of dynamic equilibria, and whether they can be attained, are derived under alternative policy assumptions. Simulations of the model show that "trade space" (the range of trade and foreign liability imbalances that can be absorbed without triggering an unstable sequence of adjustments) is sensitive to the policy regimes in place; and to the preferences of investors and particular strategies employed by policymakers within those regimes. Our benchmark scenario, representing today's conditions for the US and China, shows trade space is comfortably larger than the adjustments usually said to be necessary. That would be satisfactory if we start from equilibrium. Unfortunately, we do not. But the result does suggest that currency peace rather than currency war is likely to be a more productive strategy for reducing existing imbalances.

Background The economic value attributed by users of health services in public health systems can be useful in planning and evaluation. This value can differ from the perspectives of Willingness to Pay (WTP) and Willingness to Accept [Compensation] (WTA). Our objective was to study the perceptions of the patient about the service provided by the family physician by means of the WTA/WTP ratio. Methods An economic evaluation study by the Contingent Valuation Method was designed. Interviews were conducted with 451 subjects at six health centres (four urban and two rural) in areas with different socioeconomic characteristics. A payment card was used to measure the WTP and WTA. Other characteristics of the subject or service that could influence these responses were collected. An explicative model was constructed to study the WTA/WTP relationship. Results Four hundred and four subjects (89.6%) expressed a WTP and WTA different from zero. The WTA/WTP quotient showed a median of 1.55 (interquartile range 1-3.08) and a mean of 3.30 (IC 95%: 2.84-3.75). The WTA/WTP ratio increases with age and in low-income areas. It decreases in professional groups with more specialized activities, with growing family income, and in the chronically ill. Other characteristics related to the perception of state of health, accessibility to the service, satisfaction, or perception of risk were not explicative. Conclusions Subjects who were older and had a less favourable socioeconomic situation expressed a higher WTA/WTP ratio when valuing the visit to the family physician. These characteristics could identify a profile of "aversion to loss" with respect to this service.

SummaryThirty-four women with single autonomous “hot” nodules of the thyroid were treated with 131I. There was a variable degree of thyrotoxicosis in 26 cases while in 3 others there was only local cervical discomfort. The total amount administered varied between 2 and 80 mCi of 131I and the radiation dose to the thyroid from 2 to 450 krads. The nodule and symptoms disappeared in 14 of the patients, while in the other 14 the lesion decreased in size and the clinical manifestations improved. Only in six patients was the result unsatisfactory, without change in the size of the nodule. Results are analysed on the basis of the quantity of radioiodine administered.Modifications of the scintigram before and after treatment are discussed, observing that the “cooling” of the nodule and the reappearance of the surrounding gland are signs of good prognosis.A case is described in which the therapy failed and a thyroid carcinoma was found after surgical resection. Two cases of the series in which there were slight transitory manifestations of post-therapeutic hypothyroidism are also reported.

ResumenLa incorporación de nuevos tratamientos, procedimientos y tecnologías a la cartera de prestaciones de los sistemas de salud ha de cumplir un triple objetivo de modo equilibrado: mejora del acceso de los pacientes a soluciones innovadoras, sostenibilidad del sistema y compensación a la innovación. Sin embargo, los esquemas tradicionales basados en políticas de establecimiento de precios fijos, independientes de la adecuación de la utilización o del resultado final en condiciones de efectividad, pueden dar lugar a decisiones ineficientes. Recientemente, los acuerdos de riesgo compartido han aparecido como nuevos esquemas de acceso basados en resultados cuyo objetivo es reducir la incertidumbre de los diferentes agentes implicados, buscando un acuerdo en materia de financiación y de condiciones de uso de una tecnología sanitaria. Como elementos centrales del debate sobre su utilización se encuentran la variedad de instrumentos (de especial interés aquellos basados en resultados), las implicaciones para los distintos agentes involucrados en su diseño, y la supervisión y su posible aplicación en nuestro país. Como conclusión principal, los acuerdos de riesgo compartido deberían de ser unos esquemas de acceso al mercado a utilizar en casos muy concretos, cuando las condiciones estándar de acceso no puedan ser aplicables debido a la incertidumbre de resultados a largo plazo en condiciones de efectividad. Asimismo, estas medidas no están orientadas sólo a regular el precio sino también a actuar sobre la adecuación en la utilización, si bien, dada la experiencia internacional, es pronto para llegar a una conclusión sólida sobre los resultados de su aplicación.AbstractThe incorporation of new treatments, procedures and technologies into the services’ portfolio of healthcare providers should aim to improve three areas equally: patient access to innovative solutions, the sustainability of the health system and compensation for innovation. However, traditional schemes based on fixed prices that fail to consider the product’s appropriacy of use or its results in terms of effectiveness may lead to inefficient decision-making processes. Recently, risk-sharing agreements have appeared as new access schemes based on results that aim to reduce the uncertainty of the distinct health care players involved in reaching an agreement on new health technology financing and conditions of use. Key elements in the debate on these instruments are the huge variety of instruments available (especially those based on results), the implications for different players involved in their design and supervision, and their possible implementation in Spain. Our main conclusion is that risk-sharing agreements should be used in highly limited cases when standard conditions of access cannot be applied due to uncertainty about long-term effectiveness. These measures are aimed not only at regulating price but also at acting on the appropriate use of new technology. However, because international experience is limited, drawing a solid conclusion on the final results of the application of risk-sharing agreements would be premature.

ResumenEste trabajo presenta una visión complementaria respecto a las últimas experiencias y avances en la evaluación económica de medicamentos en el mercado español. El contexto europeo y los recientes cambios normativos parecen favorecer la incorporación de la evaluación económica como una herramienta básica en el proceso de toma de decisiones sobre financiación pública de medicamentos. Sin embargo, aún persisten dudas sobre si el apoyo gubernamental será claro y explícito y sobre el papel que desempeñarán los decisores regionales y otros agentes sanitarios en este proceso.AbstractThis article presents a complementary view of the latest experiences and advances in the economic evaluation of medicines in the Spanish market. The European context and recent normative changes seem to favour the incorporation of economic evaluation of medicines as a basic tool in the decision-making process of public funding of drugs. However, some doubts remain about whether government support for economic evaluation of medicines will be open and explicit and about the role that regional decision-makers and other health actors will play in this process.

ResumenIntroducciónLa intensa entrada de inmigrantes acaecida en España desde mediados de los años 1990 supone un importante reto para la organización del sistema sanitario español. Una cuestión de gran relevancia es el conocimiento del estado de salud de esta nueva población. El objetivo del presente trabajo es estudiar la calidad de vida relacionada con la salud, centrándonos en población inmigrante en edad productiva (16–50 años).MétodosUtilizando los datos de la Encuesta de Salud de Cataluña del año 2006, empleamos modelos probits para estudiar las cinco dimensiones del instrumento genérico de Calidad de Vida Relacionado con la Salud EQ-5D (variables dependientes). Utilizamos como variables explicativas factores sociodemográficos, salud (enfermedades diagnosticadas, accidentes padecidos) y estilos de vida. El hecho de ser inmigrante se incorpora como variable explicativa en cada modelo probit para cada dimensión de la calidad de vida.ResultadosLas personas inmigrantes presentaron peores resultados en salud en las dimensiones relacionadas con dolor/malestar y ansiedad/depresión. Nuestros resultados indican diferencias entre mujeres y hombres inmigrantes respecto a las personas nativas, así como diferencias asociadas al país de nacimiento y al tiempo de permanencia en España.DiscusiónLos resultados indican una peor calidad de vida relacionada con la salud en la población inmigrante en edad productiva. Ello introduce matices relevantes en la hipótesis del «efecto inmigrante sano». Sin embargo, por la heterogeneidad del colectivo estudiado conviene matizar los resultados, dadas las diferencias encontradas según el país de nacimiento y el tiempo de permanencia en nuestro país.AbstractIntroductionThe intense wave of immigration to Spain since the mid-1990s has posed a major challenge to the organization of the Spanish health system. Consequently, knowledge of the health status of the new immigrant population is highly important. The aim of this study is to analyze health-related quality of life in the working-age (16–50 years) immigrant population.MethodsWe use data from the 2006 Catalan Health Survey and probit models to analyze each of the five dimensions of the EQ-5D, a generic health-related quality of life measure (dependent variables). As explanatory variables we use: (i) socio-demographic characteristics, (ii) health (diagnosed illnesses, accidents), and (iii) lifestyles. Immigrant status is included as an explanatory variable, and alternative probit models were used to analyze each of the dimensions of the quality of life instrument.ResultsImmigrant status is significantly associated with lower health status in the dimensions of pain/discomfort and anxiety/depression. Our results show that the differences between the immigrant and native-born population vary between men and women, and also depend on country of birth and length of residence in Spain.DiscussionThe results show that the working-age immigrant population has lower health-related quality of life. These results add a rider in the healthy immigrant effect hypothesis. However, there is substantial heterogeneity within the immigrant collective and thus other variables, such as country of birth and time since arrival in Spain, should be taken into account before reaching any final conclusions.

ResumenLa evaluación económica de tecnologías sanitarias (EETS) se ha convertido en una herramienta básica para ayudar en la toma de decisiones en materia de salud. El continuo desarrollo de aspectos metodológicos y su posible aplicación directa a la realidad de cada país la han situado como elemento importante en la agenda de los responsables sanitarios. Este artículo introduce los objetivos generales de la EETS y describe la experiencia de varios países europeos donde se emplean dichas técnicas para decidir si se implementa una tecnología sanitaria. A continuación se evalúa la situación de España y el papel que ejerce la EETS en estos momentos. Finalmente, se identifican tareas pendientes y se mencionan algunas recomendaciones para consolidar la EETS como herramienta fundamental en la toma de decisiones sanitarias.AbstractEconomic evaluation of health care technologies (EEHT) has become a basic tool in the decision-making process in health. The continuous development of methods and their direct application to reality have placed EEHT as a key item on the agenda of health policy makers across countries. The present article introduces the aims of EEHT and describes the experience of several European countries where economic evaluation studies are currently used to select the health technologies to be implemented. The role played by EEHT in Spain at the present time is then discussed. Finally, pressing tasks are identified and recommendations are made for the consolidation of EEHT as a basic element in the decision-making process of health care technologies.

ResumenLa evaluación económica de tecnologías sanitarias se ha convertido en los últimos años en Europa en una herramienta de primer orden para los gestores sanitarios en sus estrategias de asignación de recursos sanitarios y de adopción de nuevas tecnologías. España fue uno de los países pioneros en realizar propuestas de estandarización metodológica aplicable a estudios de evaluación económica. No obstante, la falta de decisión política y de apoyo de los gestores sanitarios a este tipo de herramientas hizo que las propuestas cayeran en desuso. Sin embargo, lo esperable es que a medio plazo sea cada vez más habitual que las nuevas tecnologías sanitarias financiadas por el Sistema Nacional de Salud deban aportar una adecuada evidencia de su valor terapéutico y social en comparación con su coste. Llegado ese momento, los actores del sistema requerirán una serie de reglas claras y consensuadas por parte de los agentes del sistema sobre las cuestiones técnicas o metodológicas que deben respetar los estudios de evaluación de tecnologías sanitarias. Por este motivo, las presentes recomendaciones orientan sobre cómo realizar y analizar los estudios de evaluación económica de calidad. Las recomendaciones aparecen bajo 17 encabezamientos o dominios, y bajo cada recomendación hay además un comentario, en el cual se justifican y discuten las propuestas en relación con otras opciones posibles.AbstractOver the last few years, economic evaluation of health technologies has become a major tool used by European health policy decision-makers to create strategies for prioritizing the allocation of health resources and the approval of new technologies. Spain was a pioneer in proposing the standardization of methodology applicable to economic evaluation studies. However, because health policy decision-makers refused to support the initiative, the methodology was never put into practice.In the medium term, evidence of the economic value of new health technologies financed by the national health system will probably be increasingly required. At that time, stakeholders and decision-makers will have to agree upon a clear and concise set of rules on the technical and methodological issues that must be followed by economic evaluations of health technologies. Consequently, we have provided guidelines and recommendations for producing first-rate economic evaluations. The recommendations appear under seventeen headings or sections. In each case, the recommended requirements to be satisfied by an economic evaluation of health technologies are provided and each recommendation is followed by a commentary, providing a justification and comparing and contrasting the proposal with other available alternatives.

Background: The aim of this study was to determine the social/economic costs and health-related quality of life (HRQOL) of patients with epidermolysis bullosa (EB) in eight EU member states. Methods: We conducted a cross-sectional study of patients with EB from Bulgaria, France, Germany, Hungary, Italy, Spain, Sweden and the United Kingdom. Data on demographic characteristics, health resource utilisation, informal care, labour productivity losses, and HRQOL were collected from the questionnaires completed by patients or their caregivers. HRQOL was measured with the EuroQol 5-domain (EQ-5D) questionnaire. Results: A total of 204 patients completed the questionnaire. Average annual costs varied from country to country, and ranged from €9509 to €49,233 (reference year 2012). Estimated direct healthcare costs ranged from €419 to €10,688; direct non-healthcare costs ranged from €7449 to €37,451 and labour productivity losses ranged from €0 to €7259. The average annual cost per patient across all countries was estimated at €31,390, out of which €5646 accounted for direct health costs (18.0 %), €23,483 accounted for direct non-healthcare costs (74.8 %), and €2261 accounted for indirect costs (7.2 %). Costs were shown to vary across patients with different disability but also between children and adults. The mean EQ-5D score for adult EB patients was estimated at between 0.49 and 0.71 and the mean EQ-5D visual analogue scale score was estimated at between 62 and 77. Conclusion: In addition to its negative impact on patient HRQOL, our study indicates the substantial social/economic burden of EB in Europe, attributable mostly to high direct non-healthcare costs. Supported by the social/economic burden and health-related quality of life in patients with rare diseases in Europe Project, which has received funding from the European Union within the framework of the Health Programme [Grant A101205]. The executive agency of the European Union is not responsible for any use that may be made of the information contained here. Sí

El planteamiento de Pinto et al1 es claro y refleja una posicion sabida, pero no siempre explicita, bien por resultar una verdad incomoda (el presupuesto cuenta, iy tanto!), bien por compleja en su expresion. Dos recientes propuestas

The HIV/AIDS disease represent a priority for all health authorities in all countries and it also represents serious added socioeconomic problems for societies over the world. The aim of this paper is to analize the economic impact associated to the HIV/AIDS in an European context. We conducted a systematic literature review for five different countries (France, Germany, Italy, Spain and United Kingdom) and searched five databases. Three types of analyses were undertaken: descriptive statistics; quantitative analysis to calculate mean costs; and comparison across countries. 26 papers were included in this study containing seventy-six cost estimates. Most of the studies analyzed the health care cost of treatment of HIV/AIDS. Only 50% of the cost estimates provided mean lymphocyte count describing the patients¿ disease stage. Approximately thirty percent of cost estimates did not indicate the developmental stage of the illness in the patients included. There is a high degree of variability in the estimated annual cost per patient of the treatments across countries. There is also a great disparity in total healh care costs for patients with lymphocyte counts between 200CD4+/mm3 and 500 CD4/mm3, although the reason of variation is unclear. In spite of the potential economic impact in terms of productivity losses and cost of formal and informal care, few studies have set out to estimate the non-medical costs of HIV/AIDS in the countries selected. Another important result is that, despite the low HIV/AIDS prevalence, its economic burden is very relevant in terms of the total health care costs in this five countries. This study also shows that there are relatively few studies of HIV costs in European countries compared to other diseases. Finally, we conclude that the methodology used in many of the studies carried out leaves ample room for improvement and that there is a need for these studies to reflect the economic impact of HIV/AIDS beyond health care including other components of social burden. The authors would like to acknowledge the support received from the research project ECON2013-48217-C2-2-R -Impacto económico, sanitario y social de las enfermedades y los problemas de salud: información y herramientas para la evaluacion de políticas públicas

Background Cerebrovascular diseases are the second leading cause of death worldwide and one of the health conditions which demand the highest level of social services. The aim of this study was to estimate the social cost of non-professional (informal) care provided to survivors of cerebrovascular accidents (CVA) with some type of disability in Spain. Methods We obtained data from the 2008 Survey on Disability, Independent Living and Dependency (EDAD-08) on the main characteristics of individuals who provide informal care to survivors of CVAs in Spain. We estimated the cost of substituting informal care in favor of formal care provided by professional caregivers (proxy good method) and performed a statistical analysis of the relationship between degree of dependency and number of care hours provided using ordinary least squares regression. Results The number of disabled people diagnosed with CVA totaled 1,975 (329,544 people when extrapolating to the national population using the elevation factor provided by EDAD-08). Of these, 1,221 individuals (192,611 people extrapolated to the national population) received at least one hour of informal care per week. The estimated hours of informal care provided in 2008 amounted to 852 million. The economic valuation of the time of informal care ranges from 6.53 billion euros (at 7.67 euros/hour) to 10.83 billion euros (when calculating each hour of care at 12.71 euros). The results of our statistical analysis highlight the importance of degree of dependency in explaining differences in the number of hours of informal care provided. Conclusions The results of our study reveal the high social cost of cerebrovascular accidents in Spain. In addition, evidence is presented of a correlation between higher degree of dependency in CVA survivors and greater number of hours of care received. An integral approach to care for CVA survivors requires that the caregivers’ role and needs be taken into account.