334 results on '"Coste-efectividad"'
Search Results
2. Cost-effectiveness of sodium zirconium cyclosilicate for the treatment of hyperkalemia in patients with chronic kidney disease or heart failure in Spain
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Roberto Alcázar-Arroyo, María G Crespo-Leiro, Jordi Bover, Juan Oliva, Miren Sequera-Mutiozabal, Simona Gradari, Anisia Martínez-López, Blanca López-Chicheri, Neus Vidal-Vilar, Susana Aceituno, and Marta Cobo
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Coste-efectividad ,Ciclosilicato de sodio y zirconio ,Hiperpotasemia ,Enfermedad renal crónica ,Insuficiencia cardíaca ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Background and objective: Hyperkalemia (HK) is an electrolyte disturbance in the concentration of potassium ions (K+), whose risk increases in patients with chronic kidney disease (CKD) or heart failure (HF) and/or in patients being treated with renin–angiotensin–aldosterone system inhibitors (RAASi). The new oral K+ chelators offer a safe and effective treatment to maintain normokalemia in these patients. The objective of the analysis is to estimate the cost-effectiveness of sodium zirconium cyclosilicate (SZC) for the treatment of chronic HK in patients with CKD or HF versus standard treatment (calcium polystyrene sulfonate and lifestyle modifications) from the perspective of the Spanish National Health System. Materials and methods: Two microsimulation models reflecting the natural history of CKD and HF were used. In both models, K+ levels were simulated individually. Based on efficacy (reduction of K+ levels), quality of life of patients (utilities according to health states, and disutilities of events derived from each pathology and adverse events [AEs] of treatment) and costs considered (cost of treatment for HK, of RAASi treatment and its modification, health states, management of events derived from each pathology, HK episodes, and AEs treatment) (, 2022), clinical benefit (quality-adjusted life years [QALYs]) and cost results were obtained. A time horizon of the patient’s lifetime was used and a discount rate of 3% was applied for costs and outcomes. Results: SZC is a more effective option in both pathologies, with a difference in QALYs of 0.476 in CKD and 0.978 in HF compared to standard treatment, and it represents an incremental cost of 3,616 and 14,749, respectively, obtaining an incremental cost-utility ratio of 7,605/QALY in CKD and 15,078/QALY in HF. Conclusions: SZC is a cost-effective alternative for the treatment of HK in patients with CKD or HF, taking into account the reference efficiency values commonly used in Spain. Resumen: Antecedentes y objetivo: La hiperpotasemia (HK) es una alteración electrolítica en la concentración de iones potasio (K+), cuyo riesgo aumenta en pacientes con enfermedad renal crónica (ERC) o insuficiencia cardiaca (IC) y/o en pacientes en tratamiento con inhibidores del sistema renina-angiotensina-aldosterona (iSRAA). Los nuevos quelantes orales de K+ ofrecen un tratamiento seguro y eficaz para mantener la normopotasemia en estos pacientes. El objetivo del análisis es estimar el coste-efectividad del ciclosilicato de sodio y zirconio (CSZ) para el tratamiento de la HK crónica en pacientes con ERC o IC frente al tratamiento estándar (poliestireno sulfonato cálcico y modificaciones del estilo de vida) desde la perspectiva del Sistema Nacional de Salud (SNS) español. Materiales y métodos: Se utilizaron dos modelos de microsimulación que reflejan la historia natural de la ERC y de la IC. En ambos modelos se realizó una simulación de forma individual de los niveles de K+. En base a la eficacia (reducción de los niveles de K+), la calidad de vida de los pacientes (utilidades según estado de salud, y disutilidades de los eventos derivados de cada patología y los eventos adversos [EA] del tratamiento) y a los costes contemplados (coste del tratamiento para la HK, del tratamiento con iSRAA y su modificación, de los estados de salud, del manejo de los eventos derivados de cada patología, de los episodios de HK, y de los EA del tratamiento) (, 2022), se obtuvieron resultados de beneficio clínico (años de vida ajustados por calidad [AVAC]) y costes. Se empleó un horizonte temporal de toda la vida del paciente y se aplicó una tasa de descuento del 3% para costes y resultados. Resultados: El CSZ resulta una opción más efectiva en ambas patologías, con una diferencia de AVAC de 0,476 en ERC, y de 0,978 en IC frente al tratamiento estándar, y supone un coste incremental de 3.616 y 14.749 , respectivamente, obteniéndose un ratio coste-utilidad incremental (RCUI) de 7.605 /AVAC en ERC y 15.078 /AVAC en IC. Conclusiones: El CSZ es una alternativa con una buena relación coste-efectividad para el tratamiento de la HK en pacientes con ERC o IC, teniendo en cuenta los valores de eficiencia de referencia empleados habitualmente en España.
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- 2024
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3. Coste-efectividad del ciclosilicato de sodio y zirconio para el tratamiento de la hiperpotasemia en pacientes con enfermedad renal crónica o insuficiencia cardiaca en España.
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Alcázar-Arroyo, Roberto, Crespo-Leiro, Maria G., Bover, Jordi, Oliva, Juan, Sequera-Mutiozabal, Miren, Gradari, Simona, Marinez-Lopez, Anisia, Lopez-Chicheri, Blanca, Vidal-Vilar, Neus, Aceituno, Susana, and Cobo, Marta
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Copyright of Nefrologia is the property of Revista Nefrologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2024
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4. Lymphocyte-to-C-reactive protein ratio as a new biomarker for predicting mortality and morbidity in Fournier's gangrene.
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Yildirim, Murat, Gul, Sinan C., Angın, Yavuz S., Saglam, Alı I., Ozsoy, Ugur, Koca, Bulent, and Ozkan, Namik
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NEUTROPHIL lymphocyte ratio ,C-reactive protein ,BIOMARKERS ,FOURNIER gangrene ,MORTALITY - Abstract
Copyright of Cirugía y Cirujanos is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2024
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5. Evaluaciones económicas de intervenciones dirigidas a la prevención, tratamiento y/o rehabilitación de trastornos por consumo de alcohol: Una revisión sistemática.
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TRAPERO-BERTRAN, MARTA, GIL-DOMÉNECH, DOLORS, and MAGDALENA VARGAS-MARTÍNEZ, ANA
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ALCOHOLISM ,DRINKING age ,ECONOMIC databases ,SECONDARY prevention ,BREATH tests - Abstract
Copyright of Adicciones is the property of Sociedad Cientifica Espanola de Estudios sobre el Alcohol and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2023
6. A relação custo/efetividade de exames de imagem na eficiência do diagnóstico da covid.
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Borges Nunes Junior, Nivaldo, Barbosa Pacheco, Marcos Antônio, Rego Furtado, Poliana da Silva, Monteiro Borges, Lorena, Osterkamp Beserra, Stephanie Raissa, and Osterkamp Pedrozo Borges Nunes, Raquel Cristina
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CHEST X rays ,MEDICAL care costs ,QUANTITATIVE research ,COMPARATIVE studies ,COST effectiveness ,DESCRIPTIVE statistics ,COMPUTED tomography ,COVID-19 pandemic ,COMMUNITY-acquired pneumonia - Abstract
Copyright of Saúde Coletiva is the property of MPM Comunicacao and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2023
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7. A relação custo/efetividade de exames de imagem como parâmetro de eficiência em um serviço de saúde no diagnóstico da pneumonia comunitária adquirida.
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Borges Nunes Junior, Nivaldo and Barbosa Pacheco, Marcos Antônio
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MEDICAL economics ,LUNG radiography ,CHEST X rays ,HEALTH facilities ,MEDICAL care costs ,COST control ,TOMOGRAPHY ,COST effectiveness ,ORGANIZATIONAL effectiveness ,COMMUNITY-acquired pneumonia - Abstract
Copyright of Saúde Coletiva is the property of MPM Comunicacao and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2023
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8. EFECTOS Y COSTE-EFECTIVIDAD DE UNA INTERVENCIÓN A TRAVÉS DE INTERNET PARA CUIDADORES FAMILIARES DE ENFERMOS CON DEMENCIA: METODOLOGÍA DE UN PROGRAMA DE EJERCICIO PERSONALIZADO.
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Madruga, M., González-Guerrero, J. L., Rohlfs-Domínguez, P., and Gusi, N.
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CAREGIVERS ,QUALITY of life ,PSYCHOLOGICAL factors ,EXERCISE therapy ,SOCIAL impact ,PERSONAL trainers ,NURSING home residents - Abstract
Copyright of Journal of Sport & Health Research is the property of Journal of Sport & Health Research and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2023
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9. Cost-effectiveness analysis of subcutaneous biosimilar tocilizumab in patients with rheumatoid arthritis in Spain.
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Pérez-Ruiz F, Crespo-Diz C, Schoenenberger-Arnaiz JA, Cerezales M, Crespo C, Guigini MA, Peinado-Fabregat JI, and Climente-Martí M
- Abstract
Introduction: Rheumatoid arthritis (RA) is the most common chronic inflammatory rheumatic disease, its management and morbidity impose a great burden to healthcare systems. Development and rollout of biological disease modifying anti-rheumatic drugs has contributed to improvements for patients, however, high costs have prevented them to be widely used. This is being addressed with biosimilars, with equal benefit-risk profile and reduced costs. The objective is to analyze the cost-effectiveness of subcutaneous biosimilar tocilizumab (bsTCZ) for patients with moderate-severe RA in Spain from a healthcare system perspective., Methods: A Markov model was developed with a lifetime horizon including 5 health states: remission of the disease; low, moderate, or high activity; and death. A PICO-S-T search retrieved efficacy of treatments in meta-analysis and network meta-analysis, and was further complemented with published clinical trials. Pharmacological costs were obtained from the BotPlus database, and medical resources costs from regional tariffs. Deterministic and probabilistic sensitivity analysis were performed to validate the robustness of results. Incremental cost-effectiveness ratio (ICER) for cost/percentage of remission and cost/quality-adjusted life year (QALY) gain were calculated., Results: Lifetime cost of bsTCZ was 183 741€ (lowest) versus comparative costs ranging from 184 317€ for infliximab to 201 972€ (highest) for certolizumab. QALYs were 13.74 for upadacitinib and 13.73 for sarilumab and tocilizumab with values between 13.53 and 13.72 for the comparators. ICERs as €/remission and €/QALY showed that bsTCZ was either dominant in most of the comparisons or the most cost-effective alternative. The sensitivity analysis showed that bsTCZ long term cost, and transition from low to moderate disease activity health status were the most influential factors. Moreover, bsTCZ was either dominant or cost-effective in all the comparisons., Conclusions: bsTCZ demonstrated to be a cost-effective and cost-saving alternative for the treatment of patients with RA in Spain when compared to all the available therapeutic alternatives., Competing Interests: Declaration of competing interest FPR has earned advisory fees from protalix, horizon, arthrosis, and LG Pharma; speaker fees from Menarini, and Bioepis; and research grants from Asociación de Reumatólogos de Cruces. CCD has earned fees from: Abbvie, Almirall, Amgen, Biogen, Bristol Myers Squibb, Fresenius Kabi, Janssen-Cilag, Kern Pharma, Merck Sharp Done, Pfizer, Roche, UCB Pharma. JASA has earned fees from Fresenius Kabi and IQVIA. MC and CC are employees of Axentiva, a consulting firm that works for several pharmaceutical and medical devices companies. MAG and JIPF are employees of Fresenius Kabi Spain. MCM has earned fees from Abbvie, Fresenius Kabi, Janssen-Cilag, Kern Pharma, Leo-Pharma, Pfizer, and Roche., (Copyright © 2024. Publicado por Elsevier España, S.L.U.)
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- 2024
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10. Stratified cost-utility analysis of total hip arthroplasty in displaced femoral neck fracture
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Igor Larrañaga, Iñigo Etxebarria-Foronda, Oliver Ibarrondo, Ania Gorostiza, Cristina Ojeda-Thies, and Jose Miguel Martínez-Llorente
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Coste-efectividad ,Coste-utilidad ,Fractura de cuello de fémur desplazada ,Prótesis de cadera ,Prótesis de cadera total ,Hemiartroplastia ,Public aspects of medicine ,RA1-1270 - Abstract
Objective: To conduct a stratified cost-utility analysis of total versus partial hip arthroplasty as a function of clinical subtype. Method: All cases of this type of intervention were analysed between 2010 and 2016 in the Basque Health Service, gathering data on clinical outcomes and resource use to calculate the cost and utility in quality-adjusted life years (QALYs) at individual level. The statistical analysis included applying the propensity score to balance the groups, and seemingly unrelated regression models to calculate the incremental cost-utility ratio and plot the cost-effectiveness plane. The interaction between age group and American Society of Anesthesiologists (ASA) risk class was assessed in the multivariate analysis. Results: The study identified 5867 patients diagnosed with femoral neck fracture, of whom 1307 and 4560 were treated with total and partial hip arthroplasty, respectively. In the cost-utility analysis based on the seemingly unrelated regression, total hip arthroplasty was found to have a higher cost and higher utility (2465€ and 0.42 QALYs). Considering a willingness-to-pay threshold of €22,000 per QALY, total hip arthroplasty was cost-effective in the under-80-year-old subgroup. Among patients above this age, hemiarthroplasty was cost-effective in ASA class I-II patients and dominant in ASA class III-IV patients. Conclusions: Subgroup analysis supports current daily clinical practice in displaced femoral neck fractures, namely, using partial replacement in most patients and reserving total replacement for younger patients. Resumen: Objetivo: Realizar un análisis de coste-utilidad de la prótesis total de cadera frente a la prótesis parcial. Método: Se analizaron todos los casos intervenidos desde 2010 hasta 2016 en el Servicio Vasco de Salud, recogiendo resultados clínicos y uso de recursos para calcular individualmente el coste y la utilidad en años de vida ajustados por calidad (AVAC). El análisis estadístico incluyó el pareamiento por puntaje de propensión para balancear los grupos y modelos de regresión aparentemente no relacionados para calcular la razón de coste-utilidad incremental y el plano de coste-efectividad. La interacción de grupo de edad y riesgo según la American Society of Anesthesiologists (ASA) se incluyó en el análisis multivariante. Resultados: Se identificaron 1307 pacientes con prótesis total y 4560 con prótesis parcial. Al hacer el análisis de coste-utilidad con modelos de regresión aparentemente no relacionados el resultado fue mayor coste y mayor utilidad para la prótesis total (2465 € y 0,42 AVAC). Para un umbral de 22.000 € por AVAC, la prótesis total fue coste-efectiva en el subgrupo de menores de 80 años. En el grupo de mayores de 80 años la parcial fue coste-efectiva en los casos con riesgo ASA I-II y dominante en los ASA III-IV. Conclusiones: El análisis de subgrupos ratifica la práctica clínica habitual en las fracturas de cuello de fémur desplazadas de intervenir a la mayoría de los pacientes mediante prótesis parcial y reservar la prótesis total para los pacientes más jóvenes.
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- 2022
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11. Coste-efectividad de la terapia avanzada con productos de cura en ambiente húmedo comparada con terapia tradicional en el tratamiento de úlceras por presión de categorías I y II
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Mª del Carmen Pedraza Castañeda, Guillermina Pérez Jiménez, Laura Solís Flores, J Eduardo Barrera Arenas, Pablo Hernández Jiménez, Mª Virginia Xochigua Angulo, and Guillermo Meléndez Mier
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Coste-efectividad ,úlcera por presión ,análisis de coste ,enfermería ,Nursing ,RT1-120 - Abstract
RESUMEN Objetivo: Demostrar el coste-efectividad de la cura en ambiente húmedo (CAH) sobre la cura tradicional (CT) en pacientes hospitalizados con úlceras por presión (UPP) de categorías I y II. Metodología: Estudio longitudinal comparativo, aleatorizado, abierto, dividido en dos grupos, tratados y seguidos durante 4 semanas. El tamaño de la muestra se calculó con base en el metaanálisis de Heyer. Creamos un árbol de decisión para comparar el coste-efectividad de cada cura. Los datos se recopilaron directamente de los formularios de informes de casos de pacientes y los costes se extrajeron de los registros hospitalarios. Realizamos análisis de sensibilidad y costeefectividad incrementales. Resultados: El análisis mostró un dominio de la CAH sobre la CT (223,00€/0,84 vs. 298,00€/0,51), ya que fue más rentable al final del estudio. La hospitalización fue más corta en la CAH y la curación se logró en menos días que con la CT, lo que tiene un impacto en los costes relacionados con los tiempos de atención de enfermería, gasto de recursos materiales y días de hospitalización de los pacientes. Conclusiones: La CAH es más coste-efectiva que la CT cuando se aplica a pacientes hospitalizados con UPP de categorías I y II.
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- 2021
12. Análisis coste-efectividad de una vacuna para Helicobacter pylori en el sur de Europa
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Arcos Machancoses, Jose Vicente, Romero Prada, Martín, Crehuá Gaudiza, E., Martínez Costa, Cecilia, Arcos Machancoses, Jose Vicente, Romero Prada, Martín, Crehuá Gaudiza, E., and Martínez Costa, Cecilia
- Abstract
FUNDAMENTOS // Existen pruebas de la factibilidad de una vacuna para prevenir la infección por Helicobacter pylori. Modelizaciones en entornos de baja prevalencia informan de una muy probable coste-efectividad a largo plazo. El objetivo de este estudio fue cuantificar su eficiencia en un contexto local. MÉTODOS // Se simuló la evolución de una cohorte de nacidos a través de un modelo compartimental representativo de varios estados clínicos en relación a la infección por H. pylori. Se ejecutó dicho modelo bajo las premisas de vacunación en el periodo de lactante y de no intervención. El horizonte temporal fue equivalente a la esperanza de vida y se tuvo en cuenta la perspectiva del sistema de salud. RESULTADOS // La vacunación frente a H. pylori costaría de media 2.168 €/persona más que la no intervención. Con ello se obtendrían 0,32 años de vida ganados ajustados por calidad (AVAC), lo que implicaría una razón de coste-efectividad incremental (RCEI) media de 7.196 €/AVAC. Para una disposición a pagar de 24.506 €/AVAC, el 99,96% de las simulaciones resultaron coste-efectivas al alcanzar el horizonte temporal y se cruzó dicho umbral a partir de los treinta años de la vacunación. Las variables que más peso tuvieron para explicar la variabilidad de la RCEI fueron, en este orden, la efectividad vacunal, la incidencia de la infección en la primera infancia y el precio de la vacuna. La vacunación dejaría de ser coste-efectiva con un precio mayor de 3.634€/vial o con una cobertura poblacional efectiva menor del 11%. CONCLUSIONES // Una vacunación frente a la infección por H. pylori administrada en la infancia sería coste-efectiva a largo plazo en un entorno con las características epidemiológicas y económicas del sur de Europa.
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- 2024
13. A relação custo/efetividade de exames de imagem no diagnóstico da pneumonia comunitária adquirida.
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Junior, Nivaldo Borges Nunes, Nunes, Natalia Borges, and Pacheco, Marcos Antônio Barbosa
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X-rays ,SYSTEMATIC reviews ,RADIOGRAPHY ,COST effectiveness ,COMPUTED tomography ,COMMUNITY-acquired pneumonia - Abstract
Copyright of Saúde Coletiva is the property of MPM Comunicacao and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2022
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14. Cost-effectiveness of implantable cardioverter-defibrillators for primary prevention of sudden cardiac death.
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Ribera, Aida, Giménez, Emmanuel, Oristrell, Gerard, Osorio, Dimelza, Marsal, Josep Ramón, García-Pérez, Lidia, Ballesteros, Mónica, Ródenas, Eduard, Belahnech, Yassin, Escalona, Roxana, Rivas, Núria, Roca-Luque, Ivo, Ferreira-González, Ignacio, and Espallargues, Mireia
- Abstract
Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2022
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15. Coste-efectividad de la terapia avanzada con productos de cura en ambiente húmedo comparada con terapia tradicional en el tratamiento de úlceras por presión de categorías I y II.
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Pedraza Castañeda, Maria del Carmen, Pérez Jiménez, Guillermina, Solís Flores, Laura, Barrera Arenas, J. Eduardo, Hernández Jiménez, Pablo, Xochigua Angulo, Maria Virginia, and Meléndez Mier, Guillermo
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LENGTH of stay in hospitals ,WOUND healing ,ACQUISITION of data methodology ,PRESSURE ulcers ,MEDICAL care costs ,RANDOMIZED controlled trials ,COMPARATIVE studies ,COST effectiveness ,DESCRIPTIVE statistics ,MEDICAL records ,DATA analysis software ,SURGICAL dressings ,LONGITUDINAL method - Abstract
Copyright of Gerokomos is the property of Indemm Farma SL and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2021
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16. Is the universal population Hepatitis C virus screening a cost-effective strategy? A systematic review of the economic evidence.
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Ledesma, Francisco, Buti, María, Domínguez-Hernández, Raquel, Ángel Casado, Miguel, and Esteban, Rafael
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HEPATITIS C virus ,BABY boom generation ,IMMIGRANTS ,DIRECT costing - Abstract
Copyright of Revista Española de Quimioterapia is the property of Sociedad Espanola de Quimioterapia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2020
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17. Cirugía de las hernias: efectividad y coste para el sostenimiento del sistema sanitario.
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Vila y Blanco, Julio Miguel and González de Buitrago, Eva Jiménez
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Introduction: Hernias are very frequent pathologies in a General Surgery Service (GSS); its treatment and costs are very different, depending on the surgeon, if there is admission (SH) or major outpatient surgery (MOS). A) Main objective. Study costs of (non-pericolostomic) abdominal wall hernia surgical procedures in the GSC (cost-outcome ratio and the cost-efectiveness). Materials and Method: Descriptive, longitudinal, observational and retrospective study. Abdominal wall hernias treated between 1st October, 2015 and 30th September, 2016; after surgery follow up until 30th October, 2016 (1 to 12 months). In total 370 hernia surgeries were performed. Results: 79.4% of males, mean 59.95 years, 51.90% of ASA II, 55.8% local anesthesia, 59.72% inguinal hernias, 36.94% indirect unilateral inguinal hernias, 55.17 minutes for surgeon, 54.44% for MOS, 4.77 days of average stay in admitted patients. Perioperative complications 2.3%, early 4.8% (with 5 reoperations) and late 12.8% (3 reinterventions due to relapse). 95.41% discharge, mean time 6.59 weeks. Material costs vary from €109.87 (simple inguinal hernia) to €370.41 (eventrations). Median surgery room cost €338.80. Cost/day MOS €807.30 and with income €1056.03. Median cost of simple inguinal hernia €422.69 and eventration €709.89. Median cost due to inguinal hernia complication €1405.81 and eventration €8350.88. Median cost per process MOS € 1213.98 and that of SH €3689.80. Conclusion: The interventions of simple unilateral inguinal hernia, crural and umbilical, using a tension-free technique, prosthetic material, without drainage, MOS, local anesthesia (with/without sedation) and without complications are the most cost-effective (better cost-benefit and cost-effectiveness ratio). [ABSTRACT FROM AUTHOR]
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- 2020
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18. Beneficio económico del tratamiento dietético-nutricional en el equipo multidisciplinario de atención primaria.
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Casas-Agustench, Patricia, Megias-Rangil, Isabel, Babio, Nancy, and Megías-Rangil, Isabel
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PRIMARY care , *RANDOMIZED controlled trials , *CARDIOVASCULAR diseases risk factors , *TYPE 2 diabetes , *MALNUTRITION , *REDUCING diets , *SYSTEMATIC reviews , *PRIMARY health care , *DIET therapy , *COST effectiveness , *HEALTH care teams , *DIETETICS - Abstract
Introduction: Chronic diseases and aging are placing an ever increasing burden on healthcare services worldwide. Nutritional counselling is a priority for primary care because it has shown substantial cost savings. This review aims to evaluate the evidence of the cost-effectiveness of nutritional care in primary care provided by health professionals. A literature search was conducted using PubMed/MEDLINE between January 2000 and February 2019. The review included thirty-six randomized controlled trials (RCTs) and systematic reviews conducted in healthy people and people with obesity, type-2 diabetes mellitus, cardiovascular risk or malnutrition. All the RCTs and reviews showed that nutritional intervention led by dietitians-nutritionists in people with obesity or cardiovascular risk factors was cost-effective. Dietary interventions led by nurses were cost-effective in people who needed to lose weight but not in people at high cardiovascular risk. Some dietary changes led by a primary care team in people with diabetes were cost-effective. Incorporating dietitians-nutritionists into primary care settings, or increasing their presence, would give people access to the healthcare professionals who are best qualified to carry out nutritional treatment, and may be the most cost-effective intervention in terms of health expenditure. Notwithstanding the limitations described, this review suggests that incorporating dietitians-nutritionists into primary health care as part of the multidisciplinary team could be regarded as an investment in health. Even so, more research is required to confirm the conclusions. [ABSTRACT FROM AUTHOR]- Published
- 2020
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19. Cost‐effectiveness and cost‐utility analyses of a web‐based computer‐tailored intervention for prevention of binge drinking among Spanish adolescents
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Ana Magdalena Vargas-Martínez, Marta Lima-Serrano, and Marta Trapero-Bertran
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Coste-efectividad ,Cost effectiveness ,España ,Binge drinking ,Medicine (miscellaneous) ,Adolescents ,Toxicology ,Environmental health ,Web application ,Espanya ,Adolescentes ,health care economics and organizations ,Cost-utility ,Cost–utility analysis ,business.industry ,Cost-efectivitat ,Tailored Intervention ,Cost-utilitat ,Psychiatry and Mental health ,Spain ,Coste-utilidad ,Cost-effectiveness ,Alcohol ,business ,Psychology ,Consum excessiu - Abstract
BackgroundWorldwide, binge drinking (BD) today follows being a public health concern among adolescents. This study sought to assess the cost-effectiveness and cost-utility of a web-based computer-tailored intervention to prevent BD in adolescence.MethodsThe sample was drawn from a study evaluating the Alerta Alcohol programme. The population consisted of adolescents aged 15–19. Decision tree analysis was used to estimate costs and health outcomes, as measured by number of BD occasions and quality-adjusted life years (QALYs). Incremental Cost-Effectiveness and Cost-Utility Ratios were also calculated from National Health Service (NHS) and societal perspective and for a time horizon of four months. Multivariate deterministic sensitivity analysis of best/worst scenarios by subgroups was used to account for uncertainty.ResultsThe intervention was dominant from the societal perspective resulting in savings of €7,986.37 by one BD occasion averted per month. With regard to Incremental Cost-Utility Ratios, the intervention resulted in an incremental cost of €71.05 per QALY gained from NHS perspective and this was dominant, from societal perspective, resulting in savings of €34,126.64 per QALY gained in comparison with the control group. Subgroup analyses showed that the intervention resulted dominant for girls from both perspectives, and for those who were older (17 years or more) from NHS perspective.ConclusionComputer-tailored feedback is a cost-effective way to reduce BD and to increase QALYs among adolescents. However, long-term follow-up would probably be needed to capture major changes both in reduction of BD and in increasing of health-related quality of life.Trial registration(ClinicalTrials.gov): NCT03288896. Registration date: September 20, 2017. “Retrospectively registered”.
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- 2023
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20. Potencial sesgo de patrocinio en los análisis coste-efectividad de intervenciones sanitarias: un análisis transversal
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Ferrán Catalá-López and Manuel Ridao
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Coste-efectividad ,Sesgo ,Años de vida ajustados por calidad ,España ,Medicine (General) ,R5-920 - Abstract
Objetivo: Examinar la relación entre la fuente de financiación de los análisis coste-efectividad de intervenciones sanitarias publicados en España y las conclusiones de los estudios. Diseño: Estudio descriptivo transversal. Emplazamiento: Bases de datos de literatura científica (hasta diciembre de 2014). Participantes (unidad de análisis): Cohorte de análisis coste-efectividad de intervenciones sanitarias publicados en España entre 1989-2014 (n = 223) que presentaran como medida de resultado los años de vida ajustados por calidad (AVAC). Mediciones principales: Se establecieron relaciones entre las conclusiones cualitativas de los estudios y el tipo de fuente de financiación utilizando la prueba exacta de Fisher en tablas de contingencia. Se exploraron las distribuciones de las estimaciones de las razones coste-efectividad incremental por fuente de financiación en relación a umbrales hipotéticos de disposición a pagar entre 30.000-50.000 € por AVAC. Resultados: Un total de 136 (61,0%) estudios fueron financiados por la industria. Los estudios financiados por la industria eran menos propensos a presentar conclusiones desfavorables o neutrales que los estudios no financiados por la industria (2,2% frente al 23,0%; p
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- 2017
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21. Análisis de costes del programa integrado de tratamiento renal sustitutivo en la provincia de Toledo (2012-2013)
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José L. Conde Olasagasti, José Eugenio Garcia Diaz, Pilar Carrasco Benitez, Miguel Ángel Mareque Ruiz, María Pilar Parras Partido, Inmaculada Moreno Alia, Laura Jimenez Lopez, Juan José Cia Lecumberri, Pilar Araque, and María Luisa Fernandez
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Tratamiento renal sustitutivo ,Análisis de costes ,Coste-efectividad ,Evaluación económica ,Economía de la salud ,Hemodiálisis ,Diálisis peritoneal ,Trasplante renal ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Introducción: El coste ocasionado por los programas de tratamiento renal sustitutivo (TRS) es objeto de análisis permanente en busca de su eficiencia y sostenibilidad. Objetivo: Calcular el coste directo de la atención a la población prevalente en TRS en Toledo en los años 2012 y 2013. Método: a) Población: Todos los pacientes prevalentes en algún momento en TRS en 2012 (669) y en 2013 (682). b) Componentes del coste (€): 1) procedimiento de diálisis; 2) atención hospitalaria: ingresos, consultas, procedimientos ambulatorios y urgencias; 3) consumo de fármacos; 4) transporte. c) Cálculo y análisis: para cada uno de esos componentes se calculó el coste agregado localizado o reconstruido a partir del coste individual de cada paciente. Se calculó el coste anual y el coste paciente/año del TRS y de cada uno de sus subprogramas (€). Resultados: a) Costes agregados: el coste anual fue de 15,84 (2012) y de 15,77 millones de euros (2013). Los procedimientos de diálisis representan el 40,2% y la atención hospitalaria más el consumo de fármacos, el 41,5%. La atención a los pacientes en hemodiálisis hospitalaria (HDH) y concertada (HDC), diálisis peritoneal (DP) y trasplantados (Tx) representan, respectivamente, el 70,0; el 5,0 y el 25,0% del total. b) Coste paciente/año: considerando el número de pacientes/año proporcionado por cada subprograma, se obtuvieron los siguientes valores en 2012/2013: para todo TRS 26.130/25.379; HDH 49.167/53.289; HDC 44.657/44.971; DP 45.538/51.869 y Tx 10.909/10.984. Conclusiones: Nuestros resultados son consistentes con otros publicados, aunque arrojan valores paciente/año ligeramente superiores, debido a que incluyen elementos como farmacia extrahospitalaria, carga hospitalaria y transporte sanitario. La contribución creciente del Tx a la sobrevida del conjunto de la población en TRS contiene los costes globales y reduce el coste paciente/año, lo que hace sostenible el TRS.
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- 2017
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22. Cost-effectiveness and cost-utility study of a psychoeducational group intervention for people with depression and physical comorbidity in primary care.
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Raya-Tena A, Fernández-San-Martín MI, Martín-Royo J, Casajuana-Closas M, and Jiménez-Herrera MF
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- Humans, Female, Male, Middle Aged, Aged, Patient Education as Topic economics, Psychotherapy, Group economics, Quality of Life, Comorbidity, Quality-Adjusted Life Years, Cost-Benefit Analysis, Primary Health Care economics, Depression therapy, Depression epidemiology
- Abstract
Objective: To evaluate the cost-effectiveness and cost-utility of a psychoeducational group intervention led by primary care (PC) nurses in relation to customary care to prevent the depression and improve quality of life in patients with physical comorbidity., Design: Economic evaluation based on data from randomized, multicenter clinical trial with blind response variables and a one-year follow-up, carried in the context of the PSICODEP study., Location: 7 PC teams from Catalonia., Participants: >50 year-old patients with depression and some physical comorbidity: diabetes mellitus type 2, ischemic heart disease, chronic obstructive pulmonary disease, and/or asthma., Intervention: 12 psychoeducational group sessions, 1 per week, led by 2 PC nurses with prior training., Measurements: Effectiveness: depression-free days (DFD) calculated from the BDI-II and quality-adjusted life years (QALYs) from the Euroqol-5D. Direct costs: PC visits, mental health, emergencies and hospitalizations, drugs. Indirect costs: days of temporary disability (TD). The incremental cost-effectiveness ratios (ICER), cost-effectiveness (ΔCost/ΔDLD) and cost-utility (ΔCost/ΔQALY) were estimated., Results: The study includes 380 patients (intervention group [IG] = 204; control group [CG] = 176). 81.6% women; mean age 68.4 (SD = 8.8). The IG had a higher mean cost of visits, less of hospitalizations and less TD than the CG. The difference in costs between the IG and the CG was -357.95€ (95% CI: -2026.96 to 1311.06) at one year of follow-up. There was a mean of 11.95 (95% CI: -15.98 to 39.88) more DFD in the IG than in the CG. QALYs were similar (difference -0.01, 95% CI -0.04 to 0.05). The ICERs were 29.95€/DLD and 35,795€/QALY., Conclusions: Psychoeducational intervention is associated with an improvement in DFD, as well as a reduction in costs at 12 months, although not significantly. QALYs were very similar between groups., (Copyright © 2024 Elsevier España, S.L.U. All rights reserved.)
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- 2024
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23. Seroprevalence of measles, mumps, rubella, and varicella zoster virus antibodies among healthcare students: analysis of vaccine efficacy and cost-effectiveness.
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Ödemiş, İlker, Köse, Şükran, Akbulut, İlkay, and Albayrak, Hazal
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SEROPREVALENCE ,MUMPS vaccines ,MEASLES vaccines ,VACCINATION ,RUBELLA vaccines ,VARICELLA-zoster virus ,VACCINE effectiveness ,COST effectiveness ,MEDICAL students - Abstract
Copyright of Revista Española de Quimioterapia is the property of Sociedad Espanola de Quimioterapia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2019
24. Análisis coste-utilidad con datos de vida real de los nuevos tratamientos con anticuerpos monoclonales en la profilaxis de migraña
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Tirado Escuder, Elena
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Cost-utility ,ECONOMIA APLICADA ,Coste-efectividad ,Modelo de Markov ,AVAC ,Efficiency ,Markov model ,QALY ,Eficiencia ,Grado en Ingeniería Biomédica-Grau en Enginyeria Biomèdica ,Anticuerpos monoclonales ,Coste-utilidad ,Monoclonal antibodies ,Cost-effectiveness ,ECONOMIA FINANCIERA Y CONTABILIDAD ,Migraña ,Migraine - Abstract
[ES] Las cefaleas son un importante problema sociosanitario por sus implicaciones en la calidad de vida de los pacientes, el coste económico derivado de su elevada incapacidad, el diagnóstico complejo y la elevada prevalencia a nivel mundial. Suele presentar un diagnóstico difícil, ya que se asocian síntomas complejos y distintos en cada paciente, y suele padecerse junto con otras enfermedades. La migraña se presenta como la cefalea primaria más comúnmente conocida y es considerada la segunda cefalea más frecuente, aunque en consulta es la enfermedad neurológica más recurrente por presentar sintomatología más intensa. La evolución de la patología demuestra un aumento del gasto anual que se puede relacionar con la administración de nuevos tratamientos ventajosos caros, así como la ausencia de un diagnóstico claro que conlleva la realización de pruebas complementarias. Por ello, resulta interesante evaluar la eficiencia de estas nuevas opciones farmacológicas mediante evaluaciones sociosanitarias. Se pretende realizar un análisis coste-utilidad de los tratamientos monoclonales para el tratamiento de la migraña en varios hospitales de la Comunidad Valenciana; basado en un estudio observacional, analítico, retrospectivo, de base individual con uso de real world data (RWD). El Erenumab, Galcanezumab y Fremanezumab son las nuevas propuestas de tratamiento preventivo de la migraña, anticuerpos monoclonales que pertenecen a una nueva familia de medicamentos antimigrañosos dirigidos al receptor del péptido relacionado con el gen de la calcitonina. Estudios realizados ya han demostrado eficacia de estos medicamentos, puesto que reduce la frecuencia de la migraña, uno de los objetivos del tratamiento preventivo. Por este motivo, el presente trabajo tiene como objetivo realizar un análisis coste-utilidad de los nuevos tratamientos monoclonales, evaluando la eficiencia y computando los costes. Se emplearán los datos extraídos de las bases de datos de la farmacia hospitalaria y de la consulta de atención primaria, que generarán una nueva fuente que se construirá a partir de la información recogida de los pacientes del Hospital General de Valencia, de Alcoy y de Elda, a través de distintos sistemas corporativos de la Conselleria de Sanitat Universal i Salut. La práctica clínica demuestra que el empleo de los tratamientos monoclonales es costo-efectivos para aquellos pacientes en los que otros tratamientos han fallado previamente. Se pretende describir el uso anticuerpos monoclonales en pacientes con migraña teniendo en cuenta las variables edad y sexo, analizar la efectividad mediante las variables principales que son la frecuencia de días de migraña mensuales (MMD) experimentada por los pacientes y la tasa de respondedores (reducción del 50% de los días de migraña al mes) a través de un análisis coste-utilidad, ACU, con los tratamientos con anticuerpos monoclonales frente al comparador (toxina botulínica). Se calculará la razón de coste-efectividad incremental (ICER) y la medida de utilidad se realizará mediante los años de vida ajustados por calidad (AVACs o QALYs). Para cada tipo de tratamiento se calcularán los costes medios del periodo de análisis, que incluyen: coste del tratamiento, coste de las vistas de seguimiento, coste de posibles ingresos hospitalarios. El trabajo se va a basar en diseñar un modelo de Markov para evaluar la utilidad de las distintas alternativas de tratamiento preventivo seleccionadas para la migraña, en obtener la ratio coste-utilidad (resultado del análisis) y realizar un análisis de sensibilidad probabilístico que emplea la incertidumbre como parte del cálculo., [EN] Headaches are an important social and health problem due to their implications in the quality of life of patients, the economic cost derived from their high disability, the complex diagnosis and the high prevalence worldwide. It usually presents a difficult diagnosis, since complex and different symptoms are associated in each patient, and it usually suffers along with other diseases. Migraine is the most commonly known primary headache and is considered the second most frequent headache, although in consultation it is the most recurrent neurological disease due to presenting more intense symptoms. The evolution of the pathology shows an increase in annual expenditure that can be related to the administration of new expensive advantageous treatments, as well as the absence of a clear diagnosis that leads to additional tests. For this reason, it is interesting to evaluate the efficiency of these new pharmacological options through social and health evaluations. It is intended to carry out a cost-utility analysis of monoclonal treatments for the treatment of migraine in several hospitals in the Valencian Community; based on an observational, analytical, retrospective, individual-based study using real world data (RWD). Erenumab, Galcanezumab and Fremanezumab are the new proposals for preventive treatment of migraine, monoclonal antibodies that belong to a new family of antimigraine drugs directed at the peptide receptor related to the calcitonin gene. Studies have already shown the efficacy of these medications, since they reduce the frequency of migraines, one of the objectives of preventive treatment. For this reason, the present work aims to carry out a cost-utility analysis of the new monoclonal treatments, evaluating the efficiency and computing the costs. The data extracted from the databases of the hospital pharmacy and the primary care consultation will be used, which will generate a new source that will be built from the information collected from the patients of the General Hospital of Valencia, Alcoy and Elda. , through different corporate systems of the Conselleria de Sanitat Universal i Salut. Clinical practice shows that the use of monoclonal treatments is cost-effective for those patients in whom other treatments have previously failed. The aim is to describe the use of monoclonal antibodies in patients with migraine, taking into account the variables of age and sex, to analyze the effectiveness through the main variables, which are the frequency of monthly migraine days (MMD) experienced by patients and the rate of responders (reduced 50% of migraine days per month) through a cost-utility analysis, ACU, with treatments with monoclonal antibodies versus the comparator (botulinum toxin). The incremental cost-effectiveness ratio (ICER) will be calculated and the utility will be measured using quality-adjusted life years (QALYs or QALYs). For each type of treatment, the average costs of the analysis period will be calculated, including: treatment cost, cost of follow-up visits, cost of possible hospital admissions. The work will be based on designing a Markov model to evaluate the usefulness of the different preventive treatment alternatives selected for migraine, obtaining the cost-utility ratio (result of the analysis) and performing a probabilistic sensitivity analysis that uses the uncertainty as part of the calculation.
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- 2023
25. Stratified cost-utility analysis of total hip arthroplasty in displaced femoral neck fracture
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I. Etxebarria-Foronda, Ania Gorostiza, Igor Larrañaga, José Miguel Martinez-Llorente, Cristina Ojeda-Thies, and Oliver Ibarrondo
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medicine.medical_specialty ,Multivariate analysis ,Coste-efectividad ,Arthroplasty, Replacement, Hip ,Cost-Benefit Analysis ,Prótesis de cadera total ,Subgroup analysis ,Seemingly unrelated regressions ,Femoral Neck Fractures ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,Humans ,030212 general & internal medicine ,Prótesis de cadera ,Femoral neck ,Cost–utility analysis ,Cost-utility ,business.industry ,030503 health policy & services ,Public Health, Environmental and Occupational Health ,Hip replacement ,Surgery ,Fractura de cuello de fémur desplazada ,medicine.anatomical_structure ,Displaced femoral neck ,Treatment Outcome ,Propensity score matching ,Hemiartroplastia ,Coste-utilidad ,Cost-effectiveness ,Total hip arthroplasty ,Hemiarthroplasty ,Quality-Adjusted Life Years ,Public aspects of medicine ,RA1-1270 ,0305 other medical science ,business - Abstract
Objective: To conduct a stratified cost-utility analysis of total versus partial hip arthroplasty as a function of clinical subtype. Method: All cases of this type of intervention were analysed between 2010 and 2016 in the Basque Health Service, gathering data on clinical outcomes and resource use to calculate the cost and utility in quality-adjusted life years (QALYs) at individual level. The statistical analysis included applying the propensity score to balance the groups, and seemingly unrelated regression models to calculate the incremental cost-utility ratio and plot the cost-effectiveness plane. The interaction between age group and American Society of Anesthesiologists (ASA) risk class was assessed in the multivariate analysis. Results: The study identified 5867 patients diagnosed with femoral neck fracture, of whom 1307 and 4560 were treated with total and partial hip arthroplasty, respectively. In the cost-utility analysis based on the seemingly unrelated regression, total hip arthroplasty was found to have a higher cost and higher utility (2465€ and 0.42 QALYs). Considering a willingness-to-pay threshold of €22,000 per QALY, total hip arthroplasty was cost-effective in the under-80-year-old subgroup. Among patients above this age, hemiarthroplasty was cost-effective in ASA class I-II patients and dominant in ASA class III-IV patients. Conclusions: Subgroup analysis supports current daily clinical practice in displaced femoral neck fractures, namely, using partial replacement in most patients and reserving total replacement for younger patients. Resumen: Objetivo: Realizar un análisis de coste-utilidad de la prótesis total de cadera frente a la prótesis parcial. Método: Se analizaron todos los casos intervenidos desde 2010 hasta 2016 en el Servicio Vasco de Salud, recogiendo resultados clínicos y uso de recursos para calcular individualmente el coste y la utilidad en años de vida ajustados por calidad (AVAC). El análisis estadístico incluyó el pareamiento por puntaje de propensión para balancear los grupos y modelos de regresión aparentemente no relacionados para calcular la razón de coste-utilidad incremental y el plano de coste-efectividad. La interacción de grupo de edad y riesgo según la American Society of Anesthesiologists (ASA) se incluyó en el análisis multivariante. Resultados: Se identificaron 1307 pacientes con prótesis total y 4560 con prótesis parcial. Al hacer el análisis de coste-utilidad con modelos de regresión aparentemente no relacionados el resultado fue mayor coste y mayor utilidad para la prótesis total (2465 € y 0,42 AVAC). Para un umbral de 22.000 € por AVAC, la prótesis total fue coste-efectiva en el subgrupo de menores de 80 años. En el grupo de mayores de 80 años la parcial fue coste-efectiva en los casos con riesgo ASA I-II y dominante en los ASA III-IV. Conclusiones: El análisis de subgrupos ratifica la práctica clínica habitual en las fracturas de cuello de fémur desplazadas de intervenir a la mayoría de los pacientes mediante prótesis parcial y reservar la prótesis total para los pacientes más jóvenes.
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- 2022
26. Start-up of a Cardiology Day Hospital: Activity, Quality Care and Cost-effectiveness Analysis of the First Year of Operation.
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Gallego-Delgado, María, Villacorta, Eduardo, Valenzuela-Vicente, M. Carmen, Walias-Sánchez, Ángela, Ávila, Carmen, Velasco-Cañedo, M. Jesús, Cano-Mozo, M. Teresa, Martín-García, Agustín, García-Sánchez, María Jesús, Sánchez, Argelina, Cascón, Manuel, and Sánchez, Pedro L.
- Abstract
Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2019
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27. Coste-efectividad de la utilización de la tirotropina recombinante humana previa a la ablación con radioyodo en el tratamiento del cáncer de tiroides en hospitales españoles.
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Vallejo, J.A. and Muros, M.A.
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Resumen Objetivos Previo a la ablación con radioyodo en el tratamiento del cáncer de tiroides, se necesita aumentar los niveles de tirotropina (TSH) mediante estimulación exógena (con tirotropina humana recombinante [rhTSH]) o endógena, retirando la terapia con hormona tiroidea (THW). La utilización de rhTSH evita el hipotiroidismo y favorece la eliminación posterior de radioyodo pero supone un coste del producto. Por tanto, era necesario realizar un análisis de coste-efectividad que tuviera en cuenta todos los costes y los beneficios de la utilización de esta terapia. Material y métodos Mediante un modelo de Markov con 2 brazos de análisis (rhTSH y THW), estratificado en dosis altas (100 mCi/3.700 MBq) y bajas (30 mCi/1.110 MBq) de radioyodo, y utilizando 17 ciclos semanales se determinó el coste incremental por años de vida ajustados por calidad (AVAC) asociados a la utilización de rhTSH. Los parámetros clínicos incluidos en el modelo se basan en estudios publicados y en una encuesta realizada en España. Resultados La preparación con rhTSH para la radioablación es superior a la THW, presentando beneficios adicionales (0,048 AVAC) a la vez que un ahorro en costes (–614,16 €), con un ratio de coste-efectividad incremental (ICER) de –12.795 €/AVAC. Los análisis de sensibilidad univariantes y multivariantes demuestran que el resultado es consistente. Conclusiones La utilización de rhTSH previa a la radioablación en España supone un ahorro de costes a la vez que una serie de beneficios de salud para el paciente, por lo que es altamente coste-efectiva. Objectives In thyroid cancer treatment, the thyroid-stimulating hormone (TSH) must be elevated before radioiodine ablation, either by exogenous (with recombinant human thyrotropin [rhTSH]) or endogenous stimulation by thyroid hormone withdrawal (THW). The use of rhTSH avoids hypothyroidism and favours the subsequent elimination of radioiodine, but involves the cost of the product. For this reason, a cost-effectiveness analysis was performed, taking into account all costs involved and the benefits associated with the use of this therapy. Material and methods Using a Markov modelling with two analysis arms (rhTSH and THW), stratified into high (100 mCi/3700 MBq) and low (30 mCi/1110 MBq) radioiodine doses, and using 17 weekly cycles, the incremental cost per quality-adjusted life-year (QALY) related to the use of rhTSH was determined. The clinical inputs included in the model were based on published studies and in a treatment survey conducted in Spain. Results Radioablation preparation with rhTSH is superior to THW, showing additional benefits (0.048 AVAC), as well as cost savings (–€614.16), with an incremental cost-effectiveness rate (ICER) of –€12,795/QALY. The univariate and multivariate sensitivity analyses showed the result to be robust. Conclusions The use of rhTSH previous to radioablation in Spain has cost savings, as well as a series of health benefits for the patient, making it highly cost-effective. [ABSTRACT FROM AUTHOR]
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- 2017
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28. Clinical and Economic Impact of a Multisciplinary Intervention to Reduce Bleeding Risk in Patients With Acute Coronary Syndrome.
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de Lorenzo-Pinto, Ana, Herranz-Alonso, Ana, Cuéllar-Basterrechea, Begoña, Bellón-Cano, José María, Sanjurjo-Sáez, María, and Bueno, Héctor
- Abstract
Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2017
- Full Text
- View/download PDF
29. Análisis de costes del programa integrado de tratamiento renal sustitutivo en la provincia de Toledo (2012-2013).
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Conde Olasagasti, José L., Garcia Diaz, José Eugenio, Carrasco Benitez, Pilar, Mareque Ruiz, Miguel Ángel, Parras Partido, María Pilar, Moreno Alia, Inmaculada, Jimenez Lopez, Laura, Cia Lecumberri, Juan José, Araque, Pilar, and Luisa Fernandez, María
- Abstract
Copyright of Nefrologia is the property of Revista Nefrologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2017
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30. Percutaneous ethanol injection in thyroid nodular pathology and metastatic cervical adenopathies: A systematic review, meta-analysis and economic evaluation.
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León-Salas B, Hernández-Yumar A, Infante-Ventura D, de Armas Castellano A, González Hernández Y, Linertová R, Téllez Santana T, de Pablos-Velasco P, and Trujillo-Martín MM
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- Humans, Cost-Benefit Analysis, Ethanol therapeutic use, Thyroid Nodule pathology, Catheter Ablation methods, Lymphadenopathy drug therapy, Lymphadenopathy surgery
- Abstract
Background: Percutaneous ethanol injection (PEI) has been shown to be a valuable treatment for thyroid nodular pathology and metastatic cervical adenopathies., Objective: To evaluate the effectiveness, safety, and cost-effectiveness of PEI in thyroid nodular pathology and metastatic cervical adenopathies., Methods: A systematic review (SR) using meta-analysis was conducted on the effectiveness and safety of PEI. A SR on cost-effectiveness was also performed. The SRs were conducted according to the methodology developed by the Cochrane Collaboration with reporting in accordance with the PRISMA statement. A cost-minimization analysis was carried out using a decision tree model. Assuming equal effectiveness between two minimally invasive techniques (PEI and radiofrequency ablation (RFA)), the model compared the costs of the alternatives with a horizon of six months and from the perspective of the Spanish National Health System., Results: The search identified three RCTs (n=157) that evaluated PEI versus RFA in patients diagnosed with benign thyroid nodules: ninety-six patients with predominantly cystic nodules and sixty-one patients with solid nodules. No evidence was found on other techniques or thyroid nodular pathology. No statistically significant differences were observed between PEI and RFA in volume reduction (%), symptom score, cosmetic score, therapeutic success and major complications. No economic evaluations were identified. The cost-minimization analysis estimated the cost per patient of the PEI procedure at €326 compared to €4781 for RFA, which means an incremental difference of -€4455., Conclusions: There are no differences between PEI and RFA regarding their safety and effectiveness, but the economic evaluation determined that the former option is cheaper., (Copyright © 2023 SEEN and SED. Published by Elsevier España, S.L.U. All rights reserved.)
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- 2023
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31. A look ahead to promote the early detection of lung cancer: technical and cost implications of a confirmed diagnosis before surgery.
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Guzmán R, Guirao A, Grando L, Boada M, Sanchez D, Quiroga N, Paglialunga P, and Molins L
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- Humans, Retrospective Studies, Length of Stay, Early Detection of Cancer, Lung Neoplasms diagnosis, Lung Neoplasms surgery
- Abstract
Objective: To compare the costs and length of hospital stay among patients with a confirmed diagnosis of lung cancer (LC) prior to surgery versus those without confirmation., Methods: This retrospective, single-center study was conducted in patients who underwent a surgical procedure for LC, with or without a pathologically confirmed LC diagnosis prior to surgery, between March 2017 and December 2019. The main outcomes were costs and length of hospital stay (LOS)., Results: Among the 269 patients who underwent surgery for lung cancer between March 2017 and December 2019, 203 (75.5%) patients underwent surgery due to a histopathological diagnosis, and 66 (24.5%) because of a Multidisciplinary Cancer Committee indication. The unadjusted mean cost was significantly lower in Group II (patients with surgery based on Multidisciplinary Cancer Committee criteria) (Є2,581.80 ± Є1,002.50) than in Group I (patients with histopathological diagnosis) (Є4,244.60 ± Є2,008.80), P < 0.0001. Once adjusted for covariables, there was a mean difference of -Є1,437.20 in the costs of Group II, P < 0.0001. Unadjusted mean hospital stay was significantly longer in Group I (5.6 days) than in Group II (3.5 days)., Conclusions: The results suggest that indicating surgical resection of lung cancer based on Multidisciplinary Cancer Committee criteria, rather than performing CT-guided percutaneous lung biopsy, may result in a significant decrease in cost and length of hospital stay., (Copyright © 2023 AEC. Published by Elsevier España, S.L.U. All rights reserved.)
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- 2023
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32. A propósito de la excepcionalidad de las innovaciones farmacológicas para el cáncer Apropos of the exceptionality of new cancer drugs
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Laura Cabiedes Miragaya
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Tratamiento dirigido ,Oncología ,Coste-efectividad ,Equidad ,Contratos de riesgo compartido ,Incertidumbre ,Accesibilidad ,Toma de decisiones ,Molecular targeted therapy ,Oncology ,Cost-effectiveness ,Equity ,Risk-sharing arrangements ,Uncertainty ,Accessibility ,Decision making ,Public aspects of medicine ,RA1-1270 - Abstract
El objetivo de este artículo es analizar cómo las innovaciones farmacológicas para el cáncer son objeto de frecuentes excepciones al proceso habitual de evaluación económica de tecnologías, así como su impacto en la regulación de estos procesos y de los contratos de riesgo compartido, particularmente utilizados en este ámbito. Con este fin se seleccionaron dos agentes representativos de los primeros tratamientos dirigidos, el trastuzumab y el imatinib, y se procedió a la revisión de algunas experiencias internacionales (Australia, Gales e Inglaterra, pioneros en la aplicación de estudios de evaluación económica de tecnologías), en especial, aunque no exclusivamente, centradas en estos dos casos. De la revisión de las experiencias se desprende que, aparte de la eficiencia, otros criterios pueden resultar particularmente relevantes en los procesos de evaluación de este tipo de innovaciones. En Inglaterra y Gales (donde, a diferencia de Australia, no se aplica la "regla de rescate"), los controvertidos procesos de toma de decisiones han llevado a la regulación de nuevos enfoques en la evaluación de estos tratamientos. Asimismo, el solapamiento de los contratos de riesgo compartido o su aplicación secuencial han llamado la atención sobre posibles problemas de inconsistencia en la toma de decisiones y de equidad en el acceso, resultando en su regulación para el conjunto del sistema. Se concluye con una referencia específica al caso español, centrada en el riesgo de profundizar en la aplicación de fórmulas micro (como los contratos de riesgo compartido) frente a macro, y se sugiere una estrategia de actuación apoyada en el recientemente aprobado Real Decreto-ley 9/2011.Given that new oncology drugs are frequently involved in departures from the normal technology appraisal processes, the main objective of this article is to analyze these decision-making processes, as well as their impact on the regulation of new approaches to selecting novel drugs and the regulatory steps to deal with risk-sharing arrangements. This analysis was carried out by selecting two drugs, trastuzumab and imatinib, both agents being representive examples of the innovative targeted therapies introduced in the last decade, and by reviewing some international experiences (particularly those of Australia, England, and Wales, pioneers in the application of technology appraisals), centered mainly - but not exclusively - on these two drugs. The review of these experiences indicated that other concerns apart from efficiency are especially important in the evaluation of this type of innovations. In England and Wales (where, in contrast to Australia, the "rule of rescue" has not been adopted) the controversial decision-making processes have resulted in new approaches to the appraisal of end-of-life treatments. Moreover, overlapping or sequential risk-sharing arrangements have led to regulatory steps, paying attention to possible problems of inconsistencies in decision-making and inequalities of access. The case of Spain is critically discussed, with special emphasis on the risk of favoring the application of micro formulae (such as risk-sharing arrangements) over macro formulae. Finally, a strategy is suggested, based on the recently approved Royal Decree-law 9/2011.
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- 2013
33. Once años de evaluaciones económicas de productos sanitarios en la Red de Agencias de Evaluación. Calidad metodológica e impacto del coste-utilidad
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Sergio Márquez, Mireia Espallargues, María Asun Gutiérrez, Lidia García-Pérez, E Gimenez, and Juan Carlos Bayón
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Coste-efectividad ,030503 health policy & services ,Evaluación económica ,lcsh:Public aspects of medicine ,Public Health, Environmental and Occupational Health ,lcsh:RA1-1270 ,Efficiency ,National portfolio ,Economic evaluation ,03 medical and health sciences ,Evaluación de tecnologías sanitarias ,0302 clinical medicine ,Eficiencia ,Medical devices ,Cost-effectiveness ,030212 general & internal medicine ,Health technology assessment ,0305 other medical science ,Productos sanitarios ,Cartera común - Abstract
Resumen: Objetivo: Analizar la calidad y el impacto de los análisis de coste-utilidad de productos sanitarios realizados por la Red de Agencias de Evaluación (RedETS). Método: Los análisis de coste-utilidad de productos sanitarios se identificaron buscando entre los informes de evaluación de la base de datos de la web de RedETS (2006-2016). La calidad se evaluó con un listado de verificación de calidad de RedETS, y su impacto, comparando resultados de coste-utilidad y la inclusión en la cartera común de servicios del Sistema Nacional de Salud. Se analizó la inclusión en la cartera común si la ratio de coste-efectividad incremental superaba o no los 25.000 € por año de vida ajustado por calidad. Resultados: Se encontraron 25 análisis de coste-utilidad de productos sanitarios (12 de coste-utilidad, 10 de coste-efectividad y 3 de ambos). De ellos, 15 estudios con 19 ratios de coste-utilidad seleccionados cumplían al menos 18 de 25 criterios de verificación. Asimismo, 12 de los 15 estudios cumplían 18 de los 25 criterios. Sobre el impacto, en 6 de los 19 resultados se incluyó el producto en cartera aunque la ratio superó los 25.000 € por año de vida ajustado por calidad. En tres casos se está en proceso de reevaluación; en otro, de replanteamiento una vez realizados los informes de eficacia-seguridad de nuevos dispositivos; y en dos casos se señala en la cartera que debe seguirse un protocolo. Conclusiones: La mayoría de los análisis de coste-utilidad de productos sanitarios analizados cumplieron casi todos los ítems del listado de verificación y, por tanto, fueron exhaustivos. Estos análisis de coste-utilidad de productos sanitarios fueron coherentes con el marco de toma de decisiones para manejar eficientemente la cartera del Sistema Nacional de Salud. Abstract: Objective: To analyse the quality and impact of cost-utility evaluations of medical devices carried out by the Spanish Network of Assessment Agencies (RedETS). Method: The cost-utility evaluations of medical devices were identified by searching the evaluation reports of the RedETS website database (2006-2016). Quality and its impact were evaluated with a RedETS quality checklist, comparing cost-utility results and inclusion in the portfolio of common services of the National Health System. The portfolio inclusion status was analysed considering whether the cost-effectiveness incremental ratio was or was not less than €25,000/quality adjusted life years. Results: 25 cost-utility evaluations of medical devices were found (12 cost-utility, 10 cost-effectiveness and 3 both). Fifteen selected cost-utility studies with 19 cost-utility ratios met at least 18 of 25 verification criteria. Also, 12 of the 15 studies met 19 of the 25 criteria. On the impact, in 6 out of the 19 results, the product was included in the portfolio even though the ratio exceeded €25,000/quality adjusted life years. There are three cases undergoing a re-evaluation process, another case being reconsidered once the efficacy-safety of new devices has been reported and in two cases the portfolio states that protocols are required. Conclusions: Most of the cost-utility evaluations of medical devices published by RedETS fulfil most of the items on the checklist and, therefore, were thorough. These cost-utility evaluations of medical devices are consistent with the decision-making framework to efficiently manage the National Health System portfolio.
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- 2020
34. Is the universal population Hepatitis C virus screening a cost-effective strategy? A systematic review of the economic evidence
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Francisco Ledesma, Miguel A. Casado, Rafael Esteban, Raquel Domínguez-Hernández, and Maria Buti
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Microbiology (medical) ,Cost effectiveness ,Cost-Benefit Analysis ,Hepatitis C virus ,Population ,VHC ,medicine.disease_cause ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Mass Screening ,030212 general & internal medicine ,education ,coste-efectividad ,evaluación económica ,Pharmacology ,education.field_of_study ,cribado ,business.industry ,Welfare economics ,DAAs ,General Medicine ,Hepatitis C, Chronic ,antivirales de acción directa ,HCV ,Screening ,030211 gastroenterology & hepatology ,Systematic Review ,Cost-Effectiveness ,Economic Evaluation ,business ,Economic evidence - Abstract
espanolAntecedentes. Para conseguir el objetivo de la Organizacion Mundial de la Salud (OMS) de erradicar la hepatitis C (VHC) se necesita estrategias eficientes. La infeccion por VHC puede ser eliminada por combinaciones de antivirales de accion directa (DAA). El problema es que muchos individuos permanecen sin diagnosticar. El objetivo es realizar una revision sistematica de la evidencia de evaluaciones economicas que analicen el cribado del VHC (screening) seguido de tratamiento con DDA. Metodo. Realizamos una revision sistematica de once bases de datos incluyendo 2015-2018. Los criterios de inclusion fueron evaluacion economica que incluyera ratio de costeefectividad incremental (ICER) en coste por ano de vida ganado o ano de vida ajustado por calidad. Resultados. Extrajimos 843 referencias. Dieciseis posters/ articulos cumplieron criterio de inclusion. Diez de ellos valoraban cribado de poblacion general. Otras poblaciones analizadas fueron “baby-boomer”, usuarios de drogas parenterales, prisiones o inmigrantes. El comparador fue “practica clinica habitual”, otras poblaciones de alto riesgo o no hacer cribado. La mayoria de los estudios utilizaron simulaciones por modelo de Markov y la perspectiva del pagador. El ICER para cribado de poblacion general + tratamiento DDA frente a poblaciones de alto riesgo o practica rutinaria mostraron que esta por debajo del umbral de la disponibilidad a pagar en la mayoria de los estudios y concluyen que la estrategia es altamente coste-eficaz y que esta por debajo de los umbrales habituales de disposicion a pagar. Conclusion. Esta revision sistematica muestra que los programas de deteccion seguidos de tratamiento con DDAs son coste-efectivos no solo para poblaciones de alto riesgo sino tambien para poblacion general. Dado que hoy el VHC puede ser facilmente curado y evitadas sus consecuencias a largo plazo, el cribado universal seguido de tratamiento con combinaciones de DDA deberia ser la estrategia recomendada para alcanzar el objetivo de la OMS de erradicar el VHC para 2030. EnglishBackground. Efficient strategies are needed in order to achieve the objective of the WHO of eradicating Hepatitis C virus (HCV). Hepatitis C infection can be eliminated by a combination of direct acting antiviral (DAA). The problem is that many individuals remain undiagnosed. The objective is to conduct a systematic review of the evidence on economic evaluations that analyze the screening of HCV followed by treatment with DAAs. Methods. Eleven databases were performed in a 2015-2018-systematic review. Inclusion criteria were economic evaluations that included incremental cost-effectiveness ratio (ICER) in terms of cost per life year gained or quality-adjusted life year. Results. A total of 843 references were screened. Sixteen papers/posters meet the inclusion criteria. Ten of them included a general population screening. Other populations included were baby-boomer, people who inject drugs, prisoners or immigrants. Comparator was “standard of care”, other high-risk populations or no-screening. Most of the studies are based on Markov model simulations and they mostly adopted a healthcare payer´s perspective. ICER for general population screening plus treatment versus high-risk populations or versus routinely performed screening showed to be below the accepted willingness to pay thresholds in most studies and therefore screening plus DAAs strategy is highly cost-effective. Conclusion. This systematic review shows that screening programmes followed by DAAs treatment is cost-effective not only for high risk population but for general population too. Because today HCV can be easily cured and its long-term consequences avoided, a universal HCV screening plus DAAs therapies should be the recommended strategy to achieve the WHO objectives for HCV eradication by 2030.
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- 2020
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35. Terapias Biológicas en Artritis Reumatoide: Análisis coste-efectividad de las alternativas terapéuticas
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Ana Fernández Pérez, Natalia Pérez Rodríguez, Santiago Piñeiro Conde, Inmaculada López Rodríguez, and Victor López García
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Artritis Reumatoide ,Terapias biológicas ,Coste-efectividad ,Medicine ,Internal medicine ,RC31-1245 - Abstract
Objetivo: Análisis de coste-efectividad de las alternativas terapéuticas recogidas en el protocolo de la Comisión Autonómica Central de Farmacia y Terapéutica para el tratamiento de la Artritis Reumatoide. Material y métodos: Estudio observacional descriptivo transversal (Abril 2012) de los pacientes a tratamiento con los siguientes medicamentos biológicos: infliximab, abatacept, tocilizumab, rituximab, etanercept, adalimumab, certolizumab y golimumab. Se registró: medicamento actual y pauta, tratamiento previo con metotrexato y coste anual del tratamiento. Se elabora una comparativa con la hipótesis de cambio de tratamiento, en el caso de los pacientes con medicamentos de administración intrahospitalaria, a los medicamentos de dispensación a pacientes externos incluidos en el protocolo. Resulados: :558 pacientes; 229 a tratamiento con infliximab: 30 (13,1%) con dosis de 3mg/kg, 173 (75,5%) con 5mg/kg y 26 (11,4%) con 7mg/kg; 27 con abatacept: 5 (18,5%) con dosis de 500 mg, 19 (70,4%) con 750 mg y 3 (11,1%) con 1000 mg; 12 con tocilizumab: 100% con 8mg/kg; 66 con rituximab 1000 mg; 14 con golimumab 50mg; 5 con certolizumab 200mg; 116 con etanercept 50 mg y 101 con adalimumab 40mg. Un 95,78% (546) habían recibido metotrexato previamente. El coste medio anual se calculó por paciente considerando peso superior a 70 kg y compartiendo viales en el caso de los medicamentos que se preparan en cabina de flujo laminar: infliximab 14.665€, abatacept 14.695€, tocilizumab 14.140€, rituximab 2400€/dosis, etanercept 11.879€, adalimumab 12.895€, certolizumab 11.888€ y golimumab 10.316€/año. Siguiendo la hipótesis de cambio de tratamientos administrados en Hospital de Día a tratamientos de dispensación ambulatoria los ahorros estimados estarían comprendidos entre 1245 y 4379 €/paciente. Conclusiones: A la espera de algún estudio que demuestre superioridad de alguno de estos medicamentos frente a otro en eficacia y seguridad, debería hacerse una adecuada selección del medicamento que permita ahorrar recursos tanto en gasto farmacéutico como de personal. Es importante considerar determinados factores como la frecuencia de administración, posibilidad de alargamiento del intervalo de administración, determinaciones de anticuerpos frente a los fármacos y valoraciones diagnosticas para mejorar la eficacia/eficiencia de los tratamientos, para así evitar un posible “agotamiento terapéutico”. Objective: Cost-effectiveness of alternative therapies included in the Central Autonomous Committee Pharmacy and Therapeutics protocol for Rheumatoid Arthritis treatment. Material and methods: Descriptive study (April 2012) of patients following treatment with biologics: infliximab, abatacept, tocilizumab, rituximab, etanercept, adalimumab, certolizumab and golimumab. Joined: current medication regimen, previous methotrexate treatment and annual treatment cost. The comparison is made assuming changes in treatment, from hospital-administered drugs to medications dispensed to outpatients included in the protocol. Results: 558 patients, 229 treated with infliximab: 30 (13.1%) at a dose of 3mg/kg, 173 (75.5%) with 5mg/kg and 26 (11.4%) with 7mg/kg; 27 with abatacept : 5 (18.5%) with doses of 500 mg 19 (70.4%) with 750 mg and 3 (11.1%) at 1000 mg; 12 tocilizumab: 100% 8mg/kg; 66 with rituximab 1000 mg, 14 50mg golimumab, certolizumab 200mg 5; 116 with etanercept 50 mg and 101 with adalimumab 40mg. A 95.78% (546) had previously received methotrexate. The average annual cost was calculated considering patient weighing more than 70 kg and sharing vials in the case of drugs that are prepared under aseptic conditions: € 14,665 infliximab, abatacept € 14,695, € 14,140 tocilizumab, rituximab € 2,400 / dose, € 11,879 etanercept, adalimumab 12,895 €, certolizumab and golimumab € 11,888 € 10,316 / year. Following the hypothesis of change in treatments from day hospital administered to outpatient dispensing, estimated savings would achive between 1245 and € 4,379 / patient. Conclusions: As there is no study showing superiority of any of these drugs against the others in efficacy and safety, there should be a proper medicine selection that would ensure saving both material and personnel resources. It is important to consider certain factors such as administration frequency, possibility of lengthening the dosing interval, determinations of antibodies to drugs and diagnostic evaluations to improve the effectiveness / efficiency rate of treatments,in order to avoid a possible "therapeutic exhaustion ".
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- 2012
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36. Prevention or cure in times of crisis: the case of screening for colorectal cancer Prevenir o curar en época de crisis: a propósito del cribado de cáncer de colon y recto
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Fernando Carballo and Miguel Muñoz-Navas
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Prevención cáncer colorrectal ,Coste-efectividad ,Prevention of colorectal cancer ,Cost effectiveness ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Colorectal cancer is a serious health problem in which screening is capable of reducing both the mortality and the incidence of the disorder. Colonoscopy, the mainstay of this type of screening, allows to establish an early diagnosis and also to eliminate malignant precursor lesions. The screening test which is performed in Spanish programs is the determination of fecal occult blood using the immunochemical method which gives around 70% of positive values for colonoscopy for any type of neoplasia. As a result, in 2009 the National Health System set as an objective that these programs cover 50% of the population by 2015. It is well known that colon screening is highly cost effective with a ratio of around 2500€ per QALY, much lower than ratios of other programs. Only the direct costs of colon and rectal cancer in Spain can be estimated at more than one thousand million euros per year. Early diagnosis and the cancers avoided thanks to screening can reduce these costs by 40%. The impact that the introduction of this screening has on health services can be lessened if the indications for colonoscopy are followed adequately. In conclusion, there is no justification for not acting to prevent CRC and this is especially so in times of crisis as there is no better social cost invested than that which saves suffering, deaths and even money.El cáncer colorrectal es un grave problema de salud en el que el cribado es capaz de reducir su mortalidad e incidencia. La colonoscopia, acto central de este tipo de cribado, permite tanto el diagnóstico precoz como la eliminación de los precursores malignos que son los adenomas. La prueba de cribado que se realiza en los programas españoles es la determinación de sangre oculta en heces por método inmunoquímico con lo que se consiguen valores predictivos positivos para la colonoscopia para cualquier tipo de neoplasia cercanos al 70%. Por todo ello, en 2009, el Sistema Nacional de Salud estableció el objetivo de un 50% de cobertura poblacional para 2015 para estos programas. Se sabe que el cribado de colon es altamente coste-efectivo con una ratio alrededor de los 2.500 euros por AVAC ganado, muy inferior al de otros programas. Solo los costes directos del cáncer de colon y recto en España pueden estimarse en más de mil millones de euros anuales. El diagnóstico precoz y los cánceres evitados gracias al cribado pueden disminuir estos costes en un 40%. El impacto que sobre los servicios sanitarios tiene implantar este cribado puede atenuarse si se trabaja en la adecuación de las indicaciones de la colonoscopia. En conclusión, no hay justificación para no actuar en prevención del CCR y especialmente no la hay en época de crisis ya que no hay coste social mejor invertido que el que ahorra sufrimiento, muertes e incluso dinero.
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- 2012
37. Análisis de coste-efectividad de la vacunación antineumocócica en España Cost-effectiveness analysis of pneumococcal vaccination in Spain
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Raúl Morano, Ferrán Pérez, Max Brosa, and Isabel Pérez Escolano
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Vacunación antineumocócica ,Haemophilus influenzae no tipificable ,Otitis media aguda ,Coste-efectividad ,Pneumococcal vaccination ,Non-typeable Haemophilus influenzae ,Acute otitis media ,Cost-effectiveness ,Public aspects of medicine ,RA1-1270 - Abstract
Objetivo: Análisis de coste-efectividad de la vacunación antineumocócica pediátrica en España. Métodos: Se utilizó un modelo determinístico poblacional en forma de árbol de decisión con un horizonte temporal de 1 año para estimar el impacto de la vacunación con Synflorix® o Prevenar13® sobre la población menor de 2 años en España, bajo la perspectiva del Sistema Nacional de Salud. Los datos epidemiológicos se obtuvieron del Conjunto Mínimo Básico de Datos al alta hospitalaria y de la literatura. Los datos sobre costes se obtuvieron de bases de datos nacionales de costes sanitarios. Los principales resultados en salud medidos fueron los casos evitados de enfermedad neumocócica invasora, otitis media aguda (OMA), miringotomías y hospitalizaciones por neumonía. Todos los costes se expresaron en euros de 2010. La efectividad se midió en años de vida ajustados por calidad (AVAC). Resultados: El potencial demostrado por Synflorix® para prevenir episodios de OMA causados por Haemophilus influenzae no tipificable podría traducirse en la prevención adicional de 41.513 episodios de OMA, 36.324 prescripciones de antibióticos y 382 miringotomías, y supondrían la ganancia de 143 AVAC frente a Prevenar13®. El coste total de la vacunación con Synflorix® resultaría unos 22 millones de euros menor. Conclusiones: La vacunación antineumocócica de la población menor de 2 años en España con Synflorix®, en comparación con la vacunación con Prevenar13®, podría resultar en un mayor número de AVAC, así como en una reducción sustancial del coste total, resultando una estrategia dominante en términos de coste-efectividad.Objective: To perform a cost-effectiveness analysis of pediatric pneumococcal vaccination in Spain. Methods: A deterministic population-based model in the form of a decision-tree with a 1-year time horizon was used to estimate the impact of vaccination with Synflorix® or Prevenar13® in children aged less than 2 years in Spain from the perspective of the National Health System. Epidemiological data were obtained from the hospital discharge minimum data set (MDS) and the literature. Data on costs were obtained from national health costs databases. The main outcomes measured were the number of cases avoided of invasive pneumococcal disease, acute otitis media (AOM) and myringotomies, and hospital admissions for pneumonia. All costs were expressed in 2010 euros. Effectiveness was measured as the number of quality-adjusted life years (QALYs) gained. Results: The efficacy of Synflorix® in preventing episodes of AOM caused by non-typeable Haemophilus influenzae could lead to additional prevention of 41,513 episodes of AOM, 36,324 antibiotic prescriptions and 382 myringotomy procedures and 143 QALYs gained compared with Prevenar13®. The total vaccination cost with Synflorix® would result in savings of 22 million euros. Conclusions: Pneumococcal vaccination with Synflorix® in comparison with Prevenar13® in children aged less than 2 years old in Spain could achieve a higher number of QALYs and a substantial cost offset. Vaccination with Synflorix® would be a dominant strategy in terms of cost-effectiveness.
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- 2011
38. Evaluación económica de rituximab en combinación con fludarabina y ciclofosfamida en comparación con fludarabina y ciclofosfamida en el tratamiento de la leucemia linfática crónica Economic evaluation of rituximab added to fludarabine plus cyclophosphamide versus fludarabine plus cyclophosphamide for the treatment of chronic lymphocytic leukemia
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Luis Felipe Casado, José Antonio García Marco, Florinda Gilsanz, Marcos González, Eduardo Ríos, Javier de la Serna, Álvaro Urbano, Vicente Vicente, Carlos Rubio-Terrés, and Antonio J. Castro
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Leucemia linfática crónica ,Rituximab ,Fludarabina ,Ciclofosfamida ,Coste-efectividad ,Chronic lymphocytic leukemia ,Fludarabine ,Cyclophosphamide ,Cost-effectiveness ,Public aspects of medicine ,RA1-1270 - Abstract
Objetivos: Evaluar el coste-efectividad del esquema de rituximab, fludarabina y ciclofosfamida (R-FC) en comparación con el de fludarabina y ciclofosfamida (FC) en dos tipos de pacientes con leucemia linfática crónica (LLC): no tratados previamente o bien en recidiva/resistentes al tratamiento previo. Métodos: Dos modelos de Markov, utilizando los resultados publicados de superviviencia libre de progresión (SLP) de pacientes con LLC tratados con R-FC o FC en primera o segunda línea, las tasas de progresión de la enfermedad y las tasas de mortalidad en España. A los estados de SLP y progresión se les asignaron utilidades obtenidas en un estudio sobre LLC. Los costes de los medicamentos y de los tratamientos de soporte, así como los años de vida ajustados por calidad (AVAC), se estimaron para un periodo de 10 años. Se efectuaron análisis de sensibilidad univariados y probabilísticos (Monte Carlo). Resultados: La adición de rituximab a la quimioterapia con FC aumentó los años de vida ganados (AVG) y los AVAC tanto en primera como en segunda línea de tratamiento. La razón de coste-eficacia incremental fue de 20.703 € por AVG y de 19.343 € por AVAC con la primera línea de tratamiento, y de 23.183 € por AVG y 24.781 € por AVAC con la segunda línea de tratamiento. Conclusiones: En los pacientes con LLC no tratados previamente y en aquellos en recaída o resistentes al tratamiento previo, la adición de rituximab al esquema FC aumentó la esperanza de vida y los AVAC, y en ambos casos resultó ser un tratamiento coste-efectivo.Objectives: We evaluated the cost-effectiveness of rituximab added to the chemotherapy regimen of fludarabine plus cyclophosphamide (R-FC) versus fludarabine plus cyclophosphamide (FC) for the treatment of patients with previously untreated or relapsed/refractory chronic lymphocytic leukemia (CLL). Methods: Two Markov models were built, using published results on progression-free survival (PFS) in patients receiving first- or second-line therapy with R-FC vs FC, rates of disease progression and mortality rates in Spain. Patient-elicited utilities were applied to PFS and progressed health states. The cost of drugs, supportive care, and quality-adjusted life years (QALY) were estimated over a 10-year period. Univariate and probabilistic (Monte Carlo) sensitivity analyses were performed. Results: The addition of rituximab to chemotherapy in first- and second-line therapy increased life-years gained (LYG) and QALYs compared with chemotherapy. The incremental cost per LYG and QALY gained was €20,703 and €19,343 for first-line treatment and was €23,183 and €24,781 for second-line treatment. Conclusion: In patients with previously untreated or relapsed/refractory CLL, the addition of rituximab to the FC regimen increased life expectancy and quality-adjusted life expectancy. In both types of patient, the treatment was cost-effective.
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- 2011
39. Coste-efectividad de un programa de actividad física de tiempo libre para prevenir el sobrepeso y la obesidad en niños de 9-10 años Cost-effectiveness of an intervention to reduce overweight and obesity in 9-10-year-olds. The Cuenca study
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Pablo Moya Martínez, Mairena Sánchez López, Julio López Bastida, Francisco Escribano Sotos, Blanca Notario Pacheco, Fernando Salcedo Aguilar, and Vicente Martínez Vizcaíno
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Coste-efectividad ,Programas extraescolares ,Actividad física ,Obesidad infantil ,Cost-effectiveness ,After-school program ,Physical activity ,Childhood obesity ,Public aspects of medicine ,RA1-1270 - Abstract
Objetivos: Analizar el coste-efectividad de una intervención de actividad física de tiempo libre diseñada para reducir el sobrepeso, la obesidad y otros factores de riesgo cardiovascular en escolares. Métodos: Se realiza un análisis de coste-efectividad desde la perspectiva social e institucional de un ensayo de campo aleatorizado por cluster en 10 colegios de intervención (691 niños) y 10 de control (718 niños). Se calculan los costes netos como la diferencia entre los costes del programa y las posibles alternativas. La efectividad se mide como la reducción en las medidas de salud frente al grupo de control. Resultados: El coste total de la intervención se estima en 125.469,75€, 269,83€ por año y niño. Los escolares del grupo de intervención mostraron un descenso del grosor del pliegue cutáneo tricipital (-1,25mm; intervalo de confianza del 95% [IC95%]: -1,82 a -0,67; pP75. Conclusiones: Realizar programas de actividad física como la intervención objeto de estudio es una forma coste-efectiva de prevenir la obesidad y de hacer un uso rentable de los fondos públicos.Objective: To assess the cost-effectiveness a school-based intervention designed to reduce overweight/obesity and other cardiovascular risk factors in children. Methods: Standard cost effectiveness analysis methods and two perspectives (societal and institutional) were used. A cluster-randomized controlled trial with 10 intervention schools (691 children) and 10 control schools (718 children) was performed. Net costs were calculated by subtracting the usual after-school care cost from intervention costs. The effectiveness of the intervention was measured as the reduction in health outcomes compared with the control group. Results: The intervention costs totaled 125,469.75€, representing 269.83€/year/child. The usual after-school care was estimated at 844,56€/year/child. Intervention children showed a decrease in triceps skinfold thickness (-1.25mm, 95% CI: -1.82 to -0.67; P P75 showed a decrease in triceps skinfold thickness (-1.87mm; 95%CI: -3.43 to -0.32; P
- Published
- 2011
40. Impact of endoscopic ultrasonography on the management of a prospective cohort of 700 consecutive patients referred for diagnostic endoscopic ultrasonography Impacto de la ultrasonografía endoscópica en el manejo terapéutico de una cohorte prospectiva de 700 pacientes consecutivos referidos para USE diagnóstica
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F. González-Panizo, E. Vázquez-Sequeiros, J. R. Foruny-Olcina, V. Defarges-Pons, M. García, D. Boixeda-de-Miquel, V. Moreira-Vicente, D. Juzgado-Lucas, and J. M. Milicua-Salamero
- Subjects
Impacto ,Impacto clínico ,Coste-efectividad ,Utilidad ,Ultrasonografía endoscópica ,Impact ,Clinical impact ,Cost-effectiveness ,Usefulness ,Endoscopic ultrasonography ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background: endoscopic ultrasonography (EUS) is a high accuracy technique for the study of many digestive diseases. The degree of knowledge about the impact of EUS on the management of these patients is inadequate. Aim: to determine the therapeutic impact of endoscopic ultrasonography (EUS) on a prospective cohort of patients. Methods: all patients referred for EUS over a period of 2 years were prospectively evaluated in order to asses: 1. EUS provides new information not previously known; 2. theoretic impact of EUS on patient management; 3. real impact of EUS on final therapy; 4. changes in the aggressiveness of the therapeutic decision after EUS. Results: 700 patients were included. Preoperative assessment of digestive tumors was the commonest indication. EUS provided "new information" in the 89% of the patients. With regard to endoscopist opinion, these findings should alter the management in 79% of patients ("theoretic impact"). However, EUS prompted a change in the management in 67% of patients ("real impact"). Final therapy post-EUS was less aggressive in 34% of patients. Changes in therapeutic decision were associated with EUS findings, alcohol intake and age ≥ 57 years old. Conclusions: 1) EUS findings, advanced age, and alcohol intake are associated with a change in the management in 2 out of every 3 patients referred for EUS. 2) Therapeutic decision (post-EUS) is less aggressive in a third of these patients, what should represent a significant economic saving.Antecedentes: la ultrasonografía endoscópica (USE) es una técnica de gran precisión para el estudio de diferentes patologías digestivas. El grado de conocimiento sobre el impacto de la USE en el tratamiento de estos pacientes es escaso. Objetivo: determinar el impacto terapéutico de la USE en una cohorte prospectiva de pacientes. Material y métodos: estudio que evalúa de forma prospectiva a todos los pacientes remitidos para USE en un periodo de 2 años. Se analiza: a) si la USE aporta información no conocida previamente; b) el impacto teórico de la USE en el tratamiento; c) el impacto final/real de USE en el tratamiento; d) la variación en la decisión terapéutica tras realizar la USE. Resultados: se incluyeron 700 pacientes. La indicación más frecuente de USE era el estudio preoperatorio de tumores digestivos. La USE aportó "información nueva" en el 89% de los casos. En opinión del ecoendoscopista estos hallazgos deberían suponer un cambio terapéutico en el 79% de los pacientes ("impacto teórico"). Sin embargo, el tratamiento sólo se modificó en el 67% de los casos ("impacto real"). La estrategia terapéutica post-USE fue menos agresiva en el 34% de los casos. Los cambios en la actitud terapéutica se asociaban con los hallazgos de USE, ingesta de alcohol y edad > 57 años. Conclusiones: - Los hallazgos de la USE, la edad avanzada y el consumo de alcohol, se asocian con un cambio terapéutico en 2 de cada 3 pacientes remitidos a una unidad de USE. - La decisión terapéutica final (post-USE) es menos agresiva en un tercio de estos pacientes, lo que podría representar un ahorro económico significativo.
- Published
- 2011
41. Eficacia, coste-efectividad y efectos sobre la calidad de vida de la suplementación nutricional Efficacy, cost-effectiveness, and effects on quality of life of nutritional supplementation
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C. Gómez Candela, A. Cantón Blanco, L. M. Luengo Pérez, and G. Olveira Fuster
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Suplementación nutricional ,Eficacia ,Calidad de vida ,Coste-efectividad ,Nutritional supplements ,Effectiveness ,Quality of life ,Cost-effectiveness ,Nutritional diseases. Deficiency diseases ,RC620-627 - Abstract
El presente artículo resume los resultados y conclusiones presentados en el Simposio "Suplementación nutricional: evidencias y experiencias" celebrado en el XXIII Congreso Nacional de la SENPE (2008). La malnutrición calórico-proteica, que puede afectar al 30-50% de los pacientes hospitalizados, aumenta el tiempo de hospitalización y el coste de la atención médica en aquellos que la padecen. Un importante volumen de evidencias científicas avala que la administración de suplementos nutricionales (SN) mejora el estado nutricional o previene la aparición de malnutrición en pacientes que no cubren sus necesidades nutricionales con la dieta convencional o con la dieta adaptada, sin que, por ello, se produzca desplazamiento de la ingesta. Todo ello viene reforzado por los resultados que evidencian el papel de los SN en la mejora de parámetros tanto nutricionales como funcionales. La revisión de la literatura existente en determinados contextos clínicos (geriatría u oncología), evidencia que los SN reducen la aparición de complicaciones propias, tanto de la patología de base como del estado de desnutrición, así como que favorecen la reducción de la estancia hospitalaria y de la mortalidad. A pesar de ello, son necesarios más estudios sobre la eficacia de los SN orales en los que se realice un seguimiento más prolongado de lo que ofrecen las publicaciones disponibles actualmente. Más allá de su eficacia, los SN constituyen una intervención terapéutica segura y sin efectos adversos clínicos relevantes que, según la literatura, mejoran la funcionalidad del paciente y su calidad de vida. Cabe añadir que los SN pueden ser coste-efectivos en ciertos perfiles de paciente (ancianos malnutridos o en riesgo de desnutrición y en pacientes quirúrgicos hospitalizados). La revisión de la literatura evidencia la necesidad de realizar más estudios, con la metodología adecuada, que valoren el efecto sobre la calidad de vida de los SN así como su coste-efectividad sobre pacientes desnutridos en el contexto de situaciones clínicas concretas. Ello permitiría al facultativo la toma de decisiones clínicas basadas en la evidencia y los análisis de costes.This article summarizes the main results and conclusions presented in the Symposium "Nutritional supplementation: evidences and experiences" that took place in the XXIIIrd SENPE Congress (2008). Protein energy malnutrition, that can affect 30-50% of hospitalized patients, increases both time of hospitalization and costs of medical care of this kind of patients. There is a lot of scientific evidences demonstrating that the use of nutritional supplementation improves nutritional status or prevents malnutrition in those patients who do not meet their nutritional needs with a conventional diet or an adapted one with no replacing intake from normal food. This is strengthened by the results that demonstrate the rol of nutritional supplements improving nutritional and functional parameters. Current bibliographic reviews focused on certain clinical frameworks (i.g. geriatrics, oncology), prove that nutritional supplements reduce complications related to pathology and to nutritional status, and also reduce length of hospitalization and mortality. More studies regarding to efficacy of oral nutritional supplements are needed. These studies should be carried out with a period of follow-up longer than the current published studies have. As well as effective, nutritional supplements become a save therapeutic intervention with no important adverse events that, according to bibliography, improve patient's functionality and quality of life. It is worth mentioning that nutritional supplements can be effective on certain kind of patients, for instance, malnourished elderly or elderly in risk of malnourishment, and hospitalized surgical patients. Scientific literature refers that it is necessary to carry out more studies, with an accurate methodology, which assess the effect of nutritional supplements on quality of life and its cost-effectiveness on malnourished patients regarding specific clinical situations. That would allow physicians to make clinical decisions based on evidences and cost analysis.
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- 2010
42. Análisis de coste-utilidad del manejo de la fibrilación auricular concomitante en España Cost-utility analysis of concomitant atrial fibrillation management in Spain
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María Jesús López Gude, Desiré Rodríguez Bezos, and José Manuel Rodríguez Barrios
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Coste-utilidad ,Coste-efectividad ,Fibrilación auricular ,Ablación quirúrgica ,Cost-utility ,Cost-effectiveness ,Atrial fibrillation ,Surgical ablation ,Public aspects of medicine ,RA1-1270 - Abstract
Objetivos: La fibrilación auricular (FA) es la arritmia más común en la práctica clínica; es un factor de riesgo de accidente cerebrovascular (ACV), y está asociada a una importante morbilidad y mortalidad. Nuestro objetivo fue realizar un análisis de coste-utilidad de las diferentes opciones de tratamiento en pacientes >40 años con FA concomitante con valvulopatía mitral en España, desde la perspectiva del Sistema Nacional de Salud. Métodos: Se realizó una evaluación económica mediante un modelo de Markov con cuatro estados de salud (ritmo sinusal, FA, ACV dependiente, muerte) simulando una cohorte de 1.000 pacientes en cada opción de tratamiento más cirugía de válvula mitral (tratamiento farmacológico, ablación quirúrgica y ablación por catéter). El horizonte temporal fue de 5 años, con ciclos de 3 meses. Los datos de costes y efectos se obtuvieron de la revisión de la literatura y de la opinión de expertos clínicos, descontados al 3,5% anual. Se realizó un análisis de sensibilidad probabilístico para determinar la robustez de nuestros resultados. Resultados: Los años de vida ajustados por calidad (AVAC) ganados fueron 3,29, 3,89 y 3,83, respectivamente, para las alternativas de no ablación, ablación quirúrgica y ablación por catéter. Los costes por paciente fueron de 5.770€, 10.034€ y 11.289€, respectivamente. La razón coste/AVAC de ablación quirúrgica frente a no ablación fue de 7.145€. La ablación quirúrgica resultó dominante frente a la ablación por catéter. El análisis probabilístico de sensibilidad mostró que los resultados del modelo fueron robustos. Conclusiones: La ablación quirúrgica es una opción de tratamiento coste-efectiva en los pacientes con FA concomitante, con una razón coste-efectividad por debajo del umbral de eficiencia comúnmente aceptado en España.Objectives: Atrial fibrillation (AF) is the most common arrhythmia in clinical practice; this disorder is a risk factor for stroke and is associated with substantial morbidity and mortality. Our objective was to develop a cost-utility analysis of the different treatment alternatives in patients aged 40 years old or more with concomitant AF with valve disease in Spain, from the National Health System perspective. Methods: An economic evaluation through a Markov model with four health states (sinus rhythm, AF, dependent stroke, death) was developed to simulate the evolution of a cohort of 1,000 patients receiving each treatment alternative in addition to mitral valve surgery (drug therapy, surgical ablation and catheter ablation). The time horizon was 5 years, with a cycle length of 3 months. Data on costs and effects were obtained from the published literature and expert opinion and were discounted at 3.5%. A sensitivity analysis was developed to determine the robustness of the results. Results: The quality-adjusted life years (QALY) gained were 3.29, 3.89, and 3.83, respectively, for the alternatives of no ablation, surgical ablation and catheter ablation. The costs per patient were 5,770€, 10,034€ and 11,289€, respectively. The surgical ablation cost/QALY rate compared with no ablation was 7,145€. Surgical ablation was dominant versus catheter ablation. The probabilistic sensitivity analysis showed that the results were robust. Conclusions: Surgical ablation is a cost-effective treatment option in patients with concomitant AF, with a cost-effectiveness ratio under the efficiency threshold commonly accepted in Spain.
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- 2010
43. Application of negative pressure therapy in complex wounds of difficult healing in lower extremity
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Pardo Vitorero, Tamara, Delgado Uria, Aroa, and Universidad de Cantabria
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Extremidad inferior ,Cicatrización de heridas ,Coste-efectividad ,Terapia de presión negativa ,Heridas complejas ,Conocimientos enfermeros ,Cuidados enfermería - Abstract
Las heridas complejas de difícil cicatrización en extremidad inferior presentan una elevada prevalencia e incidencia en la actualidad y son consideradas un reto para el sistema sanitario debido a su retraso en la cicatrización, su alta probabilidad de recidiva y todas las consecuencias económicas que eso acarrea. El empleo de terapias costo-efectivas para tratar estas heridas suponen un beneficio tanto económico para el Sistema Nacional de Salud como clínico mejorando el estado físico y emocional del paciente. Entre ellas se encuentra la terapia de presión negativa (TPN), considerada una técnica de cura avanzada, la cual se aplica sobre el lecho de la herida ejerciendo una presión subatmosférica y contribuyendo al proceso de cicatrización. Debido a la reciente expansión de su uso tanto en el ámbito hospitalario como domiciliario por su alta eficacia, los profesionales de enfermería deben de poseer los conocimientos necesarios para su aplicación, así como poseer las habilidades pertinentes para llevarlo a cabo e instruir al paciente sobre la técnica. Además, requerirá de un estrecho proceso de vigilancia para comprobar que no aparecen complicaciones y que la terapia está resultando efectiva. Complex wounds of difficult healing in the lower extremity present a high prevalence and incidence at present and are considered a challenge for the health system due to their delayed healing, their high probability of recurrence and all the economic consequences that this entails. The use of cost-effective therapies to treat these wounds represents both an economic benefit for the National Health System and a clinical one, improving the physical and emotional state of the patient. Among them is negative pressure therapy (NPT), considered an advanced healing technique, which is applied to the wound bed by exerting subatmospheric pressure and achieving healing. Due to the recent expansion of its use both in the hospital and home environment due to its high efficacy, nursing professionals must have the necessary knowledge for its application, as well as possess the relevant skills to carry out and instruct the patient on the technique. It will also require a close monitoring process to check that there are no complications and that the therapy is proving effective. Grado en Enfermería
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- 2022
44. Cost-effectiveness of the CNIC-Polypill versus separate monocomponents in cardiovascular secondary prevention in Spain.
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González-Domínguez A, Durán A, Hidalgo-Vega Á, and Barrios V
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- Adult, Humans, Cost-Benefit Analysis, Secondary Prevention methods, Spain, Atorvastatin, Ramipril therapeutic use, Quality-Adjusted Life Years, Aspirin therapeutic use, Cardiovascular Diseases prevention & control
- Abstract
Introduction and Objectives: Despite advances in treatment, cardiovascular disease is the second leading cause of death in Spain. The objective of this study was to determine the cost-effectiveness of the CNIC-Polypill strategy (acetylsalicylic acid 100 mg, atorvastatin 20/40 mg, ramipril 2.5/5/10 mg) compared with the same separate monocomponents for the secondary prevention of recurrent cardiovascular events in adults in Spain., Materials and Methods: A Markov cost-utility model was adapted considering 4 health states (stable, subsequent major adverse cardiovascular event, subsequent ischemic stroke and death) and the SMART risk equation over a lifetime horizon from the perspective of the Spanish National Healthcare System. The CNIC-Polypill strategy was compared with monocomponents in a hypothetical cohort of 1000 secondary prevention patients. Effectiveness, epidemiological, cost and utilities data were obtained from the NEPTUNO study, official databases and literature. Outcomes were costs (in 2021 euros) per life-year (LY) and quality-adjusted LY (QALY) gained. A 3% discount rate was applied. Deterministic one-way and probabilistic sensitivity analyses evaluated the robustness of the model., Results: The CNIC-Polypill strategy in secondary prevention results in more LY (13.22) and QALY (11.64) gains at a lower cost than monocomponents. The CNIC-Polypill is dominant and saves є280.68 per patient compared with monocomponents. The probabilistic sensitivity analysis shows that 82.4% of the simulations are below the threshold of є25,000 per QALY gained., Conclusions: The CNIC-Polypill strategy in secondary cardiovascular prevention is cost-effective compared with the same separate monocomponents, resulting in a cost-saving strategy to the Spanish National Healthcare System., (Copyright © 2023 The Author(s). Published by Elsevier España, S.L.U. All rights reserved.)
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- 2023
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- View/download PDF
45. [Tumour necrosis factor (TNF) antagonist therapy for paediatric inflammatory bowel disease: A systematic review].
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Martín-García P, Alonso-Arroyo A, and Catalá-López F
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- Humans, Child, Adalimumab therapeutic use, Infliximab therapeutic use, Tumor Necrosis Factor Inhibitors therapeutic use, Tumor Necrosis Factor-alpha, Crohn Disease drug therapy, Colitis, Ulcerative drug therapy, Inflammatory Bowel Diseases drug therapy
- Abstract
Inflammatory bowel disease includes two chronic inflammatory diseases, ulcerative colitis and Crohn's disease. The burden of disease is increasing worldwide. A few reviews evaluating the paediatric use of tumour necrosis factor (TNF) antagonists have been published, although these mostly include observational studies and do not consider economic evaluations. This systematic review evaluated the available evidence regarding the efficacy, safety, and cost-effectiveness of TNF antagonist therapy for paediatric inflammatory bowel disease. We searched PubMed/MEDLINE, Embase, and Cochrane Central (up to May 2022). Nine randomized clinical trials and four economic evaluations that examined any anti-TNF drugs (e.g., infliximab, adalimumab, golimumab, and certolizumab) against different alternatives were included. In studies evaluating the efficacy of anti-TNF drugs in Crohn's disease, most assessed the efficacy of maintenance regimen in patients who had previously responded to induction (response=28%-63%, and clinical remission=17%-83% depending on dose, drug, and follow-up). In ulcerative colitis, maintenance treatment with anti-TNF drugs reported clinical remission rates between 17% and 44%. Nine studies reported information on adverse events. No clinical trials comparing different anti-TNF drugs were found. The findings from this review suggest that maintenance treatment with anti-TNF drugs (such as infliximab and adalimumab) in paediatric inflammatory bowel disease is probably effective and safe. However, the economic evaluations reported contradictory results of the cost-effectiveness ratios. Protocol registry: Open Science Framework: https://osf.io/wjmvf., (Copyright © 2023 Elsevier España, S.L.U. All rights reserved.)
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- 2023
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46. Usefulness of a Cardiovascular Polypill in the Treatment of Secondary Prevention Patients in Spain: A Cost-effectiveness Study.
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Barrios, Vivencio, Kaskens, Lisette, Castellano, José María, Cosin-Sales, Juan, Ruiz, José Emilio, Zsolt, Ilonka, Fuster, Valentín, and Gracia, Alfredo
- Abstract
Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2017
- Full Text
- View/download PDF
47. InnovaSEC in Action: Cost-effectiveness of Barostim in the Treatment of Refractory Hypertension in Spain.
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Soto, Marcelo, Sampietro-Colom, Laura, Sagarra, Joan, and Brugada-Terradellas, Josep
- Abstract
Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2016
- Full Text
- View/download PDF
48. Cost Effectiveness of Outpatient Asthma Clinics.
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Pérez de Llano, Luis A., Villoro, Renata, Merino, María, Neira, Maria del Carmen Gómez, Muñiz, Camino, and Hidalgo, Álvaro
- Abstract
Copyright of Archivos de Bronconeumología (English Edition) is the property of Sociedad Espanola de Neumologia y Cirugia Toracica (SEPAR) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2016
- Full Text
- View/download PDF
49. Análisis de la relación coste-efectividad de la acarbosa en el tratamiento de pacientes con intolerancia a la glucosa Cost-effectiveness analysis of acarbose in the treatment of patients with impaired glucose tolerance
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Ramón Sabés
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Evaluación económica ,Coste-efectividad ,Acarbosa ,Prevención de diabetes ,Eventos cardiovasculares ,Economic evaluation ,Cost-effectiveness ,Acarbose ,Diabetes prevention ,Cardiovascular events ,Public aspects of medicine ,RA1-1270 - Abstract
Objetivo: Realizar un análisis de la relación coste-efectividad del tratamiento farmacológico con acarbosa en pacientes con diagnóstico de intolerancia a la glucosa (ITG) y compararlo con la práctica habitual (medidas higiénico-dietéticas y sin tratamiento farmacológico) desde la perspectiva del financiador público. Material y método: A partir de los datos de eficacia provenientes del ensayo clínico STOP-NIDDM respecto a la incidencia de la diabetes mellitus tipo 2 (DM2) y los eventos cardiovasculares (ECV) en los 2 grupos del ensayo (acarbosa y placebo). Se modelizan las consecuencias sanitarias y económicas de los 2 tratamientos en poblaciones de 1.000 individuos, durante un período de 40 meses, mediante un árbol de decisión. Los datos sobre el coste de los recursos se refieren al sistema sanitario español. Resultados: En el caso base del estudio, el tratamiento con acarbosa resulta ligeramente dominante respecto de la práctica habitual, ya que presenta mejores resultados con un coste incluso algo inferior. El análisis de sensibilidad pone de relieve que el tratamiento con acarbosa deja de ser dominante para pasar a presentar, en algunos casos, una relación de coste por transición a DM2 evitada moderadamente positiva; la relación coste-efectividad es especialmente sensible al coste de los tratamientos cardiovasculares, al riesgo de transición a DM2, a la dosis diaria de acarbosa y a la proporción del coste del medicamento a cargo del financiador público. Conclusiones: El tratamiento con acarbosa en pacientes con diagnóstico de intolerancia a la glucosa resulta dominante en comparación con la práctica habitual. El coste por transición a DM2 evitada y por individuo adicional libre de ECV es moderadamente positivo en algunos de los supuestos introducidos en el análisis de sensibilidad. Para evaluar de una forma más completa el posible tratamiento a pacientes con ITG, sería necesario ampliar las alternativas que se han comparado y el horizonte temporal del estudio y utilizar alguna medida de resultados en salud que tenga en cuenta los efectos del tratamiento.Objective: To perform a cost-effectiveness analysis of treatment with acarbose in patients with impaired glucose tolerance (IGT) in comparison with conventional treatment (based on medical counseling on diet and health and without drug treatment) from the perspective of the public payer. Material and method: A cost-effectiveness analysis was performed using data on efficacy, the incidence of diabetes mellitus type 2 (DM2) and cardiovascular events from the STOP-NIDDM clinical trial of acarbose treatment vs. placebo. The study used a decision tree analysis to estimate the health and economic impact of the two alternative treatments in a population of 1,000 patients over a period of 40 months. Resource use and cost data refer to the Spanish health care system. Results: In the base case, acarbose treatment was slightly dominant over conventional treatment since it achieved improved outcomes at an even lower cost. Sensitivity analysis revealed that acarbose treatment lost dominance due to a moderately positive cost-effectiveness ratio for avoided progression to DM2 in some scenarios. The cost-effectiveness ratio was particularly sensitive to the cost of cardiovascular treatments, the risk of progression to DM2, the daily doses of acarbose, and the publicly funded share of the cost of this drug. Conclusions: Acarbose treatment in patients diagnosed with IGT appeared to be the dominant alternative compared with conventional treatment. The cost per avoided progression to DM2 and per additional individual free of a cardiovascular event was moderately low in some of the scenarios included in the sensitivity analysis. For a more comprehensive evaluation of the possible treatment of patients with IGT, the alternatives under comparison and the time horizon of the study would need to be increased and more refined health outcome measures, comprising all the treatment's health effects, would need to be introduced.
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- 2004
50. Coste-efectividad de la vacunación contra la varicela en adolescentes en España Cost-effectiveness of varicella vaccination in Spanish adolescents
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Isabel Peña-Rey, Napoleón Pérez-Farinós, Marta Cortés-García, and Carmen Amela-Heras
- Subjects
Varicela ,Vacunación ,Coste-efectividad ,Adolescencia ,Varicella ,Vaccination ,Cost effectiveness ,Adolescence ,Public aspects of medicine ,RA1-1270 - Abstract
Introducción: La varicela es una enfermedad muy contagiosa. En España, en 1996, el 91% de la población de 13 años la había padecido. Las complicaciones son más frecuentes en adultos. El herpes zoster puede reactivarse tras la primoinfección en un 15% de los casos. Se ha autorizado en España una vacuna en mayores de 13 años con serología negativa. Objetivo: Conocer la relación coste-efectividad de vacunar a los individuos susceptibles de la cohorte de 13 años en el año 2001 y realizar una análisis de la sensibilidad de parámetros que lo condicionan. Material y método: Árbol de decisión: programa Decission Analysis by Tree-Age. Las probabilidades y costes se calcularon con Microsof Excel. Para determinar la población se aplicó el porcentaje de susceptibilidad del estudio seroepidemiológico en España al Censo del Instituto Nacional de Estadística de 2001. Las probabilidades se calcularon con el teorema de Bayes aplicando la tasa de incidencia por edad de un país del hemisferio norte. Los datos hospitalarios se obtuvieron del conjunto mínimo de datos básicos (CMBD). Se ha utilizado la efectividad de la vacuna de Estados Unidos, con una efectividad total del 71% y parcial del 24%, representada por una varicela más leve en individuos vacunados (breakthrough). Para determinar los costes, se ha efectuado una consulta directa con diferentes fuentes. Sólo se tiene en cuenta los costes directos. Se les aplica un factor de descuento del 3%. Resultados: La vacunación contra la varicela podría evitar 27.278 casos, y evitar un caso costaría 131 euros al Sistema Nacional de Salud (SNS). Discusión: Ésta es una aproximación del coste de introducir la vacuna de la varicela en el calendario español, desde la perspectiva del pagador; sin embargo, para tomar la decisión se debería tener en cuenta factores hasta el momento desconocidos, como el efecto de la vacuna en la incidencia del herpes zoster. Con los datos disponibles hasta el momento actual, la introducción de la vacuna en la adolescencia parece la estrategia más adecuada, pero se necesita de más estudios sobre el tema.Introduction: Varicella is a highly contagious disease. In Spain, in 1996, 91% of the population aged 13 years old had been infected. The complications of varicella are more frequent in adults. Herpes zoster infection can be reactivated after the initial infection in 15%. A vaccine against varicella has recently been authorized in Spain for use in individuals aged more than 13 years old with negative serology. Objective: To determine the cost-effectiveness of vaccination of the cohort aged 13 years old in 2001 and to perform a sensitivity analysis of the parameters that are affected. Material and method: Tree decision: Decision Analysis by Tree-Age program. Probabilities and costs were calculated using Microsoft Excel. Population size was obtained from the 2001 Census of the National Institute of Statistics to which we applied the percentage of susceptibility from the seroepidemiological study in Spain. Probabilities were calculated by the Bayes Theorem, using the incidence rates by age of a country in the northern hemisphere. Hospital-related data were obtained from the minimum data set. We used the effectiveness of the vaccine licensed in the USA, with a total effectiveness of 71% and a partial effectiveness of 24%, represented by milder varicella in vaccinated individuals (breakthrough varicella). Only direct costs were considered. Costs were obtained by direct consultation of different sources. A discount rate of 3% was used. Results: Varicella vaccination could prevent 27,278 cases of the disease. Prevention of one case would cost the public health system 131 euros. Discussion: This study constitutes an approach to the cost of introducing varicella vaccination in the Spanish vaccination schedule, from the payer's perspective. However, to take a decision, some unknown factors, such as the effect of vaccination on the incidence of herpes zoster, should be assessed. With currently available data, the introduction of vaccination in adolescence would seem to be the best strategy, but further studies are needed.
- Published
- 2004
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