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Background The provision of healthcare during the pandemic caused by the SARS-CoV-2 virus represented a challenge for the management of the resources in the primary care centres. We proposed assessing burnout among the staff of those centres and identifying factors that contributed to its appearance and those that limited it. Methods An observational study which, by means of anonymous questionnaires, collected information about: (i) demographic variables; (ii) the characteristics of each position; (iii) the measures implemented by the medical decision-makers in order to provide care during the pandemic; and (iv) the Burnout Clinical Subtype Questionnaire (BCSQ-36). We performed a descriptive analysis of the burnout mentioned by the staff, and, by means of a multivariate analysis, we identified the factors which influenced it. Using logit models, we analysed whether receiving specific training in COVID-19, feeling involved in decision-making processes, and/or working within different healthcare systems had effects on the development of burnout. Results We analysed the replies of 252 employees of primary care centres in Spain with an average age of 45 (SD = 15.7) and 22 (SD = 11.4) years of experience. 68% of the participants (n = 173) indicated burnout of the frenetic subtype. 79% (n = 200) of the employees had high scores in at least one burnout subtype, and 62% (n = 156) in at least two. Women older than 45 had a lower probability of suffering burnout. Receiving specific training (OR = 0.28; CI95%: 0.11–0.73) and feeling involved in decision-making (OR = 0.32; CI95%:0.15–0.70) each reduced the probability of developing burnout. Working in a different department increased the likelihood of developing burnout of at least one clinical subtype (OR = 2.85; CI95%: 1.38–5.86). Conclusions The staff in primary care centres have developed high levels of burnout. Participation in decision-making and receiving specific training are revealed as factors that protect against the development of burnout. The measures taken to contain the adverse effects of a heavy workload appear to be insufficient. Certain factors that were not observed, but which are related to decisions taken by the healthcare management, appear to have had an effect on the development of some burnout subtypes.

Background The COVID-19 pandemic has changed the organisational and management strategies of healthcare institutions such as primary care centres. Organisational culture as well as leadership style are key issues for the success of these institutions. Due to the multidimensional nature of identity processes, it is necessary to explore the changes experienced by health professionals from these perspectives. This study explores health professionals’ organisational and management strategies in primary care settings during the COVID-19 pandemic. Design Qualitative, exploratory study based on the analysis of participants’ accounts within a hermeneutic phenomenologicaly approach. Methods Research was conducted in primary care settings in two neighbouring Spanish healthcare regions. The sample included participants with different demographics (gender, age), professional roles (practice managers, general practitioners, paediatricians), employment status (permanent, temporary, zero-hours), and years of experience (under or over ten years’ experience). Data were collected between July and December 2020 through focus groups and in-depth, semi-structured individual interviews. Results A total of 53 primary care workers participated in the study, of which 38 were individually interviewed and 15 participated in three focus groups. Of these, 78.4% were healthcare professionals, 49% were female nurses, and 70.5% had more than 10 years of work experience in primary care. Two main themes emerged: “liquid” healthcare and “the best healthcare system in the world”. During the first wave of the COVID-19 pandemic, new, more fluid organisational and management models were implemented in primary care settings, which have remained in place since. Primary care workers’ perceived a lack of appreciation and inclusion in decision-making that risked their alienation and disengagement. Conclusion Primary care workers’ professional identity became gradually blurred due to shifting perceptions of their professional roles in a context of increasing improvisation and flexible working practices. This affected their professional performance. Trial Registration The study was approved by the Clinical Research Ethical Committee of the Talavera de la Reina Integrated Management Area (CEIm del AGI de Talavera de la Reina in Spain, Hospital Nuestra Señora del Prado, ref: 23/2020).

Background Tenosynovial Giant-Cell Tumour (TGCT) is a benign clonal neoplastic proliferation arising from the synovium, causing a variety of symptoms and often requiring repetitive surgery. This study aims to define the economic burden—from a societal perspective—associated with TGCT patients and their health-related quality of life (HRQOL) in six European countries. Methods This article analyses data from a multinational, multicentre, prospective observational registry, the TGCT Observational Platform Project (TOPP), involving hospitals and tertiary sarcoma centres from six European countries (Austria, France, Germany, Italy, the Netherlands, and Spain). It includes information on TGCT patients’ health-related quality of life and healthcare and non-healthcare resources used at baseline (the 12-month period prior to the patients entering the registry) and after 12 months of follow-up. Results 146 TGCT patients enrolled for the study, of which 137 fulfilled the inclusion criteria. Their mean age was 44.5 years, and 62% were female. The annual average total costs associated with TGCT were €4866 at baseline and €5160 at the 12-month follow-up visit. The annual average healthcare costs associated with TGCT were €4620 at baseline, of which 67% and 18% corresponded to surgery and medical visits, respectively. At the 12-month follow-up, the mean healthcare costs amounted to €5094, with surgery representing 70% of total costs. Loss of productivity represented, on average, 5% of the total cost at baseline and 1.3% at follow-up. The most-affected HRQOL dimensions, measured with the EQ-5D-5L instrument, were pain or discomfort, mobility, and the performance of usual activities, both at baseline and at the follow-up visit. Regarding HRQOL, patients declared a mean index score of 0.75 at baseline and 0.76 at the 12-month follow-up. Conclusion The results suggest that TGCT places a heavy burden on its sufferers, which increases after one year of follow-up, mainly due to the healthcare resources required—in particular, surgical procedures. As a result, this condition has a high economic impact on healthcare budgets, while the HRQOL of TGCT patients substantially deteriorates over time.

Background: The economic burden of diabetes from a societal perspective is well docu mented in the cost-of-illness literature. However, the effect of considering social costs in the results and conclusions of economic evaluations of diabetes-related interventions remains unknown. Objective: To investigate whether the inclusion of social costs (productivity losses and/or informal care) might change the results and conclusions of economic evaluations of diabetes related interventions. Methods: A systematic review was designed and launched on Medline and the Cost Effectiveness Analysis Registry from the University of Tufts, from the year 2000 until 2018. Included studies had to fulfil the following criteria: i) being an original study published in a scientific journal, ii) being an economic evaluation of an intervention on diabetes, iii) including social costs, iv) being written in English, v) using quality-adjusted life years as outcome, and vi) separating the results according to the perspective applied. Results: From the 691 records identified, 47 studies (6.8%) were selected. Productivity losses were included in 45 of the selected articles (73% used the human capital approach) whereas informal care costs in only 13 (when stated, the opportunity cost method was used in seven studies and the replacement cost in one). The 47 studies resulted in 110 economic evaluation estimations. The inclusion of social costs changed the conclusions in 8 estimations (17%), 6 of them switching from not cost-effective from the healthcare perspective to cost-effective or dominant from the societal per spective. Considering social costs altered the results from cost-effective to dominant in 9 estimations (19%). Conclusion: When social costs are considered, the results and conclusions of economic evaluations performed in diabetes-related interventions can alter. Wide methodological variations have been observed, which limit the comparability of studies and advocate for the inclusion of a wider perspective via the consideration of social costs in economic evaluations and methodological guidelines relating to their estimation and valuation.

Spinal muscular atrophy (SMA) is one of the most common severe hereditary diseases of infancy and early childhood. The progression of this illness causes a high degree of disability, hence, a significant burden is experienced by individuals with this disease and their families. We analyzed the time taken to care for patients suffering from SMA in European countries and the burden on their informal caregivers. We designed a cross-sectional study recording data from France, Germany, Spain and the United Kingdom. The primary caregivers completed a self-administered questionnaire that included questions about the time of care, The Zarit Burden Interview, type of SMA and socio-demographic characteristics. Multivariate analyses were used to study the associations between the type of SMA, time of care and burden supported by informal caregivers. The caregivers provided 10.0 h (SD = 6.7) per day of care (the principal caregivers provided 6.9 h, SD = 4.6). The informal caregivers of patients with type I SMA had a 36.3 point higher likelihood (p &lt, 0.05) of providing more than 10 hours of care per day in comparison with caregivers of patients with type III SMA. The severity of the disease was associated with more time of care and a higher burden on the caregivers.

Background: this study aimed to estimate the economic impact and health-related quality of life (HRQOL) of patients with spinal muscular atrophy (SMA) in three European countries. It was used a cross-sectional study carried out in France, Germany, and the United Kingdom. Data were collected from July 2015 to November 2015. Healthcare costs (hospitalizations, emergencies, medical tests, drugs used, visits to general practitioners (GPs) and specialists, medical material and healthcare transport), and non-healthcare costs (social services and informal care) were identified and valued. EuroQol instruments, the Zarit interview, and the Barthel Index were also used to reflect the burden and the social impact of the disease beyond the cost of healthcare. Results: we included 86 children with SMA, 26.7% of them had Type I, and 73.3% Type II or III. The annual average cost associated with SMA reaches &euro, 54,295 in the UK, &euro, 32,042 in France and &euro, 51,983 in Germany. The direct non-healthcare costs ranged between 79&ndash, 86% of the total cost and the informal care costs were the main component of these costs. Additionally, people suffering from this disease have a very low health-related quality of life, and there are large differences between countries. Conclusions: SMA has a high socioeconomic impact in terms of healthcare and social costs. It was also observed that the HRQOL of affected children was extremely reduced. The figures shown in this study may help to design more efficient and equitable policies, with special emphasis on the support provided to the families or on non-healthcare aid.

The aim of this study was to estimate the incremental cost-utility ratio (ICUR) of a multi-modal intervention in frail and pre-frail subjects aged ≥70 years with type-2 diabetes versus usual care g...

Background: Breastfeeding provides health benefits for women and newborns. However, few studies have explored how these health benefits translate into economic savings. Research aim: This study aimed to estimate the healthcare costs savings generated by exclusive breastfeeding for healthy newborns. Methods: We designed a longitudinal two-group observational study that included healthy women and newborns ( N = 236) in Toledo, Spain. Over the first 6-months of the infants’ lives, we reviewed their clinical histories to determine their consumption of healthcare resources and the type of nutrition provided. The sample was categorized into two groups: exclusive breastfeeding ( n = 46) and non-exclusive breastfeeding for 6 months ( n = 190). Two-part regression models were applied to determine whether there were differences in healthcare costs between the groups. Results: The average age of the women was 32 ( SD: 5.3). The average birth weight of the newborns was 3.3 kg. ( SD: 0.38). At 6 months, 19.5% ( n = 46) of the women breastfed exclusively, 28.4% ( n = 67) combined breastfeeding with formula, and 45.8% ( n = 108) used formula only. Healthcare costs during follow-up reached €785.58 (44% for specialized care, 42% for primary care, 9.8% for medical emergencies, 3% for medications and approximately 1% for medical tests). The statistical analysis estimated a lower healthcare cost of between €454.40 and €503.50 for exclusively breastfed newborns. Conclusion: Breastfeeding generated savings in healthcare costs; therefore, it could be a cost-efficient option compared with alternatives. Researchers who evaluate the efficiency of strategies that promote breastfeeding can contribute to the sustainability of health services.

AIMS: To estimate the social-economic costs of Type 1 Diabetes Mellitus (T1DM) in patients aged 0-17 years in Spain from a social perspective. METHODS: We conducted a cross-sectional observational study in 2014 of 275 T1DM pediatric outpatients distributed across 12 public health centers in Spain. Data on demographic and clinical characteristics, healthcare utilization and informal care were collected from medical records and questionnaires completed by clinicians and patients' caregivers. RESULTS: A valid sample of 249 individuals was analyzed. The average annual cost for a T1DM patient was €27,274. Direct healthcare costs were €4070 and direct non-healthcare cost were €23,204. Informal (familial) care represented 83% of total cost, followed by medical material (8%), outpatient and primary care visits (3.1%) and insulin (2.1%). Direct healthcare cost per patient statistically differed by glycated haemoglobin (HbA1c) level [mean cost €4704 in HbA1c ?7.5% (?58mmol/mol) group vs. €3616 in HbA1c

Objectives: To analyze whether the adoption of a societal perspective would alter the results and conclusions of economic evaluations for rare disease–related healthcare technologies. Methods: A search strategy involving all the active substances considered as orphan drugs by the European Medicines Agency plus a list of 76 rare diseases combined with economic-related terms was conducted on Medline and the Cost-Effectiveness Registry from the beginning of 2000 until November 2018. We included studies that considered quality-adjusted life years as an outcome, were published in a scientific journal, were written in English, included informal care costs or productivity losses, and separated the results according to the applied perspective. Results: We found 14 articles that fulfilled the inclusion criteria. Productivity losses were considered in 12 studies, the human capital approach being the method most frequently used. Exclusively, informal care was considered in 2 articles, being valued through the opportunity cost method. The 14 articles selected resulted in 26 economic evaluation estimations, from which incremental cost-utility ratio values changed from cost-effective to dominant in 3 estimates, but the consideration of societal costs only modified the authors’ conclusion in 1 study. Conclusions: The presence of societal costs in the economic evaluation of rare diseases did not affect the conclusions of the studies except in a single specific case. In those studies where the societal perspective was considered, we did not find significant changes in the economic evaluation results due to the higher costs of treatments and the low quality-adjusted life years gained.

The aims were to determine Spanish women&rsquo, s expectations about exclusive breastfeeding (EB) and the effect of expectations and other factors on EB during the first 6 months. A prospective cohort study was conducted with 236 participants. Variables were maternal age, marital status, occupation, expectations about breastfeeding, knowledge about breastfeeding, type of delivery, type of feeding, and duration of EB. Data were collected through three personal interviews, at the hospital (before delivery) and in two telephone calls in the first and sixth months postpartum. Average age was 32.3 years (SD = 5.3), average duration of EB was 2.73 months (SD = 2.49). Of 236 women who had decided to breastfeed before birth, 201 (85.2%) offered EB after delivery. Achievement of expectations was most influenced by the decision to continue breastfeeding &lsquo, as long as I can&rsquo, (OR: 5.4, CI: 2.0&ndash, 14.6) and previous experience (OR: 3.2, CI: 1.2&ndash, 8.5). Knowledge of breastfeeding acquired from relatives (OR: 9.2, CI: 3.0&ndash, 27.9), caesarean delivery (OR: 4.6, CI: 1.7&ndash, 12.8) and maternal age (36&ndash, 40 years old) (OR: 7.5, CI: 1.8&ndash, 30.9) were associated with failure to achieve EB. Achievement of EB may depend on a woman&rsquo, s confidence in her ability to do so and on knowledge obtained in the social environment.

A correction to this paper has been published: https://doi.org/10.1007/s10198-021-01323-y

Objectives: This study assessed the health-related quality of life (HRQOL) of pediatric patients with type 1 diabetes mellitus (T1DM) and their caregivers.Methods: CHRYSTAL was an observational cross-sectional study conducted in Spain in 2014 on 275 patients under 18 years old diagnosed with T1DM. Patient/caregiver pairs were stratified by patients' HbA1c level (?7.5% versus

Background The main objective of this study was to analyse how the inclusion (exclusion) of social costs can alter the results and conclusions of economic evaluations in the field of Alzheimer’s disease interventions. Methods We designed a systematic review that included economic evaluations in Alzheimer’s disease. The search strategy was launched in 2000 and ran until November 2018. The inclusion criteria were: being an original study published in a scientific journal, being an economic evaluation of any intervention related to Alzheimer’s disease, including social costs (informal care costs and/or productivity losses), being written in English, using QALYs as an outcome for the incremental cost–utility analysis, and separating the results according to the perspective applied. Results It was finally included 27 studies and 55 economic evaluations. Around 11% of economic evaluations changed their main conclusions. More precisely, three of them concluded that the new intervention became cost-effective when the societal perspective was considered, whereas when using just the health care payer perspective, the new intervention did not result in a cost–utility ratio below the threshold considered. Nevertheless, the inclusion of social cost can also influence the results, as 37% of the economic evaluations included became the dominant strategy after including social costs when they were already cost-effective in the health care perspective. Conclusions Social costs can substantially modify the results of the economic evaluations. Therefore, taking into account social costs in diseases such as Alzheimer’s can be a key element in making decisions about public financing and pricing of health interventions.

BACKGROUND: In spite of its high prevalence and its clinical relevance, the economic impact of malnutrition has not been sufficiently explored.OBJECTIVE: To study whether malnutrition predicts total hospital healthcare costs and costs related to specialist visits, emergency department visits and hospitalization in older adults.METHODS: Concurrent cohort study in Albacete City, Spain. The study sample included 827 subjects aged 70 and over from the FRADEA Study. Mini Nutritional Assessment®-Short Form (MNA®-SF) was recorded at baseline. Use of hospital resources (hospital admissions, emergency visits, and specialist visits), and hospital healthcare costs were recorded at follow-up. Generalized linear models (GLM) adjusted for age, sex, comorbidity, polypharmacy, and disability in basic activities of daily living were used to estimate the impact of nutritional factors on total healthcare costs per person/year (€ base year 2013) as well as specialist visit costs, emergency department visit costs and hospitalization costs.RESULTS: The average cost associated with the use of health resources was 1922€/year. Subjects with MNA®-SF between 0 and 7 had an average total health cost of 3492€/year, 2744€/year in those with MNA®-SF between 8 and 11, and 1542€/year in those with MNA®-SF between 12 and 14. Of the total health cost, 67.2% was associated with hospital admission costs. Adjusted healthcare costs were 714€/year greater in subjects with malnutrition or nutritional risk. Subjects with malnutrition or nutritional risk presented an increased adjusted risk of hospitalization (OR1.72, 95% CI 1.22-2.43).CONCLUSIONS: Malnutrition assessed by MNA®-SF is a prognostic factor of high healthcare cost and use of resources in older adults.

Fundamentos: El impacto económico que causan las enfermedades va mucho más allá del gasto sanitario, transmitiéndose a la sociedad a través de diferentes dimensiones. El principal objetivo de este estudio fue estimar la evolución de las pérdidas de productividad laboral causadas por muertes prematuras en España durante el periodo 2005-2009. Métodos: Se emplearon varias fuentes estadísticas (Registro de defunciones según la causa de muerte, Encuesta de Población Activa y Encuesta de Estructura Salarial) para desarrollar un modelo de simulación basado en el enfoque de capital humano que permitió estimar las pérdidas laborales ocasionadas por muertes prematuras para el periodo analizado. Adicionalmente, se llevaron a cabo dos escenarios alternativos en los que se analizó la influencia de la evolución epidemiológica en los resultados obtenidos. Resultados: El modelo de simulación mostró una caída de las pérdidas laborales asociadas a muertes prematuras que fue desde 8.935 millones de euros en 2005 a 8.073 millones de euros en 2009. El análisis de las causas reducidas de muerte señaló que nueve causas de enfermedad (accidentes de tráfico, tumor maligno de tráquea, suicidios, infarto agudo de miocardio, SIDA, cirrosis, tumor de mama, enfermedades cerebrovasculares y cáncer de colon) supusieron el 35,6% del total de Años Potenciales de Vida Laboral Perdidos y 36,6% del total de pérdida estimada. Las pérdidas estimadas representaron el 0,98%, 0,85% y 0,77% del Producto Interior Bruto de 2005, 2007 y 2009, respectivamente. Conclusiones: Las pérdidas laborales ocasionadas por muertes prematuras en España disminuyeron sustancialmente en el periodo analizado. Esta reducción se debió fundamentalmente a la favorable evolución epidemiológica de la mortalidad prematura. Background: The economic impact caused by diseases goes far beyond health care costs and, therefore it is transferred to the society through different dimensions. The aim of this study was to estimate the productivity losses due to premature deaths caused by diseases occurred in Spain during the period 2005-2009. Methods: We used data from several sources (Death Registry, Labour Force Survey and Wage Structure Survey) to develop a simulation model based on the human-capital approach that allowed us to estimate the labour productivity losses caused by premature deaths in the period analysed. Additionally, we also carried out two alternative scenarios in which we analysed how epidemiologic data influenced our results. Results: Our model showed the estimated loss of productivity due to premature death fell from 8,935 billion euros in 2005 to 8,073 billion euros in 2009. Nine diseases (traffic accidents, malignant tumour of the trachea, suicides, acute myocardial infarction, AIDS, cirrhosis, breast tumour, cerebrovascular disease and colon cancer) accounted for 35.6% of the total Years of Potential Productive Life Lost and 36.5% of the estimated productivity losses. The estimated losses represented 0.98%, 0.85% and 0.77% of Gross Domestic Product in 2005, 2007 and 2009, respectively. Conclusions: The labour productivity losses caused by premature deaths decreased substantially in the period analysed. This reduction was mainly due to the epidemiological evolution of premature mortality.

Background The aim of this study was to determine the economic burden and health-related quality of life (HRQOL) of patients with Spinal Muscular Atrophy (SMA) and their caregivers in Spain. Methods This was a cross-sectional and retrospective study of patients diagnosed with SMA in Spain. We adopted a bottom up, prevalence approach design to study patients with SMA. The patient’s caregivers completed an anonymous questionnaire regarding their socio-demographic characteristics, use of healthcare services and non-healthcare services. Costs were estimated from a societal perspective (including healthcare costs and non-healthcare costs), and health-related quality of life (HRQOL) was assessed using the EQ-5D questionnaire. The main caregivers also answered a questionnaire on their characteristics and on their HRQOL. Results A total of 81 caregivers of patients with different subtypes of SMA completed the questionnaire. Based on the reference unitary prices for 2014, the average annual costs per patient were € 33,721. Direct healthcare costs were € 10,882 (representing around 32.3% of the total cost) and the direct non-healthcare costs were € 22,839 (67.7% of the total cost). The mean EQ-5D social tariff score for patients was 0.16, and the mean score of the EQ-5D visual analogue scale was 54. The mean EQ-5D social tariff score for caregivers was 0.49 and their mean score on the EQ-5D visual analogue scale was 69. Conclusion The results highlight the burden that SMA has in terms of costs and decreased HRQOL, not only for patients but also for their caregivers. In particular, the substantial social/economic burden is mostly attributable to the high direct non-healthcare costs.

Objectives: To pilot the feasibility of using a discrete choice experiment (DCE) design to investigate individual preferences from the decision-maker perspective regarding the use of public funding for orphan drugs and generate prior information for future experimental designs. Methods: A DCE was used on a convenience sample of participants from five European countries (England, France, Germany, Italy and Spain), exploring their preferences in distinct healthcare scenarios involving orphan drugs. A preliminary review of the empirical literature on distributive preferences informed the selection of attributes and their levels in the design. An online questionnaire was used to conduct the DCE survey. Results: A total of 199 questionnaires were completed. The five country model showed relative preference for some attributes over others: cost of treatment, improvement in health, value for money and availability of treatment alternatives received the greatest attention. However, disease severity, beginning of life, waiting times and side effects were also shown to be important social values that should not be ignored. Conclusions: The findings presented in this study provide insight about the preferences that can influence decisions on orphan drugs in different countries. This study also provides valuable prior information that could inform future DCE designs in this area.

The main aim of this study is to estimate the productivity losses caused by diseases and injuries occurred in Spain in 2009. Using several data sources from the National Statistics Institute and The National Institute of Social Security, a simulation model based on the human-capital approach is performed to estimate the labour losses due to premature deaths and disability (permanent and temporary).The total productivity losses are estimated to amount to 42,430 million of euros, of which 8,073 million of euros are due to the losses caused by premature deaths (19% of the total loss), 18,050 million of euros to permanent disability (42% of the total loss) and 16,306 million of euros to temporary disability (38.4% of the total loss). These figures represented 3.93% of the 2009 Gross Domestic Product of Spain, in other words, 60.3% of the total Public Health Expenditure in 2009. By type of disease or injury, diseases of musculoskeletal system and connective tissue accounted for 22.9% of the total loss, followed by external causes with 13.5%, metal disorders with 10.5% and tumors with 10.4%.

Schizophrenia is a disease that causes strong societal rejection and requires a significant allocation of healthcare and social resources. The chronicity and characteristics of the disease require continued care, often provided by nonprofessionals close to the person diagnosed with schizophrenia.To analyze the value of informal care associated with the loss of personal autonomy (dependency) caused by schizophrenia in Spain; to study the association between the level of dependency and the number of hours of informal care provided; and to examine the association between the level of dependency/hours of informal care and the burden borne by caregivers.We used the Survey on Disabilities, Autonomy and Dependency to obtain information on the characteristics of disabled individuals with schizophrenia and the individuals who provide them with personal care. Assessment of informal care time was performed using the proxy good method. Statistical multivariate analyses using ordered probit models were conducted to study the impact of the degree of dependency on the hours of care provided and probit models to study the burden placed on caregivers in terms of health, professional, and leisure/social dimensions.The economic value of care varies between 523.06 and 866.7 euro per week censoring at 16 hours of care per day (667.22-1,105.66 when no time censored). A primary informal caregiver of a severe or greatly dependent individual with schizophrenia was between 20.5% and 23.8% more likely to provide a high level of informal care (over 70 hours per week), between 6.1% and 6.4% less likely to provide a medium level of informal care (between 31 and 70 hours per week), and between 14.4% and 17.6% less likely to provide low-level care (30 hours or less per week). Informal caregivers who provide care for severely/greatly dependent or moderately dependent people had a higher probability of suffering from health, professional, and family/socially related problems than caregivers who cared for non-dependent people.The results show a part of the high social cost of schizophrenia in Spain. At the same time, the study provides evidence that more severe levels of dependency are positively associated with more hours of informal care and higher caregiver burden.The results show that health or social care programs targeted at persons with autonomy limitations cannot overlook the importance of informal care, since doing so would lead to inefficiencies or inequities and reduce the well-being of citizens.Information on informal care should be incorporated in the design of health and social care policies geared toward improving equity and efficiency in the allocation of social resources. Longitudinal studies of patients diagnosed with schizophrenia would provide further information on the characteristics and impact of informal care.

Background There is evidence suggesting that most thromboembolic complications could be prevented with adequate pharmacological anticoagulation. We estimated the direct health care costs of anticoagulant treatment with oral vitamin K antagonists in patients diagnosed with non-valvular atrial fibrillation. Methods This observational study examined the clinical records of patients diagnosed with non-valvular atrial fibrillation who received anticoagulant treatment with oral vitamin K antagonists. Data from clinical records were used in the study: international normalized ratio, number of monitoring visits, type of anticoagulant, hospital admissions from complications, and concomitant medication. Drug cost was calculated based on the official Spanish Ministry of Health price list. Monitoring expenses were included the cost of the medical supplies used in the procedures. Hospitalization costs were calculated using the Diagnosis Related Group price for each case. Hospital visits costs were calculated by one of four different scenarios, using either the invoice rates for the regional health care authority or cost per visit as established by analytical accounting methods. Results We collected data from 1,257 patients diagnosed with non-valvular atrial fibrillation who were receiving oral anticoagulant therapy. Depending on the scheme used, the direct health care costs for these patients ranged from €423,695 - €1,436,038 per annum. The average cost per patient varied between €392 - €1,341, depending on the approach used. Patients with international normalized ratio values within the therapeutic range on 25% of their visits represented an average cost between €441.70 - €1,592. Those within the therapeutic range on 25%–50% of visits had associated costs of €512.37 - €1,703.91. When international normalized ratio values were within the therapeutic range on 50% - 75% of the visits, the costs ranged between €400.80- €1,375.74. The average cost was €305.23 - €1,049.84 when the values were within the therapeutic range for over 75% of visits. Conclusions Most direct health care costs associated with the sampled patients arise from the specialist-care monitoring required for the treatment. Good monitoring is inversely related to direct health care costs.

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