Gaceta sanitaria最新文献

Objective: There is evidence on the efficiency of new direct oral anticoagulants (DOAC), mostly based on experimental efficacy data, but there is also a need to assess their cost-effectiveness in routine clinical practice using patient-level data. We designed a retrospective cohort study to assess the cost-effectiveness of DOAC compared to acenocoumarol in patients with non-valvular atrial fibrillation (NVAF) with a follow-up of up to 7 years.

Method: Basque Health Service-registered patients who started oral anticoagulant treatment between 2013 and 2016 were included in the study and followed up until the end of 2019. Data were extracted from an electronic medical record management system. Effectiveness was expressed in terms of life years gained and adjusted for health-related quality of life (i.e., quality-adjusted life years [QALY]). Propensity score techniques were used to adjust the estimates for differences between groups in baseline characteristics.

Results: A total of 10,843 new users of oral anticoagulants with a mean follow-up of 4.1 years were included. The incremental cost-effectiveness ratio of DOAC compared to acenocoumarol ranged from €1,732 to €2,556/QALY, while the incremental net benefit for different willingness-to-pay thresholds was only negative for values below €3,000/QALY.

Conclusions: Based on the analysis of data from clinical practice and the similarity of results using several different techniques to adjust for bias associated with observational studies, we conclude that DOAC would be an efficient alternative for the treatment of patients with NVAF.

Objective: Provide a method for reusing National Institute of Statistics (INE) socioeconomic data and reconstructing the Spanish National Health System primary care areas (PCA) from INE census tracts.

Method: The reconstruction of PCA boundaries entailed aligning, assigning, and integrating census tracts within the limits of the PCA using 2022 INE and 2018 Atlas VPM digital maps.

Results: 36,282 census tracts were assigned to 2,405 PCA. The alignment of digital maps showed a programmatic assignment of 99.7% of the census tracts within PCA; just ten census tracts must be manually assigned. The net average income per capita distribution from INE was consistent along the newly reconstructed PCA.

Conclusions: We have proposed a reliable solution to integrate socioeconomic data from INE census statistics into PCA, enhancing data researchers' capacities in joint analyses of socioeconomic determinants and healthcare.

Objective: To analyse the seasonal variability of surgical procedures with guaranteed maximum waiting times with a view to figure out whether there are differences between urgent admissions and need-sensitive procedures, and those supply-sensitive.

Method: Retrospective longitudinal observational study with administrative data on hospital episodes of the National Health System for 14 autonomous communities, years 2003 to 2022, aggregated monthly. The elective supply-sensitive surgical procedures with guaranteed times were selected. Then, as to conduct, the comparative analyses, we selected need-sensitive elective procedures for aortic-coronary bypass surgery in patients over 40 years of age, percutaneous transluminal coronary angioplasty in patients over 40 years of age, and breast cancer surgery in adult women up to 85 years of age to compare differences in seasonal variability. Finally, in order to get a basal level of seasonal variation we used emergency admissions for hip fracture in patients over 65 years of age and admission for acute myocardial infarction in patients over 40 years of age. A multiplicative decomposition of the series was applied to calculate the seasonal rate of change, and a placebo test was applied to test the seasonal variability of health care delivery across comparison groups.

Results: Supply-sensitive elective surgery showed a marked seasonal variability, with rates of variation above 1.20 in months such as February, March, May and June, and very low values in the summer months, 0.42 in August. The placebo test confirmed significant differences with respect to the expected distribution according to working days. In contrast, in those need-sensitive procedures and emergency admissions, the seasonal variability was found to be almost non-existent.

Conclusions: A reasonable management objective for hospitals could be to reduce the monthly variability in elective supply-sensitive surgical activity through improving indication, re-organizing of human resources and incentives to reduce activity.

Objective: After expiry of the patent, price competition can lead to savings. However, in Spain, competition in the retail price of prescription off-patent medicines in pharmacies is rare, while large discounts are negotiated in the wholesale market. Some countries have moved from "competition by discount" to "competition by price". This article compares retail prices in Spain with other countries, and the factors that promote price competition.

Method: This article reviews the literature comparing prices and the factors influencing competition. A detailed analysis of the design of the market was conducted for Spain and Sweden. Interviews were conducted with experts. The systems were compared for the definition of exchange groups, prescription and substitution, how retail prices and profit margins are regulated, and safeguards to avoid risk of shortages.

Results: Depending on sample and methodology, prices in Spain may be on average 51% to 109% greater than Sweden. Broadly, the literature recommends that the off-patent market should be regulated by competitive forces rather than price caps. Spain and Sweden have many features in common. Key differences are: 1) Sweden allows price differences between medicines, and for prices to rise as well as fall, 2) the tendering process, 3) patient choice, and 4) the architecture of the exchange groups CONCLUSIONS: In Spain, first generic or biosimilar entry provokes a 25-40% discount, but thereafter prices are static. In Sweden, price competition is dynamic. This includes, within limits, freedom to set prices, product differentiation, and patient choice.

Objective: To analyze the use of resources and healthcare costs of a cohort of long-term survivors of breast cancer in four autonomous communities in Spain (Aragon, Catalonia, Madrid and Navarre) by assessing their pathways in the National Health System.

Method: Patient pathways were analyzed based on their interactions with the National Health System between 2012 and 2016. Healthcare pathways were obtained from the CONCEPT project and were use to examine resource use, associated costs, and to analyze potential differences between cohorts and regions. A total of 18,527 women were included, of whom 6115 were long-term survivors of breast cancer and 12,412 formed the control group, consisting of women with no history of the disease, matched by age and healthcare area with the survivors. Regression models were applied to analyze factors associated with the cost of trajectories.

Results: Long-term survivors of breast cancer had a higher use of healthcare resources, and a higher number of comorbidity and drug use compared to the control group, with statistically significant differences. Costs were also higher for survivors, especially in outpatient clinics. Factors such as the number of drugs, comorbidity and the Charlson index were identified as the main factors associated with higher healthcare costs in both groups.

Conclusions: This study identified the costs of healthcare pathways in long-term breast cancer survivors and suggests that the methodology used could help healthcare professionals allocate resources more efficiently.

Objective: This study investigates the health effects of loneliness among adults (18+ years) and elderly adults (60+ years).

Method: Using data from the Health Survey of Catalonia (ESCA), 2013-2019, the effects of loneliness on health and healthcare utilization outcomes are estimated. Ordinary least squares estimates are provided to explore the channels affecting such relationships.

Results: Loneliness is significantly associated to worse health outcomes in all age groups. Among adults, it reduces self-perceived health by 7.1%, increases multi-morbidities by 22.1%, and raises the probability of depression and anxiety by 65.8%. Consequently, a positive and strong association between suffering from loneliness and the use of healthcare resources is documented: with a 7.4% rise in medication use, 20.9% more emergency care visits, and 6.1% higher primary care use. Results for the elderly are aligned with adults, although the magnitude associated to self-perceived health is substantially greater (13.2%). Channels exploration identifies living alone (with a 97.3% increase) and poor household habitability (33.5% increase) as key predictors in all the analysis. Being foreign (60.3% increase in the adult population and 106% in the elderly population) and gender (women, 26.8% for the adult population and 27.5% in the elderly population) become relevant factors explaining loneliness.

Conclusions: This study documents the impact of loneliness in Catalonia. Loneliness is associated to significant worse health and more use of healthcare. Tackling individuals with higher risk factors for loneliness could help preventing its concerning consequences on health and healthcare system.

Objective: To analyze the effectiveness and cost-effectiveness of non-pharmacological interventions for functional somatic disorders through a review of systematic reviews with meta-analysis and economic evaluations.

Method: Searches were carried out in PubMed/MEDLINE, EMBASE, Cochrane Database of Systematic Reviews and PsycINFO (until June 2024). Outcome measures were improvement in symptoms (for systematic reviews) and incremental cost-effectiveness ratio (for economic evaluations). Methodological quality was assessed with AMSTAR-2 for systematic reviews and with QHES for economic evaluations. A narrative synthesis of the studies was performed, without meta-analysis.

Protocol registration: Open Science Framework (https://osf.io/u3w2b/).

Results: 32 studies were included (27 systematic reviews and 5 economic evaluations). All systematic reviews included randomized trials, except 2 that also included non-randomized studies. In systematic reviews, the most studied conditions were gastrointestinal disorders (12/27) and physical symptoms not explained by an organic pathology (6/27), while in economic evaluations they were undifferentiated somatoform disorders (2/5). The systematic reviews that included comparisons of psychological therapies, mindfulness and herbal medicine seemed to indicate improvements in symptoms. However, those systematic reviews that included acupuncture were inconclusive. All economic evaluations were associated with randomized trials. The incremental cost-effectiveness ratios were dominant (less costs, more effective) in 2 studies evaluating cognitive behavioral therapy. Of the systematic reviews, 20 presented critically low quality, 5 low quality and 2 moderate quality, while the 5 economic evaluations presented high quality.

Conclusions: The evidence on the effectiveness and cost-effectiveness of non-pharmacological interventions for functional somatic disorders should be interpreted with caution since the majority of the systematic reviews were of low or critically low methodological quality, and with a high level of uncertainty in the case of economic evaluations. The diversity of definitions of the diagnosis and interventions makes it difficult to generalize these results.

Objective: To highlight the differences in pricing applied to health interventions by the autonomous communities, as well as the heterogeneous definition of the basic list of services.

Method: A comparative analysis of the prices of representative procedures included in the common basket of health services was conducted, based on information from official publications of the autonomous communities.

Results: Significant prices variations for the same intervention were identified across autonomous communities, along with notable heterogeneity in service definitions.

Conclusions: The Interterritorial Council should promote transparency in the criteria used to set prices and enhance the coordination of regional health services in the definition, implementation, and development of analytical accounting systems. Additionally, it should standardize the specification of services included in the common basket of benefits to facilitate the analysis of regional differences in production costs.