Relationship between efficiency and clinical effectiveness indicators in an adjusted model of resource consumption : a cross-sectional study

Background: Adjusted clinical groups (ACG®) have been widely used to adjust resource distribution; however, the relationship with effectiveness has been questioned. The purpose of the study was to measure the relationship between efficiency assessed by ACG® and a clinical effectiveness indicator in adults attended in Primary Health Care Centres (PHCs). Methods: Research design: cross-sectional study. Subjects: 196, 593 patients aged >14 years in 13 PHCs in Catalonia (Spain). Measures: Age, sex, PHC, basic care team (BCT), visits, episodes (diagnoses), and total direct costs of PHC care and co-morbidity as measured by ACG® indicators: Efficiency indices for costs, visits, and episodes (costs EI, visits EI, episodes EI); a complexity or risk index (RI); and effectiveness measured by a general synthetic index (SI). The relationship between EI, RI, and SI in each PHC and BCT was measured by multiple correlation coefficients (r). Results: In total, 56 of the 106 defined ACG® were present in the study population, with five corresponding to 44.5% of the patients, 11 to 68.0% of patients, and 30 present in less than 0.5% of the sample. The RI in each PHC ranged from 0.9 to 1.1. Costs, visits, and episodes had similar trends for efficiency in six PHCs. There was moderate correlation between costs EI and visits EI (r = 0.59). SI correlation with episodes EI and costs EI was moderate (r = 0.48 and r = −0.34, respectively) and was r = −0.14 for visits EI. Correlation between RI and SI was r = 0.29. Conclusions: The Efficiency and Effectiveness ACG® indicators permit a comparison of primary care processes between PHCs. Acceptable correlation exists between effectiveness and indicators of efficiency in episodes and costs

Prevalence of severe atopic dermatitis in adults in 3 areas of Spain

The study was sponsored by Sanof

Variability in prescription drug expenditures explained by adjusted clinical groups (ACG) case-mix: A cross-sectional study of patient electronic records in primary care

<p>Abstract</p> <p>Background</p> <p>In view of rapidly increasing prescription costs, case-mix adjustment should be considered for effective control of costs. We have estimated the variability in pharmacy costs explained by ACG in centers using patient electronic records, profiled centers and physicians and analyzed the correlation between cost and quality of prescription.</p> <p>Methods</p> <p>We analyzed 65,630 patient records attending five primary care centers in Spain during 2005. Variables explored were age, gender, registered diagnosed episodes of care during 2005, total cost of prescriptions, physician and center. One ACG was assigned to each patient with ACG case-mix software version 7.1. In a two-part model, logistic regression was used to explain the incurrence of drug expenditure at the first stage and a linear mixed model that considered the multilevel structure of data modeled the cost, conditional upon incurring any expense. Risk and efficiency indexes in pharmacy cost adjusted for ACG were obtained for centers and physicians. Spearman rank correlation between physician expenditure, adjusted for ACG, and a prescription quality index was also obtained. Pediatric and adult data were analyzed separately.</p> <p>Results</p> <p>No prescription was recorded for 13% of adults and 39.6% of children. The proportion of variance of the incurrence of expenditure explained by ACGs was 0.29 in adults and 0.21 in children. For adults with prescriptions, the variance of cost explained by ACGs was 35.4%, by physician-center was 1.8% and age 10.5% (residual 52.3%). For children, ACGs explained 22.4% of cost and physician-center 10.9% (residual 66.7%). Center efficiency index for adults ranged 0.58 to 1.22 and for children 0.32 to 2.36.</p> <p>Spearman correlation between expenditure and prescription quality index was -0.36 in family physicians (p = 0.019, N = 41) and -0.52 in pediatricians (p = 0.08, N = 12).</p> <p>Conclusion</p> <p>In our setting, ACG is the variable studied that explains more variability in pharmacy cost in adults compared to physician and center. In children there is greater variability among physicians and centers not related to case-mix. In our sites, ACG is useful to profile physicians and centers using electronic records in real practical conditions. Physicians with lower pharmaceutical expenditure have higher scores for a prescription quality index.</p

Economic Burden Associated with the Treatment with a Cardiovascular Polypill in Secondary Prevention in Spain: Cost-Effectiveness Results of the NEPTUNO Study

Alberto Cordero,1,2 Regina Dalmau González-Gallarza,3 Lluis Masana,4– 6 Valentín Fuster,7,8 Jose Mª Castellano,7,9,10 José Emilio Ruiz Olivar,11 Ilonka Zsolt,11 Antoni Sicras-Mainar,12 Jose Ramón González Juanatey2,13,14 1Cardiology Service, San Juan University Hospital, Alicante, Spain; 2Cardiovascular Diseases Network Research Center (CIBERCV), Madrid, Spain; 3Cardiology Service, La Paz University Hospital, Madrid, Spain; 4Sant Joan University Hospital, Vascular Medicine and Metabolism Unit, Reus, Spain; 5Pere Virgili Institute of Health Research (IISPV), Reus, Spain; 6Center for Biomedical Research Network on Diabetes and Associated Metabolic Diseases (CIBERDEM), Reus, Spain; 7National Center for Cardiovascular Research (CNIC), Carlos III Health Institute, Madrid, Spain; 8Mount Sinai Medical Center, New York, NY, USA; 9Integral Center for Cardiovascular Diseases (CIEC), Montepríncipe University Hospital, HM Hospitales Group, Madrid, Spain; 10School of Medicine, CEU San Pablo University, Madrid, Spain; 11Corporate Medical Affairs, Ferrer, Barcelona, Spain; 12Health Economics and Outcomes Research Department, Atrys Health, Madrid, Spain; 13Cardiology Service, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain; 14Santiago de Compostela Health Research Institute (IDIS), Santiago de Compostela, SpainCorrespondence: Antoni Sicras-Mainar, Atrys Health SA, Calle Príncipe de Vergara, 132, planta 1, Madrid, 28002, Spain, Tel +34 917 819 465, Fax +34 915 776 744, Email [email protected]: The aim of this study was to estimate health-care resources utilization, costs and cost-effectiveness associated with the treatment with CNIC-Polypill as secondary prevention of atherosclerotic cardiovascular disease (ASCVD) compared to other treatments, in clinical practice in Spain.Patients and Methods: An observational, retrospective study was performed using medical records (economic results [healthcare perspective], NEPTUNO-study; BIG-PAC-database) of patients who initiated secondary prevention between 2015 and 2018. Patients were followed up to 2 years (maximum). Four cohorts were balanced with a propensity-score-matching (PSM): 1) CNIC-Polypill (aspirin+atorvastatin+ramipril), 2) Monocomponents (same separate drugs), 3) Equipotent (equipotent drugs) and 4) Other therapies ([OT], other cardiovascular drugs). Incidence of cardiovascular events, health-care resources utilization and healthcare and non-healthcare costs (2020 Euros) were compared. Incremental cost-effectiveness ratios per cardiovascular event avoided were estimated.Results: After PSM, 1614 patients were recruited in each study cohort. The accumulated incidence of cardiovascular events during the 24-month follow-up was lower in the CNIC-Polypill cohort vs the other cohorts (19.8% vs Monocomponents: 23.3%, Equipotent: 25.5% and OT: 26.8%; p< 0.01). During the follow-up period, the CNIC-Polypill cohort also reduced the health-care resources utilization per patient compared to the other cohorts, particularly primary care visits (16.6 vs Monocomponents: 18.7, Equipotent: 18.9 and OT: 21.0; p< 0.001) and hospitalization days (2.3 vs Monocomponents: 3.4, Equipotent: 3.7 and OT: 4.0; p< 0.001). The treatment cost in the CNIC-Polypill cohort was lower than that in the other cohorts (€ 4668 vs Monocomponents: € 5587; Equipotent: € 5682 and OT: € 6016; p< 0.001) (Difference: -€ 919, -€ 1014 and -€ 1348, respectively). Due to the reduction of cardiovascular events and costs, the CNIC-Polypill is a dominant alternative compared to the other treatments.Conclusion: CNIC-Polypill reduces recurrent major cardiovascular events and costs, being a cost-saving strategy as secondary prevention of ASCVD.Keywords: secondary prevention, cardiovascular events, use of healthcare resources, healthcare costs, Spain, CNIC-polypil