Relationship between patient dependence and direct medical-, social-, indirect-, and informal-care costs in Spain

Josep Darbà,1 Lisette Kaskens2 1Department of Economics, University of Barcelona, 2BCN Health Economics and Outcomes Research SL, Barcelona, Spain Objective: The objectives of this analysis were to examine how patients' dependence on others relates to costs of care and explore the incremental effects of patient dependence measured by the Dependence Scale on costs for patients with Alzheimer's disease (AD) in Spain. Methods: The Co-Dependence in Alzheimer's Disease study is an 18 multicenter, cross-sectional, observational study among patients with AD according to the clinical dementia rating score and their caregivers in Spain. This study also gathered data on resource utilization for medical care, social care, caregiver productivity losses, and informal caregiver time reported in the Resource Utilization in Dementia Lite instrument and a complementary questionnaire. The data of 343 patients and their caregivers were collected through the completion of a clinical report form during one visit/assessment at an outpatient center or hospital, where all instruments were administered. The data collected (in addition to clinical measures) also included sociodemographic data concerning the patients and their caregivers. Cost analysis was based on resource use for medical care, social care, caregiver productivity losses, and informal caregiver time reported in the Resource Utilization in Dementia Lite instrument and a complementary questionnaire. Resource unit costs were applied to value direct medical-, social-, and indirect-care costs. A replacement cost method was used to value informal care. Patient dependence on others was measured using the Dependence Scale, and the Cumulative Index Rating Scale was administered to the patient to assess multi-morbidity. Multivariate regression analysis was used to model the effects of dependence and other sociodemographic and clinical variables on cost of care. Results: The mean (standard deviation) costs per patient over 6 months for direct medical-, social-, indirect-, and informal-care costs were estimated at €1,028.10 (€1,655.00), €843.80 (€2,684.80), €464.20 (€1,639.00), and €33,232.20 (€30,898.90), respectively. Dependence was independently and significantly associated with direct medical-, social-, informal-, and total-care costs. Conclusion: The costs of care for patients with AD in Spain are substantial, with informal care accounting for the greatest part. Interventions that reduce patient dependence on caregivers may be associated with important reduction in direct medical-, social-, informal-, and total-care costs. Keywords: Alzheimer, Dependence Scale, direct medical care costs, social care costs, indirect care costs, informal care costs

Treatment persistence and adherence and their consequences on patient outcomes of generic versus brand-name statins routinely used to treat high cholesterol levels in Spain: a retrospective cost-consequences analysis

Abstract Background High blood lipoprotein concentrations are one of the major risk factors for cardiovascular diseases. Drug therapy is the base of treatment; statins in particular. Both brand-name and generic presentations are available for statin therapy of high cholesterol levels. Factors that may influence their use in routine medical practice include, among others, patient persistence and adherence to treatment as prescribed by physicians. The aim of this retrospective analysis was to provide real-world evidence of treatment persistence and adherence and their consequences on economic and patient outcomes of generic versus brand-name statins routinely used to treat high cholesterol levels in Spain. Methods Existing real-world electronic medical records abstracted from a database of two regions in Spain were analyzed. The analysis compared generic versus brand-name statins data from subjects’ who started treatment between July 1, 2010 and June 30, 2012. Treatment persistence, adherence expressed as medication possession ratio (MPR), healthcare resource utilization and their costs were analyzed together with patient’s at-goal rates of low-density-lipoprotein-cholesterol (LDL-c), incidence of any major cardiovascular event (CVE) and all-cause mortality during a 5-year follow-up period. Multivariate analyses were applied. Results A total of 13,244 records were included. Persistence was lower with generics; adjusted hazard ratio -HR- [95% confidence interval]: 0.86 [0.82–0.91], p < 0.001) and MPR was also lower: 61.5% vs. 65.1% (p < 0.001). Less patients with generics reached their LDL-c goal: 39.2% [38.3–40.2%] vs. 42.0% [40.2–43.7%]; adjusted odds ratio; 0.87 [0.80–0.95], p = 0.003. Compared to brand-name statins, the observed probability of occurrence of a CVE; HR: 1.31 [1.15–1.50], p < 0.001, and also all-cause deaths; HR: 1.36 [1.15–1.62], was significantly higher with generics; p < 0.001 in both cases. Adjusted mean total healthcare cost per patient was also higher with generic than with brand-name statins: €9118 (9059–9176) vs. €7980 (7853–8808) [adjusted difference: €1137 (997–1277), p < 0.001]. Conclusion This retrospective cost-consequences analysis found poorer treatment persistence and adherence in patients who first started therapy with generic instead of brand-name statins in routine medical practice in Spain. Also, patients receiving generics were more unlikely to reach LDL-c goals, showed increased probability of having CVE and all-cause mortality at a higher cost to payers

Economic evaluation of nimesulide versus diclofenac in the treatment of osteoarthritis in France, Italy and Spain

Objectives: to assess and compare the incremental costs of the 15-day treatment of osteoarthritis (OA) with nimuselide vs. diclofenac in France, Italy and Spain. Design: a cost-minimisation analysis was performed through a decision tree, assuming the perspective of the NHS. A meta-analysis was performed to assess the incidence of gastrointestinal adverse events (GIAEs) in patients with OA treated with nimesulide or diclofenac. Results: three studies were included in the meta-analysis. The incidence of GIAEs is higher in patients treated with diclofenac than in those treated with nimusulide. Nimesulide is cost-saving in all three countries: treatment costs are reduced by Euro 1.5 per case in France, Euro 2 in Italy and Euro 3.6 in Spain. Final results are not sensitive to variation of incidence rates of gastric and intestinal events and to changes in the resources consumption: nimesulide always remain cost-saving. Conclusions: this is the first economic analysis carried out in three different countries on original epidemiological data comparing nimesulide vs diclofenac directly. Projecting our results to the estimated OA prevalence in the entire population of the three countries, the expected savings to the NHS would vary from Euro 17,500,000 in France to a maximum of Euro 30,000,000 in Spain. It can b stated that these findings can provide support to clinicians and policy-makers for the adoption of this cost-saving treatment strategy in patients with OA

Estimating the economic consequences of an increased medication adherence due to a potential improvement in the inhaler technique with Spiromax&reg; compared with Turbuhaler&reg; in patients with moderate-to-severe chronic obstructive pulmonary disease in Spain

Josep Darb&agrave;,1 Gabriela Ram&iacute;rez,2 Juan L Garc&iacute;a-Rivero,3 Sagrario Mayoralas,4 Jos&eacute; Francisco Pascual,5 Diego Vargas,6 Adi Bijedic7 1Department of Economics, Universitat de Barcelona, 2BCN Health Economics &amp; Outcomes Research S.L., Barcelona, 3Hospital Laredo, Cantabria, 4Hospital Ram&oacute;n y Cajal, Madrid, 5Hospital General Universitario de Alicante, Alicante, 6Hospital de Alta Resoluci&oacute;n el Toyo, Andalusia, 7Market Access and HEOR Department, TEVA Pharmaceutical, Madrid, Spain Objective: The objective of this study was to estimate the economic impact of the introduction of DuoResp&reg; Spiromax&reg;, budesonide/formoterol fixed-dose combination (FDC), focusing on an increase in medication adherence due to an enhancement of the inhalation technique for the treatment of COPD patients in Spain and 5 regions including Andalusia, Catalonia, Galicia, Madrid, and Valencia.Methods: A 4-year budget impact model was developed for the time period of 2015&ndash;2018. This study aimed at evaluating the budget impact associated with the introduction of DuoResp Spiromax in comparison with Symbicort&reg; Turbuhaler&reg; and Rilast&reg; Turbuhaler. National and regional data on COPD prevalence were obtained from the literature. Input data on health care resource utilization were obtained by clinical consultation. Resource included primary care visits, specialist visits, hospitalization, and emergency room visits as well as the length of hospital stay. Based on both pharmacological and health care resource costs, overall annual treatment cost per patient was estimated in EUR 2015. Results: It was calculated that 130,777 adults were treated with budesonide/formoterol FDC delivered by a dry powder inhaler, Turbuhaler, in Spain in 2015. However, the target population decreases over the next 4 years. This pattern was observed in 4 regions, but for Andalusia, the treated population increased slightly. The overall budget savings in Spain with the market share of DuoResp Spiromax were estimated to be &euro;6.01 million for the time period of 2015&ndash;2018. Region-specific data resulted in savings of &euro;902,133 in Andalusia, &euro;740,520 in Catalonia, &euro;464,281 in Galicia, &euro;748,996 in Madrid, and &euro;495,812 in Valencia for the time period of 2015&ndash;2018. Conclusion: The introduction of budesonide/formoterol FDC delivered by Spiromax for COPD treatment is likely to contribute in a reduction of health care costs for Spain and in 5 Spanish regions. This model forecasts that Spain and these 5 Spanish regions were likely to have savings, which might be due to fewer days of hospitalization, avoided emergency room, and primary care visits. Keywords: dry powder inhaler, economic evaluation, region-specific estimates, payers&rsquo; perspectiv

Epidemiology and societal costs of gastroesophageal reflux disease and Barrett's syndrome in Germany, Italy and Spain

AIM: To estimate the economic consequences for society arising from populations with poorly treated gastroesophageal reflux disease (GERD) and Barrett's esophagus in Germany, Italy and Spain. METHODS: The following epidemiologic data were used: total population figures, the prevalence and incidence of GERD and its complications, and data on patients with poorly treated GERD, as well as data on treatment costs and active workers' presenteeism and absenteeism. These data were used to calculate the economic consequences arising from the population with poorly treated GERD and Barrett's esophagus for the healthcare system and employers in each country. RESULTS: The size of the population with poorly treated GERD with Barrett's esophagus was estimated to be 29,678 in Spain, 19,327 in Germany and 10,079 in Italy. Costs for the healthcare systems in Spain, Germany and Italy for the population with poorly treated GERD with Barrett's esophagus were estimated to be €18, 12 and 7 million, respectively, for each country. Total costs for absenteeism and presenteeism for employers due to poorly treated GERD with Barrett's esophagus were €10 million for Germany, €1 million for Italy and none for Spain. CONCLUSION: Costs due to poorly treated GERD with Barrett's esophagus represent a substantial burden for the healthcare systems of all three studied countries. Costs for employers owing to absenteeism or presenteeism of employees were low or no costs were foun

Identification of factors involved in medication compliance: incorrect inhaler technique of asthma treatment leads to poor compliance

Josep Darb&agrave;,1 Gabriela Ram&iacute;rez,2 Antoni Sicras,3 Laura Garc&iacute;a-Bujalance,4 Saku Torvinen,5 Rainel S&aacute;nchez-de la Rosa6 1Department of Economics, Universitat de Barcelona, 2BCN Health Economics &amp; Outcomes Research S.L., 3Department of Planning, Badalona Serveis Assistencials S.A., Barcelona, 4Market Access Department, Teva Pharmaceutical, Madrid, Spain; 5Market Access Department, Teva Pharmaceuticals Europe BV, Amsterdam, the Netherlands; 6Medical Department, Teva Pharmaceutical, Madrid, Spain Objective: To identify the impact of delivery device of inhaled corticosteroids and long-acting &beta;2-agonist (ICS/LABA) on asthma medication compliance, and investigate other factors associated with compliance. Materials and methods: We conducted a retrospective and multicenter study based on a review of medical registries of asthmatic patients treated with ICS/LABA combinations (n=2,213) whose medical devices were either dry powder inhalers (DPIs, such as Accuhaler&reg;, Turbuhaler&reg;, and NEXThaler&reg;) or pressurized metered-dose inhalers (pMDI). Medication compliance included persistence outcomes through 18 months and medication possession ratios. Data on potential confounders of treatment compliance such as asthma exacerbations, comorbidities, demographic characteristics, and health care resource utilization were also explored. Results: The probability of asthma medication compliance in case of DPIs was lower compared to pMDIs, which suggests that inhaler devices influence inhalation therapies. There were additional confounding factors that were considered as explanatory variables of compliance. A worse measure of airflow obstruction (forced expiration volume in 1 second), comorbidities and general practitioner (GP) consultations more than once per month decreased the probability of compliance. Within comorbidities, alcoholism was positively associated with compliance. Patients of 29&ndash;39, 40&ndash;50, and 51&ndash;61 age groups or suffering from more than two exacerbations during the study period were more likely to comply with their medication regime. The effects of DPIs toward compliance varied with the different DPIs. For instance, Accuhaler&reg; had a greater negative effect on compliance compared to Turbuhaler&reg; and Nexthaler&reg; in cases of patients who suffered exacerbations. We found that GP consultations reduced the probability of medication compliance for patients treated with formoterol/budesonide combination. For retired patients, visiting the GP increased the probability of medication compliance. Conclusion: We concluded that inhaler devices influence patients&rsquo; compliance for long-term asthma medication. The impact of Accuhaler&reg;, Turbuhaler&reg;, and NEXThaler&reg; on medication compliance was negative. We also identified some confounders of medication compliance such as patient&rsquo;s age, severity of asthma, comorbidities, and health care costs. Keywords: adherence, inhaler devices, medication possession ratio, dry powder inhalers, pressurized metered-dose inhalers, persistenc