A multiple stakeholder multicriteria decision analysis in diabetic macular edema management: the MULTIDEX‑EMD study

Background The clinical and economic management of retinal diseases has become more complex following the introduction of new intravitreal treatments. Multicriteria decision analysis (MCDA) ofers the potential to overcome the challenges associated with traditional decision-making tools. Objectives A MCDA to determine the most relevant criteria to decision-making in the management of diabetic macular edema (DME) based on the perspectives of multiple stakeholders in Spain was developed. This MCDA was termed the MULTIDEX-EMD study. Methods Nineteen stakeholders (7 physicians, 4 pharmacists, 5 health authorities and health management experts, 1 psychologist, and 2 patient representatives) participated in this three-phase project. In phase A, an advisory board defned all of the criteria that could infuence DME treatment decision-making. These criteria were then screened using a discrete choice experiment (DCE) (phase B). Next, a multinomial logit model was ftted by applying the backward elimination algorithm (relevant criteria: p value<0.05). Finally, the results were discussed in a deliberative process (phase C). Results Thirty-one criteria were initially defned (phase A) and grouped into 5 categories: efcacy/efectiveness, safety, organizational and economic impact, patient-reported outcomes, and other therapeutic features. The DCE results (phase B) showed that 10 criteria were relevant to the decision-making process for a 50- to 65-year-old DME patient: mean change in best corrected visual acuity (p value<0.001), percentage of patients with an improvement of ≥15 letters (p value<0.001), efect duration per administration (p value=0.008), retinal detachment (p value<0.001), endophthalmitis (p value=0.012), myocardial infarction (p value<0.001), intravitreal hemorrhage (p value=0.021), annual treatment cost per patient (p value=0.001), health-related quality of life (HRQoL) (p value=0.004), and disability level (p value=0.021). Conclusions From a multi-stakeholder perspective, the selection of an appropriate treatment for DME patients should guarantee patient safety and maximize the visual acuity improvement and treatment efect duration. It should also contribute to system sustainability by being afordable, it should have a positive impact on HRQoL, and it should prevent disability

Riesgo cardiovascular en el estudio área de Toledo

Dentro del Estudio Área de Toledo, y en una muestra aleatoria de un total de 53 adolescentes de entre 16 y 17 años, pertenecientes a 50 familias, se obtuvieron datos antropométricos, hormonales y lipoproteicos al igual que los del nacimiento, junto con los de sus progenitores. Además se procedió a evaluar la ingesta de alimentos y hábitos nutricionales, su consumo de energía y nutrientes, así como del desarrollo precoz de biomarcadores mayores y condicionales de riesgo cardiovascular y de resistencia/sensibilidad a la insulina, para identificar a los sujetos en riesgo cardiovascular y de síndrome metabólico en edades tempranas. Los datos obtenidos han permitido comprobar el valor pronóstico de la determinación de lípidos y lipoproteínas al nacimiento y permiten definir un grado elevado de asociación familiar, preferentemente materno-filial, para muchos marcadores antropométricos, de riesgo cardiovascular y de resistencia/sensibilidad a la insulina, así como de calidad de la dieta. [ABSTRACT] In the environment of Toledo Study Area, and in a random sample of 53 adolescents from 16 to 17 years, belonging to 50 families, we obtained anthropometric, hormonal and lipid profile data (the same at birth), and also their progenitors data. In addition we proceeded to evaluate food intake and nutritional habits, nutrients and energy consumption, as well as early development of major and conditional cardiovascular risk factors biomarkers and insulin resistance-sensitivity, to identify subjects with cardiovascular risk and metabolic syndrome in early ages. The obtained information has allowed us to determine predictive value of lipids and lipoproteins measurement at birth and to define the high degree of familiar association, preferably mother related, for many anthropometric markers, cardiovascular risk markers and insulin resistance-sensitivity, as well as diet quality