Epidemiological trends of HIV/HCV coinfection in Spain, 2015-2019

Altres ajuts: Spanish AIDS Research Network; European Funding for Regional Development (FEDER).Objectives: We assessed the prevalence of anti-hepatitis C virus (HCV) antibodies and active HCV infection (HCV-RNA-positive) in people living with HIV (PLWH) in Spain in 2019 and compared the results with those of four similar studies performed during 2015-2018. Methods: The study was performed in 41 centres. Sample size was estimated for an accuracy of 1%. Patients were selected by random sampling with proportional allocation. Results: The reference population comprised 41 973 PLWH, and the sample size was 1325. HCV serostatus was known in 1316 PLWH (99.3%), of whom 376 (28.6%) were HCV antibody (Ab)-positive (78.7% were prior injection drug users); 29 were HCV-RNA-positive (2.2%). Of the 29 HCV-RNA-positive PLWH, infection was chronic in 24, it was acute/recent in one, and it was of unknown duration in four. Cirrhosis was present in 71 (5.4%) PLWH overall, three (10.3%) HCV-RNA-positive patients and 68 (23.4%) of those who cleared HCV after anti-HCV therapy (p = 0.04). The prevalence of anti-HCV antibodies decreased steadily from 37.7% in 2015 to 28.6% in 2019 (p < 0.001); the prevalence of active HCV infection decreased from 22.1% in 2015 to 2.2% in 2019 (p < 0.001). Uptake of anti-HCV treatment increased from 53.9% in 2015 to 95.0% in 2019 (p < 0.001). Conclusions: In Spain, the prevalence of active HCV infection among PLWH at the end of 2019 was 2.2%, i.e. 90.0% lower than in 2015. Increased exposure to DAAs was probably the main reason for this sharp reduction. Despite the high coverage of treatment with direct-acting antiviral agents, HCV-related cirrhosis remains significant in this population

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

An Economic Comparison in the Elderly of Adjuvanted Quadrivalent Influenza Vaccine with Recombinant Quadrivalent Influenza Vaccine in Spain

Influenza infections impose a high burden of morbidity and mortality among older adults, at great cost to individuals and society. Enhanced influenza vaccines, which contain either an immune adjuvant or higher than normal doses of influenza virus antigens, are recommended for older adults. We used a health economics model to evaluate the cost effectiveness in Spain of a recently licensed recombinant quadrivalent influenza vaccine (QIVr), which contains three times the standard dose of influenza virus hemagglutinin but no neuraminidase, compared with an MF59-adjuvanted quadrivalent influenza vaccine (aQIV). Based on current tender prices in Spain and a conservative assumption that QIVr is 10.7% relatively more effective than aQIV, the incremental cost-effectiveness ratio (ICER) for QIVr was EUR 101,612.41 per quality-adjusted life year (QALY) gained. To meet the Spanish willingness-to-pay threshold of EUR 25,000 per QALY gained, QIVr would need to be 34.1% relatively more effective than aQIV. In a probabilistic sensitivity analysis conducted to confirm the robustness of the analysis, 99.7% of simulations for QIVr were higher than the willingness-to-pay curve. These findings suggest that QIVr is not currently a cost-effective influenza vaccine option relative to aQIV for older persons living in Spain

Trasplante renal de donante vivo incompatible: Actualización

YesEl trasplante renal de donante vivo incompatible (TRDVI) es la donación, por parte de un donante vivo, de un riñón que presenta incompatibilidad sanguínea ABO y/o HLA con el receptor. En un informe anterior, similar a este, publicado en 2014 por AETSA, se consideró que la evidencia era escasa y de baja calidad, aunque con resultados concordantes, en términos de la supervivencia del injerto y la supervivencia y mortalidad de los pacientes sometidos a este tipo de trasplante. Hemos considerado recomendable una actualización ese informe de 2014 puesto que se han publicado numerosos estudios, e incluso una evaluación económica, sobre este asunto. A pesar de la variabilidad y la mediana calidad de los estudios primarios que han sido valorados en esta ocasión, los resultados mostrados son consistentes y se mantienen las afirmaciones del informe anterior de 2014. La supervivencia del injerto y de los pacientes sometidos a TRDVI con incompatibilidad HLA son altas y comparables, aunque ligeramente inferiores, en general, a los valores ofrecidos por los trasplantes ABOi. En los estudios sobre ABOi, los resultados recopilados sobre ambas variables de supervivencia mantienen las afirmaciones del informe anterior, manteniéndose en valores altos y comparables a trasplantes ABOc

Adaptación informe “C-reactive protein point-of-care testing (CRP-poct) to guide antibiotic prescribing in primary care settings for acute respiratory tract infections”. Executive summary

Este documento ha sido realizado por la AETSA, Evaluación de Tecnologías Sanitarias de Andalucía en el marco de la financiación del Ministerio de Sanidad, Consumo y Bienestar Social para el desarrollo de las actividades del Plan anual de Trabajo de la Red Española de Agencias de Evaluación de Tecnologías Sanitarias y Prestaciones del SNS, aprobado en el Pleno del Consejo Interterritorial del SNS de 15 de noviembre de 2018 (conforme al Acuerdo del Consejo de Ministros de 7 de diciembre de 2018)YesSe ha realizado un informe de evaluación de la eficacia, seguridad y efectividad de la determinación de la proteína C reactiva a la cabecera del paciente para las infecciones agudas del tracto respiratorio en atención, a partir de la adopción del informe de EUnetHTA sobre la misma tecnología complementado con la adaptación al contexto español de algunos de sus apartados incluida una revisión de la evaluación económica de la tecnología

Criterios de calidad y de buenas prácticas en organismos dedicados a la evaluación de tecnologías sanitarias: línea de desarrollos metodológicos de la Red Española de Agencias de Evaluación de Tecnologías Sanitarias y Prestaciones del SNS

Este documento ha sido financiado por el Ministerio de Sanidad, Servicios Sociales e Igualdad, en el marco del plan anual de trabajo de la Red Española de Agencias de Evaluación de Tecnologías y Prestaciones del SNS, aprobado en el Pleno del Consejo Interterritorial de 13 de abril de 2016.YesEl objetivo de este proyecto es proporcionar una herramienta que recoja los criterios de calidad y buenas prácticas a seguir por las distintas agencias y organismos pertenecientes a Redets. Liderado por AETSA y con la participación de todos los nodos de Redets se desarrollaron 67 estándares de calidad agrupados en cuatro bloques y doce dimensiones de calidad

Criterios de calidad para la red española de agencias de evaluación de tecnologías sanitarias del sistema nacional de salud

YesMediante la búsqueda de literatura y formación de un grupo de trabajo se planteó el objetivo de desarrollar una herramienta de autoevaluación de calidad el proceso de gestión de la propia RedETS y del Pleno de Consejo de la Red en todas sus funciones. La literatura localiza sobre calidad para redes de evaluación es limitada, si bien permitió, junto con la experiencia acumulada del informe anterior desarrollado en 2016, elaborar 26 estándares y consensuarlos para crear la herramienta final resultado de este informe. Dicha herramienta puede ser útil y complementaria a la ya creada para los nodos de la RedETS, se espera que mejore el proceso de autoevaluación de la calidad global de la red, así como que contribuya al asesoramiento y apoyo a otras redes de ETS que pretendan implantar sistemas de calidad

Cost-Effectiveness and Burden of Disease for Adjuvanted Quadrivalent Influenza Vaccines Compared to High-Dose Quadrivalent Influenza Vaccines in Elderly Patients in Spain.

Influenza is a contagious respiratory disease that causes severe illness and death, particularly in elderly populations. Two enhanced formulations of quadrivalent influenza vaccine (QIV) are available in Spain. Adjuvanted QIV (aQIV) is available for those aged 65+ and high-dose QIV (HD-QIV) for those aged 60+. In this study, we used a health economic model to assess the costs and outcomes associated with using aQIV or HD-QIV in subjects aged 65+. Using aQIV instead of HD-QIV to vaccinate an estimated 5,126,343 elderly people results in reductions of 5405 symptomatic cases, 760 primary care visits, 171 emergency room visits, 442 hospitalizations, and 26 deaths in Spain each year. Life-years (LYs) and quality-adjusted LYs (QALYs) increases by 260 and 206, respectively, each year. Savings from a direct medical payer perspective are EUR 63.6 million, driven by the lower aQIV vaccine price and a minor advantage in effectiveness. From a societal perspective, savings increase to EUR 64.2 million. Results are supported by scenario and sensitivity analyses. When vaccine prices are assumed equal, aQIV remains dominant compared to HD-QIV. Potential savings are estimated at over EUR 61 million in vaccine costs alone. Therefore, aQIV provides a highly cost-effective alternative to HD-QIV for people aged 65+ in Spain

Clinical effectiveness, safety, and economic assessment of mass screening for hepatitis C Systematic review

The first Global Health Sector Strategy on viral hepatitis 2016-2021 provided the initial roadmap for the elimination of viral hepatitis as a public health problem by 2030. With the development of new therapeutic strategies that allow the elimination of the virus, the hypothesis is raised that population-based screening could increase the cases diagnosed in the initial stages of the disease, contributing to early treatment of infected people, avoiding the progression of chronic liver disease and its transmission.The localized evidence does not demonstrate the clinical effectiveness of population-based screening for hepatitis C in reducing mortality, morbidity and/or its influence on quality of life. Not enough studies were identified to assess the safety of the population screening strategy. The compiled economic analyzes, bearing in mind the methodological limitations they present, show that the screening of the highest-risk subgroups would be the most efficient strategy. While population screening followed by treatment could be an efficient medium and long-term strategy to achieve the goal of eliminating viral hepatitis, it requires significant financial investment in health systems.Este documento ha sido realizado por AETSA, Evaluación de Tecnologías Sanitarias de Andalucía en el marco de la financiación del Ministerio de Sanidad para el desarrollo de las actividades del Plan anual de Trabajo de la Red Española de Agencias de Evaluación de Tecnologías Sanitarias y Prestaciones del SNS, aprobado en el Pleno del Consejo Interterritorial del SNS de 28 de octubre de 2020 (conforme al Acuerdo del Consejo de Ministros de 9 de diciembre de 2020).YesLa primera estrategia mundial contra las hepatitis víricas, propone como objetivo la eliminación, antes de 2030, de la amenaza que supone para la salud pública la hepatitis C, por lo que parece razonable evaluar el cribado poblacional para esta infección como herramienta de diagnóstico precoz que permita el tratamiento temprano e impida la transmisión. Hemos estudiado esta intervención mediante la realización de una revisión sistemática de la literatura entre 2013 y septiembre de 2020, en cuanto a variables clínicas y económicas. La evidencia localizada no demuestra la efectividad clínica del cribado poblacional de la hepatitis C en la reducción de la mortalidad, la morbilidad y/o su influencia sobre la calidad de vida. Los análisis económicos recopilados, con las limitaciones metodológicas que presentan, muestran que el cribado de los subgrupos de más riesgo sería la estrategia más eficiente, mientras que el cribado poblacional seguido del tratamiento podría ser una estrategia eficiente a medio y largo plazo para alcanzar el objetivo de eliminación de las hepatitis víricas, si bien requiere de importantes inversiones económicas en los sistemas sanitarios