Description of day case costs and tariffs of cataract surgery from a sample of nine European countries

The project IMPACT-HTA has received funding from the European Union's Horizon 2020 research and innovation programme under Grant Agreement No. 779312.Background: The lack of transparency in the methodology of unit cost estimation and the usage of confidential or undisclosed information prevents cost comparisons and makes the transferability of the results across countries difficult. The objective of this article is to compare the methodologies used in the estimation of the cost of a day case cataract extirpation that are described in the official and publicly available sources and to study how these translate into different unit cost estimates. Methods: A literature review was conducted to identify the main sources of unit costs of cataract extirpation. A semistructured questionnaire to obtain information on national costing methodologies was developed and sent to consortium partners in nine European countries. Additionally, publicly available sources of unit cost of cataract surgery in those countries included in the European Healthcare and Social Cost Database (EU HCSCD) were analysed. Results: The findings showed a considerable diversity across countries on unit costs varying from 432.5€ in Poland (minor degree of severity) to 3411.96€ in Portugal (major degree of severity). In addition, differences were found in the year of cost publication and on the level of detail of different types of cataract surgery. The unit of activity were Diagnosis-Related Groups in all countries except Slovenia. All unit costs include direct costs and variable overheads (except Germany where nursing costs are financed separately). Differences were identified in the type of fixed overheads included in unit costs. Methodological documents explaining the identification, measurement and evaluation of resources included in the unit costs, as well as use of appropriate cost drivers are publicly available only in England, Portugal and Sweden. Conclusions: We can conclude that while unit costs of cataract extirpation are publicly available, the information on methodological aspects is scarce. This appears to pose a significant problem for cross-country comparisons of costs and transferability of results from one country to another.European Commission 77931

Factors associated with improvement in disability-adjusted life years in patients with HIV/AIDS

Background: The epidemic of HIV/AIDS and treatments that have emerged to alleviate, have brought about a shift in the burden of disease from death to quality of life/disability. The aim was to determine which factors are associated with improvements in the level of health of male and female patients with HIV/AIDS in Andalusia, in terms of disability-adjusted life years. Methods: Descriptive study based on a sample group of 8800 people on the Andalusian AIDS register between 1983 and 2004. Dependent variables: Life lost due to premature mortality (YLL), years lost due to disability (YLD) and disability-adjusted life years (DALY). Independent variables: vital state, sex, age at the time of diagnosis, age at the time of death, transmission category, province of residence, AIDS-indicator disease and the period of diagnosis. A bivariate analysis was carried out to find out if the health level variables changed in accordance with the independent variables. Using the independent variables which had a statistically significant link with the level of health variables, a multivariate linear regression model, disaggregated by gender, was constructed. Results: Amongst the women, we found a model which explained the level of health of 64.9%: a link was found between a higher level of health (lower DALYs) and not intravenous drug use, the province of residence, being diagnosed during the HAART era and older age at the time of diagnosis. Amongst the men, we found a model which explained the level of health of 64.4%: a link was found between a higher level of health (lower DALYs) and intravenous drug use, the province of residence, being diagnosed during the HAART era and older age at the time of diagnosis. Conclusion: A higher level of health (lower DALY) amongst both men and women was found to be linked to not be intravenous drug user, the province of residence, being diagnosed during the HAART era and older age at the time of diagnosis

Scoping review of the methodology of large health surveys conducted in Spain early on in the COVID-19 pandemic

BackgroundThe use of health surveys has been key in the scientific community to promptly communicate results about the health impact of COVID-19. But what information was collected, where, when and how, and who was the study population?ObjectiveTo describe the methodological characteristics used in large health surveys conducted in Spain early on in the COVID-19 pandemic.MethodsScoping review. Inclusion criteria: observational studies published between January 2020 and December 2021, with sample sizes of over 2,000 persons resident in Spain. Databases consulted: PubMed, CINAHL, Literatura Latinoamericana y del Caribe en CC de la Salud, Scopus, PsycINFO, Embase, Sociological Abstracts, Dialnet and Web of Science Core Collection. We analyzed the characteristics of the literature references, methodologies and information gathered in the surveys selected. Fifty five studies were included.ResultsSixty percentage of the studies included had mental health as their main topic and 75% were conducted on the general adult population. Thirteen percentage had a longitudinal design, 93% used the internet to gather information and the same percentage used non-probability sampling. Thirty percentage made some type of sampling correction to reduce coverage or non-response biases, but not selection biases. Sixty seven percentage did not state the availability of their data.ConclusionsConsistent with the extensive use of non-probability sampling without any bias correction in the extraordinary setting created by COVID-19, quality population frameworks are required so that probability and representative samples can be extracted quickly to promptly address other health crises, as well as to reduce potential coverage, non-response and particularly selection biases by utilizing reweighting techniques. The low data accessibility despite the huge opportunity that COVID-19 provided for Open Science-based research is striking

Development of the European Healthcare and Social Cost Database (EU HCSCD) for use in economic evaluation of healthcare programs

This study has received funding from the European Union's Horizon 2020 research and innovation programme under Grant agreement no. 779312.Introduction: Costs are one of the critical factors for the transferability of the results in health technology assessment and economic evaluation. The objective is to develop a cost database at the European level to facilitate cross-border cost comparisons in different settings and explains the factors that lead to differences in healthcare costs in different countries, taking into account the differences between health systems and other factors. Methodology: The core of the database is compounded of three main categories (primary resources, composite goods and services, and complex processes and interventions) organized into 13 subcategories. A number of elements providing as detailed information of unit cost as possible were identified in order to mitigate the problem of comparability. Consortium partners validated both the database structure and selected costing items. Results: Twenty-seven costing items included in the EU HCSCD resulted in 1450 unit costs when taking into account all item subtypes and countries. Cross-country differences in costs are driven by the type of resources included in the costing items (e.g., overhead costs in case of complex processes and interventions) or by the variety of existing brands and/or models and the type of unit value in most of the primary resources. Conclusion: The EU HCSCD is the only public unit healthcare and social cost database at European level that gather data on unit costs and explains differences in costs across countries. Its maintenance and regular data updating will enable establishing specific systems for generating and recording information that will meet many of its current limitations.European Commission 77931

Identificación de barreras y facilitadores para la (des)prescripción de benzodiacepinas: un estudio cualitativo con pacientes y profesionales sanitarios

Background. There has been a steadily growing trend in prescribing benzodiazepines over last decade. Spain is one of the countries where this class of drugs is most extensively prescribed by primary healthcare physicians. The aim of this study is to identify factors that might be acting as barriers and enablers for benzodiazepine (de)prescription from patient and professional perspectives. Methods. Qualitative study through semi-structured interviews with medical practitioners (n=17) and patients (n=27), and a nominal group with medical practitioners (n=19). Interviews were audio-recorded, transcribed and analyzed using thematic analysis. Results. The analysis revealed key themes and was organized around barriers and enablers connected to three interrelated dimensions: the social and community context of prescription; the structure, organization and/or management of the health system, and the doctor-patient relationship. The excessive workload of professionals was widely cited as influencing over-prescription. (De) prescription of benzodiazepine was facilitated by encouraging the social prescription of health assets or developing strategies to therapeutic alliance processes and better doctor-patient communication. Conclusion. Our findings suggest that there is a role for the salutogenic approach and the health asset model in the development of a more person-centred clinical care. This study considers the importance of encouraging the use of non-pharmacological methods and techniques in the health system and promoting the creation of multidisciplinary teams, therapeutic alliance processes and better doctor-patient communication by giving professionals training in psychosocial skills.Fundamento. La tendencia en la prescripción de benzodiacepinas ha crecido en la última década. España está entre los países donde este tipo de fármacos es el más prescrito por profesionales en Atención Primaria. El propósito de este estudio es identificar factores que podrían estar actuando como barreras y facilitadores en la (des)prescripción de benzodiacepinas desde la perspectiva de pacientes y profesionales sanitarios. Material y métodos. Estudio cualitativo a través de entrevistas semiestructuradas con profesionales sanitarios (n=17) y pacientes (n=27), y un grupo nominal con profesionales sanitarios (n=19). Las entrevistas fueron transcritas y analizadas utilizando un análisis temático. Resultados. El análisis reveló temas claves organizados como barreras y facilitadores conectados a tres dimensiones interrelacionadas: el contexto comunitario y social de la prescripción; la estructura, organización y/o gestión del sistema sanitaria, y la relación médico-paciente. La excesiva carga laboral de los profesionales fue ampliamente citada como influyente en la prescripción excesiva. Acciones como promover la prescripción social de activos en salud o desarrollar estrategias para facilitar la alianza terapéutica y mejorar la comunicación médico-paciente, fueron vistos como facilitadores. Conclusiones. Los hallazgos sugieren el rol que el enfoque salutogénico y el modelo de activos en salud pueden jugar en el desarrollo de una atención clínica centrada en la persona. El estudio considera la importancia de promover métodos y técnicas de intervención no farmacológicos, la promoción de equipos multidisciplinares y la formación en habilidades psicosociales.This work was supported by the CIBER of Epidemiology and Public Health (CIBERESP)

INES: aplicación interactiva para construir modelos de supervivencia dividido. Manual del usuario

En este manual se presenta la herramienta de modelización INES (INteractive tool for construction and Extrapolation of partitioned Survival models; Modelo interactivo para extrapolación de supervivencia y coste) mediante modelos de supervivencia divididos (partitioned survival model, PSM). Es una herramienta de acceso abierto y está diseñada para ser utilizada por investigadores con un buen conocimiento de los principios de la evaluación económica (EE) de tecnologías sanitarias y entienden las fortalezas y debilidades de los modelos de supervivencia dividido, pero no están lo suficientemente familiarizados con un paquete estadístico como Excel o R para poder construir y validar ellos mismos un nuevo PSM. INES ofrece una herramienta rápida, flexible y robusta para calcular un PSM que se puede utilizar en muchos contextos diferentes. Este manual describe las características, propiedades de la herramienta INES y en aquellos tipos de EE en las que puede ser adecuada.This manual presents (in spanish) a new tool for conducting economic modelling of health technologies using partitioned survival analysis.Departamento de Economia Aplicada, UG

Características clínicas y psicosociales de personas con fibromialgia. Repercusión del diagnóstico sobre sus actividades

Actualmente se sabe muy poco de las características de las personas diagnosticadas de fibromialgia, su grado de incapacidad y la respuesta del sistema sanitario. Los objetivos de este trabajo son: conocer el perfil sociodemográfico, clínico y psicosocial de las y los pacientes con fibromialgia; describir la respuesta que obtienen del sistema sanitario, y estudiar la repercusión de este síndrome en las actividades habituales de las personas que lo padecen, incluyendo las del ámbito laboral. La fibromialgia fue diagnosticada mayoritariamente en mujeres. Causa una mala percepción del estado de salud y situaciones de incapacidad laboral, afectando negativamente al entorno familiar de la persona que la padece

Impact, economic evaluation, and sustainability of integrated vector management in urban settings to prevent vector-borne diseases: a scoping review

Background: The control of vector-borne diseases (VBD) is one of the greatest challenges on the global health agenda. Rapid and uncontrolled urbanization has heightened the interest in addressing these challenges through an integrated vector management (IVM) approach. The aim was to identify components related to impacts, economic evaluation, and sustainability that might contribute to this integrated approach to VBD prevention. Main body: We conducted a scoping review of available literature (2000–2016) using PubMed, Web of Science, Cochrane, CINAHL, Econlit, LILACS, Global Health Database, Scopus, and Embase, as well as Tropical Diseases Bulletin, WHOLIS, WHO Pesticide Evaluation Scheme, and Google Scholar. MeSH terms and free-text terms were used. A data extraction form was used, including TIDieR and ASTAIRE. MMAT and CHEERS were used to evaluate quality. Of the 42 documents reviewed, 30 were focused on dengue, eight on malaria, and two on leishmaniasis. More than a half of the studies were conducted in the Americas. Half used a quantitative descriptive approach (n = 21), followed by cluster randomized controlled trials (n = 11). Regarding impacts, outcomes were: a) use of measures for vector control; b) vector control; c) health measures; and d) social measures. IVM reduced breeding sites, the entomology index, and parasite rates. Results were heterogeneous, with variable magnitudes, but in all cases were favourable to the intervention. Evidence of IVM impacts on health outcomes was very limited but showed reduced incidence. Social outcomes were improved abilities and capacities, empowerment, and community knowledge. Regarding economic evaluation, only four studies performed an economic analysis, and intervention benefits outweighed costs. Cost-effectiveness was dependent on illness incidence. The results provided key elements to analyze sustainability in terms of three dimensions (social, economic, and environmental), emphasizing the implementation of a community-focused eco-bio-social approach. Conclusions: IVM has an impact on reducing vector breeding sites and the entomology index, but evidence of impacts on health outcomes is limited. Social outcomes are improved abilities and capacities, empowerment, and community knowledge. Economic evaluations are scarce, and cost-effectiveness is dependent on illness incidence. Community capacity building is the main component of sustainability, together with collaboration, institutionalization, and routinization of activities. Findings indicate a great heterogeneity in the interventions and highlight the need for characterizing interventions rigorously to facilitate transferability.This study was funded by WHO/TDR

Optimal start in dialysis shows increased survival in patients with chronic kidney disease

Objective To compare the survival among patients with chronic kidney disease who had optimal starts of renal replacement therapy, dialysis or hemodialysis, with patients who had suboptimal starts. Methods A retrospective cohort consisting of >18 year-old patients who started renal replacement therapy, using peritoneal dialysis or hemodialysis, in any public hospital or associated center of the Andalusian Public Health System, between the 1st of January of 2006 and the 15th of March of 2017. The optimal start was defined when all the following criteria were met: a planned dialysis start, a minimum of six-month follow-up by a nephrologist, and a first dialysis method coinciding with the one registered at 90 days. The information was obtained from the registry of the Information System of the Transplant Autonomic Coordination of Andalusia. Results A total of 10,692 patients were studied. 4,377 (40.9%) of these patients died. A total of 4,937 patients (46.17%) achieved optimal starts of renal replacement therapy and showed higher survival rates (HR 0.669; 95% CI 0.628–0.712) in the multivariate analysis of Cox regression model

Estado clínico y psicosocial de reclusos VIH positivos en tratamientos con antirretrovirales

Tesis Univ. Granada. Departamento de Medicina. Leída el 15 de mayo de 200