The opportunity costs of caring for people with dementia in Southern Spain

Objective

The aim of this paper is to study the opportunity costs (OC) that are involved in being a caregiver and to compare them with the direct costs assumed by the State and the families. We evaluate direct cost (those that imply a payment-out-of-pocket) and indirect cost (those that imply a dedication in time). We hypothesized that costs increase with the severity of the dementia, with the educational level and active occupational situation of caregiver. They are greater if the caregiver is male, but if the patient and caregiver cohabit they are reduced.

Analysis of economic and social costs of adverse events associated with blood transfusions in Spain

Objective

To calculate, for the first time, the direct and social costs of transfusion-related adverse events in order to include them in the National Healthcare System's budget, calculation and studies. In Spain more than 1,500 patients yearly are diagnosed with such adverse events.

Atención sanitaria e impacto económicoHealthcare and economic impact

This chapter reviews the current model of HIV patient care and its economic impact. There are clinical and geographical differences in the care HIV patients receive and a need to develop new models of comprehen-sive HIV care has been identified.HIV infection in Spain is an important and expensive public health problem. The main costs are due to an-tiretroviral therapy, indirect costs and the cost of admission, consultation and diagnostic testing. A strong correlation between severity and cost has been identified.Patients diagnosed late have a poorer clinical course, increased mortality and require more medical and therapeutic resources.Early detection of the disease significantly improves the clinical outcomes of patients.The increased number of patients receiving treatment and their progressive ageing will increase costs of HIV healthcare in the coming years.     

Impacto económico de la dermatitis atópica en adultos: estudio de base poblacional (estudio IDEA)

Objective

To determine resource usage and costs associated with atopic dermatitis in adults according to severity and comorbid conditions in daily clinical practice.

Impacto sanitario y económico de la vacunación frente al cáncer de cérvix y lesiones precursoras en España

Objective

To evaluate the healthcare and economic impact of vaccination against cervical cancer with the HPV 16/18 AS04-adjuvanted vaccine (Cervarix^®) in Spain from the perspective of the national health system.

Material and methods

A health economics model was adapted to the Spanish environment. The model simulated the impact of current vaccination programs on the burden of precancerous lesions and cervical cancer. National epidemiological data and the vaccine efficacy shown in clinical trials were used.

Results

Considering the average vaccination coverage in Spain, the model estimated that vaccination with Cervarix^® would prevent 45,060 cases of atypical squamous cells of undetermined significance (ASCUS), 35,166 cases of low-grade squamous intraepithelial lesions (LSIL), 29,549 cases of high-grade squamous intraepithelial lesions (HSIL) and 1,053 cases of cervical cancer. Thus, vaccination would save 89,271,085 € in direct medical costs.

Conclusions

Vaccination with Cervarix^® in Spain would significantly reduce the number of cases of cervical cancer and precancerous lesions and the associated medical costs.     

Análisis de dos estrategias para el manejo de la amenaza de parto pretérmino

Objective

To compare two strategies for the management of threatened preterm labor (TPL). The first strategy was based on clinical criteria alone, while the second used rapid fibronectin testing and cervical length measured by vaginal ultrasound.

Material and methods

We compared the costs and perinatal outcomes of both strategies. In the study group, both markers were used to select women at highest risk. The study group consisted of a prospective group of 122 women attending the emergency department for TPL. The control group (n = 112) was composed of a historical cohort of women admitted for TPL. Pregnant women classified as low risk for premature birth were discharged from the emergency department and were monitored on an outpatient basis. The sensitivity and specificity of both tests in predicting preterm labor were estimated. The results measured were prematurity < 37 weeks, neonatal complications, length of hospital stay and costs resulting from admission, medication and subsequent follow-up visits.

Results

Prematurity and perinatal outcomes were similar in both groups. The use of tocolytics and corticosteroids was reduced by employing the two markers. The median length of hospital stay was 0 days in the study group (2.6 days among hospitalized patients) and 5 days in the control group. The costs incurred per patient were 446.24 euros in the study group (IQR: 1,390.08) and 1,634.04 euros (IQR: 1,092.65) in the control group.

Conclusions

Based on the use of these techniques to select patients with true preterm labor and the similar perinatal results obtained in both groups, we conclude that universal treatment of all women with suspected preterm labor is not warranted. This strategy saves approximately 1,200 € per patient.     

Short-term association between road traffic noise and healthcare demand generated by Parkinson's disease in Madrid,Spain

ObjectiveTo analyse whether there is a short-term association between road traffic noise in the city of Madrid and Parkinson's disease (PD)-related demand for healthcare.MethodsTime-series analysis (2008–2009) using variables of analysis linked to emergency and daily PD-related demand for healthcare (ICD-10: G20–G21), namely, PD-hospital admissions (HAs), PD-outpatient visits (OVs) and PD-emergency medical calls in Madrid. The noise pollution measurements used were Leqd, equivalent sound level for the daytime hours (from 8 a.m. to 10 p.m.), and Leqn, equivalent sound level for night time hours (from 10 p.m. to 8 a.m.) in dB(A). We controlled for temperature, pollution, trends and seasons, and used the Poisson regression model to calculate relative risk (RR).ResultsThe association between Leqd and HAs was found to be linear. Leqd and Leqn at lag 0.1 and temperature at lags 1 and 5 were the only environmental variables associated with increased PD-related healthcare demand. The RR (lag 0) for Leqd and HA was 1.07 (1.04–1.09), the RR (lag 0) for Leqd and OV was 1.28 (1.12–1.45), and the RR (lags 0.1) for Leqn and emergency medical calls was 1.46 (1.06–2.01).ConclusionThe above results indicate that road traffic noise is a risk factor for PD exacerbation. Measures to reduce noise-exposure levels could result in a lower PD-related healthcare demand.     

Estudio de coste-efectividad del manejo diagnóstico del derrame pleural en una unidad de patología pleural ambulatoria

Objective

To evaluate the diagnostic efficacy of pleural procedures, safety, delay and cost of the diagnosis of pleural effusion (PE) by analysing the parameters that are dependent on the area of patient management (outpatient or inpatient).

Patients and Methods

Prospective non-randomized study. Two groups were established depending on whether they were managed in a specific outpatient unit or as a conventional hospital inpatient, with the rest of the criteria being the same for the study of the PE.

Results

We included 60 outpatients and 34 inpatients. The median number of visits as an outpatient was 2 (range 2–3), and the time an inpatient was hospitalized was 13 (range 7.7–25–2) days. The number of analytical and imaging studies was significantly higher in the inpatient group. There were no differences in the number of cytology and pleural biopsies, or complications between groups. There were no differences in time to performing computed tomography. The number of days until the pleural biopsy and the time until to obtain a diagnosis was lower in the outpatient group. Mean total cost for an outpatient was €1.352 and €9.793,2 for inpatients.

Conclusions

Management of ambulatory diagnosis of PE patients is highly cost-effective. The effectiveness and safety of forms of the study is at least similar. In this study, the mean cost for a hospitalised inpatient for a PE was 7.2 times higher than outpatient management.