Disability-adjusted Life Years Lost to Ischemic Heart Disease in Spain.

INTRODUCTION AND OBJECTIVES: The health indicator disability-adjusted life years combines the fatal and nonfatal consequences of a disease in a single measure. The aim of this study was to evaluate the burden of ischemic heart disease in 2008 in Spain by calculating disability-adjusted life years. METHODS: The years of life lost due to premature death were calculated using the ischemic heart disease deaths by age and sex recorded in the Spanish National Institute of Statistics and the life-table in the 2010 Global Burden of Disease study. The years lived with disability, calculated for acute coronary syndrome, stable angina, and ischemic heart failure, used hospital discharge data and information from population studies. Disability weights were taken from the 2010 Global Burden of Disease study. We calculated crude and age standardized rates (European Standard Population). Univariate sensitivity analyses were performed. RESULTS: In 2008, 539 570 disability-adjusted life years were lost due to ischemic heart disease in Spain (crude rate, 11.8/1000 population; standardized, 8.6/1000). Of the total years lost, 96% were due to premature death and 4% due to disability. Among the years lost due to disability, heart failure accounted for 83%, stable angina 15%, and acute coronary syndrome 2%. In the sensitivity analysis, weighting by age was the factor that changed the results to the greatest degree. CONCLUSIONS: Ischemic heart disease continues to have a huge impact on the health of our population, mainly because of premature death. The results of this study provide an overall vision of the epidemiologic situation in Spain and could serve as the basis for evaluating interventions targeting the acute and chronic manifestations of cardiac ischemia.

The national burden of cerebrovascular diseases in Spain: a population-based study using disability-adjusted life years / Carga de las enfermedades cerebrovasculares en España: estudio de base poblacional utilizando los años de vida ajustados por discapacidad

Background and objective: The aim of the present study was to determine the national burden of cerebrovascular diseases in the adult population of Spain. Patients and methods: Cross-sectional, descriptive population-based study. We calculated the disability-adjusted life years (DALY) metric using country-specific data from national statistics and epidemiological studies to obtain representative outcomes for the Spanish population. DALYs were divided into years of life lost due to premature mortality (YLLs) and years of life lived with disability (YLDs). DALYs were estimated for the year 2008 by applying demographic structure by sex and age-groups, cause-specific mortality, morbidity data and new disability weights proposed in the recent Global Burden of Disease study. In the base case, neither YLLs nor YLDs were discounted or age-weighted. Uncertainty around DALYs was tested using sensitivity analyses. Results: In Spain, cerebrovascular diseases generated 418,052 DALYs, comprising 337,000 (80.6%) YLLs and 81,052 (19.4%) YLDs. This accounts for 1,113 DALYs per 100,000 population (men: 1,197 and women: 1,033) and 3,912 per 100,000 in those over the age of 65 years (men: 4,427 and women: 2,033). Depending on the standard life table and choice of social values used for calculation, total DALYs varied by 15.3% and 59.9% below the main estimate. Conclusions: Estimates provided here represent a comprehensive analysis of the burden of cerebrovascular diseases at a national level. Prevention and control programmes aimed at reducing the disease burden merit further priority in Spain (AU)

Fundamento y objetivo: El objetivo del presente estudio fue determinar la carga de las enfermedades cerebrovasculares en la población adulta española. Pacientes y métodos: Estudio transversal descriptivo de base poblacional. Se calcularon los años de vida ajustados por discapacidad (AVAD) utilizando datos específicos nacionales procedentes de estadísticas y estudios epidemiológicos para obtener resultados representativos a nivel nacional. Los AVAD fueron divididos en años de vida perdidos (AVP) y años vividos con discapacidad (AVD). Los AVAD fueron estimados para el año 2008 mediante la aplicación de la estructura demográfica por sexo y grupos de edad, la mortalidad por causas específicas, los datos de morbilidad y los nuevos pesos de discapacidad que se proponen en el reciente estudio de la carga global de enfermedades. En el caso base, los AVP y los AVD no fueron descontados ni ponderados por edad. La incertidumbre en torno a los AVAD se examinó mediante análisis de sensibilidad. Resultados: En España, las enfermedades cerebrovasculares generaron 418.052 AVAD, incluyendo 337.000 (80,6%) AVP y 81.052 (19,4%) AVD. Esto representa 1.113 AVAD por 100.000 habitantes (1.197 hombres y 1.033 mujeres) y 3.912 por 100.000 en los mayores de 65 años (4.427 hombres y 2.033 mujeres). En función de la tabla de vida estándar y la elección de las valoraciones sociales utilizadas en los cálculos, los AVAD totales variaron entre un 15,3 y un 59,9% por debajo de los resultados principales. Conclusiones: Las estimaciones proporcionadas aquí representan un análisis exhaustivo de la carga de las enfermedades cerebrovasculares a nivel nacional. Los programas de prevención y control para reducir la carga de enfermedad cerebrovascular merecen una mayor prioridad en España (AU)

The national burden of cerebrovascular diseases in Spain: a population-based study using disability-adjusted life years.

BACKGROUND AND OBJECTIVE: The aim of the present study was to determine the national burden of cerebrovascular diseases in the adult population of Spain. PATIENTS AND METHODS: Cross-sectional, descriptive population-based study. We calculated the disability-adjusted life years (DALY) metric using country-specific data from national statistics and epidemiological studies to obtain representative outcomes for the Spanish population. DALYs were divided into years of life lost due to premature mortality (YLLs) and years of life lived with disability (YLDs). DALYs were estimated for the year 2008 by applying demographic structure by sex and age-groups, cause-specific mortality, morbidity data and new disability weights proposed in the recent Global Burden of Disease study. In the base case, neither YLLs nor YLDs were discounted or age-weighted. Uncertainty around DALYs was tested using sensitivity analyses. RESULTS: In Spain, cerebrovascular diseases generated 418,052 DALYs, comprising 337,000 (80.6%) YLLs and 81,052 (19.4%) YLDs. This accounts for 1,113 DALYs per 100,000 population (men: 1,197 and women: 1,033) and 3,912 per 100,000 in those over the age of 65 years (men: 4,427 and women: 2,033). Depending on the standard life table and choice of social values used for calculation, total DALYs varied by 15.3% and 59.9% below the main estimate. CONCLUSIONS: Estimates provided here represent a comprehensive analysis of the burden of cerebrovascular diseases at a national level. Prevention and control programmes aimed at reducing the disease burden merit further priority in Spain.

Estudio descriptivo de las características sociodemográficas de la discapacidad en América Latina / Descriptive study about social and demographical characteristic of the disability in Latin America

El objetivo de ese estudio es conocer las características socio demográficas de la discapacidad en América Latina y evaluar la metodología utilizada en las encuestas poblacionales para el análisis de la discapacidad. Es un estudio descriptivo que analiza los datos y la metodología de las encuestas de discapacidad de los países de América Latina realizadas después del 2001. Ha sido observado una grande diferencia en la prevalencia de la discapacidad encontrada en las encuestas que utilizaron la CIF para el análisis estadístico de las personas con discapacidad. Además ha sido verificado que en América Latina la discapacidad motora es la más prevalente y acomete mas los hombres con más de 65 años y con bajo nivel educacional. La principal causa es la enfermedad crónica. Concluyese que la CIF es una buena herramienta metodológica para la elaboración de encuestas de discapacidad.

The objective of this study was to ascertain the social and demographical characteristics of disability in Latin America and verify the methodology used in the survey by questionnaires for the analysis of disabilities. It is a descriptive study that analyzed the data and methodology of disability surveys conducted in Latin America after 2001. It was noted that there is a big difference in the prevalence of disability found in the surveys that used the International Classification of Functioning, Disability and Health (ICF) for statistical analysis of people with disabilities. It was also shown that in Latin America motor disabilities are more prevalent in men over 65 years old and with a low educational level. The main cause is chronic disease. The conclusion is that ICF is a good methodological tool to use in disability survey questionnaires.

[Descriptive study about social and demographical characteristic of the disability in Latin America]. / Estudio descriptivo de las características sociodemográficas de la discapacidad en América Latina.

The objective of this study was to ascertain the social and demographical characteristics of disability in Latin America and verify the methodology used in the survey by questionnaires for the analysis of disabilities. It is a descriptive study that analyzed the data and methodology of disability surveys conducted in Latin America after 2001. It was noted that there is a big difference in the prevalence of disability found in the surveys that used the International Classification of Functioning, Disability and Health (ICF) for statistical analysis of people with disabilities. It was also shown that in Latin America motor disabilities are more prevalent in men over 65 years old and with a low educational level. The main cause is chronic disease. The conclusion is that ICF is a good methodological tool to use in disability survey questionnaires.

Discapacidad atribuible al exceso de peso en España / Disability attributable to excess weight in Spain

Fundamento y objetivo: Estimar la discapacidad debida al exceso de peso en la población española en el año 2006. Población y método: A partir de la prevalencia del exceso de peso por sexo y grupo de edad quinquenal (Encuesta Nacional de Salud [ENS], 2006), de los datos de prevalencia de las morbilidades asociadas (ENS y conjunto mínimo básico de datos hospitalarios, 2006) y de los riesgos relativos publicados, se han calculado las fracciones atribuibles poblacionales y la discapacidad atribuible al exceso de peso para los individuos entre 35 y 79 años, expresándola como años vividos con discapacidad (AVD). Resultados: En el año 2006 se perdieron en España 791.650 AVD en relación con el exceso de peso en la población entre 35 y 79 años. El 46,7% de ellos se perdieron en varones y el 53,3% en mujeres. El sobrepeso fue responsable del 45,7% del total de los AVD perdidos. Los AVD en varones superan a los perdidos en mujeres en menores de 60 años. En el grupo quinquenal de 35-39 años existe una diferencia de un 16,6% a favor de los varones, mientras que en el grupo de 74-79 años la diferencia es de un 23,8% mayor en mujeres. La osteoartritis y el dolor crónico de espalda responden del 60%, y la hipertensión arterial y la diabetes mellitus del 37% de los AVD perdidos. Conclusiones: El exceso de peso conlleva una importante carga de discapacidad asociada, así como de consumo de recursos sociosanitarios. Los AVD perdidos es una útil herramienta que permite cuantificar de forma numérica la importancia relativa de los distintos problemas de salud, así como realizar estudios comparativos entre distintas enfermedades y monitorizar en el tiempo la eficacia de las medidas encaminadas a su control (AU)

Background and objective: To estimate the disability attributable to higher than optimal body mass index in the Spanish population in 2006. Population and method: Excess body weight prevalence data were obtained from the 2006 National Health Survey (NHS), while the prevalence of associated morbidities was extracted from the 2006 NHS and from a national hospital data base. Population attributable fractions were applied and disability attributable was expressed as years life with disability (YLD). Results: In 2006, in the Spanish population aged 35-79 years, 791.650 YLD were lost due to higher than optimal body mass index (46.7% in males and 53.3% in females). Overweight (body mass index 25-29.9) accounted for 45.7% of total YLD. Males YLD were higher than females under 60. The 35-39 quinquennial group showed a difference for males of 16.6% while in the 74-79 group the difference was 23.8% for women. Osteoarthritis and chronic back pain accounted for 60% of YLD while hypertensive disease and type 2 diabetes mellitus were responsible of 37% (AU)

Mortalidad atribuible al exceso de peso en España / Mortality attributable to excess weight in Spain

Fundamento y objetivo: Estimar la mortalidad atribuible al exceso de peso en la población española en el año 2006. Pacientes y método: A partir de la prevalencia del exceso de peso por sexo y grupo de edad quinquenal (Encuesta Nacional de Salud 2006), de los datos de los ficheros de defunciones del Instituto Nacional de Estadística y los riesgos relativos publicados, se han calculado las fracciones atribuibles poblacionales y la mortalidad atribuible al exceso de peso para los individuos entre 35 y 79 años. Resultados: En el año 2006 se produjeron en España 25.671 muertes atribuibles al exceso de peso, 16.405 en varones y 9.266 en mujeres. La mortalidad atribuible al exceso de peso supuso un 15,8% del total de muertes en varones y un 14,8% en mujeres, pero si nos referimos solo a aquellas causas donde el exceso de peso es factor de riesgo, las cifras se elevan hasta el 31,6% en varones y el 28% en mujeres. La causa más frecuente de mortalidad atribuible fue la enfermedad cardiovascular (58% del total). La segunda causa de mortalidad fue la tumoral. La causa individual donde el exceso de peso tiene una mayor contribución es la diabetes mellitus tipo 2, con cerca de un 70% de los fallecimientos en varones y un 80% en mujeres. El sobrepeso (índice de masa corporal 25-29,9 kg/m2) fue responsable del 54,9% de las muertes en los varones y del 48,6% en las mujeres. Conclusiones: El exceso de peso es un grave problema de salud pública, con una importante mortalidad asociada. El análisis de los fallecimientos atribuibles es una útil herramienta para conocer la situación real y la monitorización de las medidas encaminadas a su control (AU)

Background and objective: Estimate the mortality attributable to higher than optimal body mass index in the Spanish population in 2006. Patients and method: Excess body weight prevalence data were obtained from the 2006 National Health Survey, while data on associated mortality were extracted from the National Statistic Institute. Population attributable fractions were applied and mortality attributable to higher than optimal body mass index was calculated for people between 35 and 79 years. Results: In 2006, among the Spanish population aged 35-79 years, 25,671 lives (16,405 males and 9,266 women) were lost due to higher than optimal body mass index. Mortality attributable was 15.8% of total deaths in males and 14.8% in women, but if we refer to those causes where excess body weight is a risk factor, it is about a 30% of mortality (31.6% in men and 28% in women). The most important individual cause was cardiovascular disease (58%), followed by cancer. The individual cause with a major contribution to deaths was type 2 diabetes; nearly 70% in males and 80% in women. Overweight accounted for 54.9% deaths in men and 48.6% in women. Conclusions: Excess body weight is a major public health problem, with an important associated mortality. Attributable deaths are a useful tool to know the real situation and to monitor for disease control interventions (AU)

[Mortality attributable to excess weight in Spain]. / Mortalidad atribuible al exceso de peso en España.

BACKGROUND AND OBJECTIVE: Estimate the mortality attributable to higher than optimal body mass index in the Spanish population in 2006. PATIENTS AND METHOD: Excess body weight prevalence data were obtained from the 2006 National Health Survey, while data on associated mortality were extracted from the National Statistic Institute. Population attributable fractions were applied and mortality attributable to higher than optimal body mass index was calculated for people between 35 and 79 years. RESULTS: In 2006, among the Spanish population aged 35-79 years, 25,671 lives (16,405 males and 9,266 women) were lost due to higher than optimal body mass index. Mortality attributable was 15.8% of total deaths in males and 14.8% in women, but if we refer to those causes where excess body weight is a risk factor, it is about a 30% of mortality (31.6% in men and 28% in women). The most important individual cause was cardiovascular disease (58%), followed by cancer. The individual cause with a major contribution to deaths was type 2 diabetes; nearly 70% in males and 80% in women. Overweight accounted for 54.9% deaths in men and 48.6% in women. CONCLUSIONS: Excess body weight is a major public health problem, with an important associated mortality. Attributable deaths are a useful tool to know the real situation and to monitor for disease control interventions.

[Disability attributable to excess weight in Spain]. / Discapacidad atribuible al exceso de peso en España.

BACKGROUND AND OBJECTIVE: To estimate the disability attributable to higher than optimal body mass index in the Spanish population in 2006. POPULATION AND METHOD: Excess body weight prevalence data were obtained from the 2006 National Health Survey (NHS), while the prevalence of associated morbidities was extracted from the 2006 NHS and from a national hospital data base. Population attributable fractions were applied and disability attributable was expressed as years life with disability (YLD). RESULTS: In 2006, in the Spanish population aged 35-79 years, 791.650 YLD were lost due to higher than optimal body mass index (46.7% in males and 53.3% in females). Overweight (body mass index 25-29.9) accounted for 45.7% of total YLD. Males YLD were higher than females under 60. The 35-39 quinquennial group showed a difference for males of 16.6% while in the 74-79 group the difference was 23.8% for women. Osteoarthritis and chronic back pain accounted for 60% of YLD while hypertensive disease and type 2 diabetes mellitus were responsible of 37%. CONCLUSIONS: Excess body weight is a health risk related to the development of various diseases with an important associated disability burden and social and economical cost. YLD analysis is a useful monitor tool for disease control interventions.

Carga de enfermedad en adolescentes y jóvenes en España / Burden of disease in adolescents and young people in Spain

Objetivo. Se analiza la carga de enfermedad de los adolescentes y jóvenes en España en el año 2008. Material y métodos. Estudio transversal de base poblacional. Se estiman los años de vida ajustados por discapacidad (AVAD) por sexo y causa específica en personas de 15-29 años. Las fuentes de información fueron: 1) Defunciones por edad, sexo y causa; 2) Estimaciones de la población a julio de 2008; y 3) Estimaciones del patrón de discapacidad para países europeos con baja mortalidad. Resultados. En 2008, los adolescentes y jóvenes perdieron 786.479 AVAD (414.346 en varones). Las enfermedades no transmisibles causaron 661.282 AVAD (84% respecto al total). Las principales causas específicas de carga de enfermedad fueron: depresión (16% de AVAD), abuso de alcohol (11%), migrañas (9%), trastorno bipolar (7%), esquizofrenia (6%), accidentes de circulación (5%) y adicción a drogas (5%). Conclusiones. La carga de enfermedad expresada en AVAD permite definir las pérdidas de salud en adolescentes y jóvenes. A estas edades, la promoción y protección de la salud son fundamentales, para prevenir la aparición de enfermedades en el adulto(AU)

Objective. This article analyses the burden of disease in adolescents and young people in Spain in 2008. Materials and methods. A cross-sectional population-based study. We estimated disability-adjusted life years (DALYs) by sex and cause for subjects aged 15-29 years. Data sources were used: (1) National death records by age, sex and cause; (2) population data (both in July 2008); and (3) estimates of the disability pattern for European countries with very low mortality. Results. In 2008, adolescents and young people lost 786,479 DALYs (414,346 in males). Non-communicable diseases generated 661,282 DALYs (84% of the total). The main specific causes of disease burden were: unipolar depression (16% of DALYs), alcohol use disorders (11%), migraine (9%), bipolar disorder (7%), schizophrenia (6%), road traffic accidents (5%) and drug addiction disorders (5%). Conclusions. The burden of disease expressed in DALYs can define the loss of health in adolescents and young people. At these ages, health promotion and protection are essential to prevent the onset of disease in adulthood(AU)

Burden of disease in adolescents and young people in Spain.

OBJECTIVE: This article analyses the burden of disease in adolescents and young people in Spain in 2008. MATERIAL AND METHODS: A cross-sectional population-based study. We estimated disability-adjusted life years (DALYs) by sex and cause for subjects aged 15-29 years. Data sources were used: 1) National death records by age, sex and cause; 2) Population data (both in July 2008); and 3) Estimates of the disability pattern for European countries with very low mortality. RESULTS: In 2008, adolescents and young people lost 786,479 DALYs (414,346 in males). Non-communicable diseases generated 661,282 DALYs (84% of the total). The main specific causes of disease burden were: unipolar depression (16% of DALYs), alcohol use disorders (11%), migraine (9%), bipolar disorder (7%), schizophrenia (6%), road traffic accidents (5%) and drug addiction disorders (5%). CONCLUSIONS: The burden of disease expressed in DALYs can define the loss of health in adolescents and young people. At these ages, health promotion and protection are essential to prevent the onset of disease in adulthood.

[Burden of disease in the elderly population in Spain]. / Aproximación a la carga de enfermedad de las personas mayores en España.

OBJECTIVE: We analyzed the burden of disease in the elderly population in Spain in 2008. METHODS: A population-based cross-sectional study was performed to calculate the disability-adjusted life years (DALYs) of the Spanish population aged ≥ 60 years old. DALYs are the sum of the number of years of life lost (YLLs) and the number of years lived with disability (YLDs). Data sources included the national mortality register for YLLs, and inference of Euro-A subregion (including Spain) estimates for YLDs. RESULTS: In the elderly population, DALYs lost due to all diseases were estimated at 2.1 million. The main causes of DALYs were malignancies (21.3%), neuropsychiatric disorders (21.1%) and cardiovascular diseases (20.4%). The main specific subcategories were dementias, ischemic heart disease, cerebrovascular disease, chronic obstructive pulmonary disease, lung cancer, hearing loss and osteoarthritis. CONCLUSIONS: Burden of disease analysis allows distinct health problems to be reassessed in relation to classical mortality analysis.

Aproximación a la carga de enfermedad de las personas mayores en España / Burden of disease in the elderly population in Spain

Objetivo: Analizar la carga de enfermedad de las personas mayores en España en el año 2008. Métodos: Estudio transversal de base poblacional. Se calcularon los años de vida ajustados por discapacidad (AVAD) en personas de 60 y más años de edad. Los AVAD resultan de sumar los años de vida perdidos (AVP) y los años vividos con discapacidad (AVD). Los datos se obtuvieron, para los AVP, del Registro de Mortalidad, y para los AVD por inferencia de las estimaciones de la subregión Euro-A (que incluye España). Resultados: Las personas mayores perdieron 2,1 millones de AVAD, destacando los tumores malignos (21,3%), las enfermedades neuropsiquiátricas (21,1%) y las cardiovasculares (20,4%). Las principales causas específicas fueron demencias, cardiopatía isquémica, enfermedad vascular cerebral, enfermedad pulmonar obstructiva crónica, cáncer de pulmón, pérdidas de audición y artrosis. Conclusiones: La carga de enfermedad permite replantear la importancia de los distintos problemas de salud en relación con el clásico análisis de mortalidad (AU)

Objective: We analyzed the burden of disease in the elderly population in Spain in 2008. Methods: A population-based cross-sectional study was performed to calculate the disability-adjusted life years (DALYs) of the Spanish population aged ≥ 60 years old. DALYs are the sum of the number of years of life lost (YLLs) and the number of years lived with disability (YLDs). Data sources included the national mortality register for YLLs, and inference of Euro-A subregion (including Spain) estimates for YLDs. Results: In the elderly population, DALYs lost due to all diseases were estimated at 2.1 million. The main causes of DALYs were malignancies (21.3%), neuropsychiatric disorders (21.1%) and cardiovascular diseases (20.4%). The main specific subcategories were dementias, ischemic heart disease, cerebrovascular disease, chronic obstructive pulmonary disease, lung cancer, hearing loss and osteoarthritis. Conclusions: Burden of disease analysis allows distinct health problems to be reassessed in relation to classical mortality analysis (AU)

The burden of premature mortality in Spain using standard expected years of life lost: a population-based study.

BACKGROUND: Measures of premature mortality have been used to guide debates on future health priorities and to monitor the population health status. Standard expected years of life lost (SEYLL) is one of the methods used to assess the time lost due to premature death. This article affords an overview of premature mortality in Spain for the year 2008. METHODS: A population-based study was conducted estimating SEYLL by sex and age groups. SEYLL, a key component of the disability-adjusted life years measure of disease burden, was calculated using Princeton West standard life tables with life expectancy at birth fixed at 80 years for males and 82.5 years for females. Population data and specific death records were obtained from the official registers of the National Institute of Statistics. All data were analysed and prepared in GesMor and Epidat software packages. RESULTS: The burden of premature mortality was estimated at 2.1 million SEYLL when age at death is taken into account. Males lost 60.9% and females lost 39.1% of total SEYLL. Malignant tumors (34.5%) and cardiovascular diseases (24.0%) were the leading categories in terms of SEYLL. Ischaemic heart disease (8.5%) and lung cancers (8.0%) were the most common specific causes of SEYLL followed by cerebrovascular diseases (5.9%), colorectal cancer (4.1%), road traffic accidents (3.5%), Alzheimer and other dementias (2.9%), chronic obstructive pulmonary disease (2.8%), breast cancer (2.8%) and suicides (2.6%). CONCLUSIONS: In Spain, premature mortality was essentially due to chronic non-communicable diseases. Data provided in this study are relevant for a more balanced health agenda aimed at reducing the burden of premature mortality. This study also represents a first step in estimating the overall burden of disease in terms of premature death and disability.

Evaluación económica de intervenciones en enfermedades infecciosas en España: revisión sistemática y análisis comparativo / Economic evaluation of interventions for infectious diseases in Spain: systematic review and comparative analysis

Fundamento: Existe la necesidad de evaluar intervenciones que se dirigen a prevenir, controlar y reducir la carga de las enfermedades infecciosas; siendo la evaluación económica un instrumento que puede ayudar a asignar recursos sanitarios de un modo eficiente. En este contexto, el objetivo de este trabajo ha sido analizar la evolución de los estudios de evaluación económica sobre enfermedades infecciosas publicados en España, así como comparar sus principales características metodológicas con las de los estudios dirigidos a otras enfermedades. Métodos: Revisión sistemática y análisis comparativo calculando odds ratios (OR). Se realizaron búsquedas de estudios publicados entre 1983 y 2008 en PubMed/MEDLINE, SCOPUS, ISI Web of Knowledge, CRD, IME e IBECS, y además manualmente en revistas especializadas e informes técnicos. Se revisaron las variables: revista y año de publicación, intervención, tipo de estudio, diseño, perspectiva, tipo de costes, fuente de financiación, y si se presentaban (o no) recomendaciones. Resultados: Se incluyeron 101 estudios en la revisión. En su mayoría resultaron ser análisis coste-efectividad (n=56; 55,4%), se evaluaban tratamientos (n=60; 59,4%) y utilizaban técnicas de análisis de decisiones y modelos matemáticos de simulación (n=63; 62,4%). Los trabajos en enfermedades infecciosas mostraron las siguientes asociaciones (respecto a los estudios en otras causas [n=376]) con: análisis coste-beneficio (OR=3,55; intervalo de confianza [IC] del 95%: 1,63–7,74), prevención (OR=4,14; IC del 95%: 2,49–6,90), y perspectiva social (OR=2,55; IC del 95%: 1,43–4,56). Conclusiones: Si bien existe un aumento progresivo de trabajos sobre enfermedades infecciosas durante las últimas décadas, los estudios identificados presentaron heterogeneidad en la calidad de la información respecto a los métodos de análisis y las fuentes de datos (AU)

Background: There exists the need to evaluate interventions addressed to prevent, control and reduce the burden of the infectious diseases; being economic evaluation an instrument can help to allocate healthcare resources efficiently. In this context, we assessed the evolution of economic evaluation of interventions for infectious diseases published in Spain, as well as we compared their main methodological characteristics with those of the studies directed to other diseases. Methods: Systematic review and comparative analysis calculating odds ratios (OR). Electronic searches for literature beetwen 1983 and 2008 were conducted in PubMed/MEDLINE, SCOPUS, ISI Web of Knowledge, CRD, IME e IBECS, and manually in specialized journals and technical reports. The following variables were identified to analyze the characteristics of the reports: journal and year of publication, intervention, type of study, design, perspective, type of costs, financing source, and decision-making recommendations. Results: One-hundred and one studies were included in the review. The main characteristics of the reports were: cost-effectiveness analysis (n=56; 55.4%), treatments evaluations (n=60; 59.4%) and the use of decision analysis and mathematical simulation models (n=63; 62.4%). Economic evaluation studies of infectious diseases showed the following associations (compared to a cohort of studies of other disease conditions [n=376]): cost-benefit analysis (OR, 3.55; 95% confidence interval [CI], 1.63 to 7.74), prevention (OR, 4.14; 95% CI, 2.49 to 6.90), and societal perspective (OR, 2.55; 95% CI, 1.43 to 4.56). Conclusion: Although there is an increase in the number of economic evaluations of infectious diseases published during last decades, the studies showed heterogeneity in the quality of the information regarding methods of analysis and data sources (AU)

Burden of disease and economic evaluation of healthcare interventions: are we investigating what really matters?

BACKGROUND: The allocation of limited available healthcare resources demands an agreed rational allocation principle and the consequent priority setting. We assessed the association between economic evaluations of healthcare interventions published in Spain (1983-2008) and the disease burden in the population. METHODS: Electronic databases (e.g., PubMed/MEDLINE, SCOPUS, ISI Web of Knowledge, CRD, IME, IBECS) and reports from health technology assessment agencies were systematically reviewed. For each article, multiple variables were recorded such as: year and journal of publication, type of study, health intervention targetted, perspective of analysis, type of costs and sources of information, first author's affiliation, explicit recommendations aimed at decision-making, and the main disease cause to which the intervention was addressed. The following disease burden measures were calculated: years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life years (DALYs), and mortality by cause. Correlation and linear regression models were fitted. RESULTS: Four hundred and seventy-seven economic evaluations were identified. Cardiovascular diseases (15.7%), infectious diseases (15.3%), malignant neoplasms (13.2%), and neuropsychiatric diseases (9.6%) were the conditions most commonly addressed. Accidents and injuries, congenital anomalies, oral conditions, nutritional deficiencies and other neoplasms were the categories with a lowest number of studies (0.6% for each of them). For the main disease categories (n = 20), a correlation was seen with: mortality 0.67 (p = 0.001), DALYs 0.63 (p = 0.003), YLLs 0.54 (p = 0.014), and YLDs 0.51 (p = 0.018). By disease sub-categories (n = 51), the correlations were generally low and non statistically significant. CONCLUSIONS: Examining discrepancies between economic evaluations in particular diseases and the overall burden of disease helps shed light on whether there are potentially over- and under-investigated areas. The approach taken could help policy-makers understand whether resources for economic evaluation are being allocated by using summary measures of population health.

Does the development of new medicinal products in the European Union address global and regional health concerns?

BACKGROUND: Since 1995, approval for many new medicinal products has been obtained through a centralized procedure in the European Union. In recent years, the use of summary measures of population health has become widespread. We investigated whether efforts to develop innovative medicines are focusing on the most relevant conditions from a global public health perspective. METHODS: We reviewed the information on new medicinal products approved by centralized procedure from 1995 to 2009, information that is available to the public in the European Commission Register of medicinal products and the European Public Assessment Reports from the European Medicines Agency. Morbidity and mortality data were included for each disease group, according to the Global Burden of Disease project. We evaluated the association between authorized medicinal products and burden of disease measures based on disability-adjusted life years (DALYs) in the European Union and worldwide. RESULTS: We considered 520 marketing authorizations for medicinal products and 338 active ingredients. New authorizations were seen to increase over the period analyzed. There was a positive, high correlation between DALYs and new medicinal product development (ρ = 0.619, p = 0.005) in the European Union, and a moderate correlation for middle-low-income countries (ρ = 0.497, p = 0.030) and worldwide (ρ = 0.490, p = 0.033). The most neglected conditions at the European level (based on their attributable health losses) were neuropsychiatric diseases, cardiovascular diseases, respiratory diseases, sense organ conditions, and digestive diseases, while globally, they were perinatal conditions, respiratory infections, sense organ conditions, respiratory diseases, and digestive diseases. CONCLUSIONS: We find that the development of new medicinal products is higher for some diseases than others. Pharmaceutical industry leaders and policymakers are invited to consider the implications of this imbalance by establishing work plans that allow for the setting of future priorities from a public health perspective.