ABSTRACT
Objective: We simulated the impact of implementing different health interventions to improve the HIV continuum of care for people diagnosed, on treatment, and virologically suppressed in Spain for the 20202030 period. Methods: The model was carried out in four phases involving a multidisciplinary expert panel: (1) literature review; (2) selection/definition of the interventions and their effectiveness; (3) consensus meeting; and (4) development of an analytical decision model to project the impact of implementing/strengthening these interventions to improve the HIV continuum of care, corresponding to 20172019 (87% diagnosed, 97% on treatment, 90% with viral suppression), through the creation of different scenarios for 20202030. A total of 19 interventions were selected based on expanding the offer of HIV rapid tests and implementing training/peer programmes, electronic alerts, multidisciplinary care, and mHealth, among others. The effectiveness of the interventions was defined by the percentage increases in diagnosis, treatment, and viral suppression after their implementation, targeting the entire population and specific groups at high-risk (men who have sex with men, migrants, female sex workers, transgender people, and people who inject drugs). Results: Implementing eight interventions for diagnosis, three for treatment, and eight for viral suppression for the target populations during 20202030 would increase the continuum of care to approximately 100% diagnosed (remaining residual undetectable cases), 98% treated, and 96% virologically suppressed. Conclusions: Planification, prioritization, and implementation of selected interventions based on the current HIV continuum of care could allow achievement of the 95-95-95 UNAIDS goals in Spain by 2030.(AU)
Objetivo: Simulamos el impacto de la implementación de diferentes intervenciones sanitarias para mejorar la atención continua de las personas diagnosticadas, en tratamiento y con supresión vírica del VIH en España para el período 2020-2030. Métodos: El modelo se llevó a cabo en 4 fases con la participación de un panel de expertos multidisciplinario: (1) revisión de la literatura médica publicada; (2) selección/definición de las intervenciones y su eficacia; (3) reunión de consenso, y (4) desarrollo de un modelo de toma de decisiones analítico para proyectar el impacto de la implementación/refuerzo de estas intervenciones para mejorar la atención continua de las personas con VIH, correspondiente al período 2017-2019 (87% diagnosticados, 97% en tratamiento y 90% con supresión vírica), a través de la creación de diferentes escenarios para el período 2020-2030. Se seleccionaron un total de 19 intervenciones sobre la base de ampliar la oferta de pruebas rápidas de VIH, y la implementación de programas de formación/entre pares, alertas electrónicas, atención multidisciplinaria y mHealth, entre otras. La efectividad de las intervenciones se definió a partir del porcentaje de incremento en el diagnóstico, tratamiento y supresión vírica tras la implementación, dirigida a toda la población y a grupos específicos de alto riesgo (hombres que mantienen relaciones sexuales con otros hombres, migrantes, trabajadoras sexuales, personas transgénero y personas que consumen drogas inyectables). Resultados: La implementación de 8 intervenciones para el diagnóstico, 3 para el tratamiento y 8 para la supresión vírica dirigidas a las poblaciones objetivo durante el período 2020-2030 debería mejorar la atención continua recibida en aproximadamente un 100% de personas diagnosticadas (con un remanente de casos residuales indetectables), un 98% de personas tratadas y un 96% de personas con supresión vírica...(AU)
Subject(s)
Humans , Male , Female , Acquired Immunodeficiency Syndrome , HIV , Transgender Persons , Sexual and Gender Minorities , HIV Infections/drug therapy , Communicable Diseases , Microbiology , SpainABSTRACT
OBJECTIVE: We simulated the impact of implementing different health interventions to improve the HIV continuum of care for people diagnosed, on treatment, and virologically suppressed in Spain for the 2020-2030 period. METHODS: The model was carried out in four phases involving a multidisciplinary expert panel: (1) literature review; (2) selection/definition of the interventions and their effectiveness; (3) consensus meeting; and (4) development of an analytical decision model to project the impact of implementing/strengthening these interventions to improve the HIV continuum of care, corresponding to 2017-2019 (87% diagnosed, 97% on treatment, 90% with viral suppression), through the creation of different scenarios for 2020-2030. A total of 19 interventions were selected based on expanding the offer of HIV rapid tests and implementing training/peer programmes, electronic alerts, multidisciplinary care, and mHealth, among others. The effectiveness of the interventions was defined by the percentage increases in diagnosis, treatment, and viral suppression after their implementation, targeting the entire population and specific groups at high-risk (men who have sex with men, migrants, female sex workers, transgender people, and people who inject drugs). RESULTS: Implementing eight interventions for diagnosis, three for treatment, and eight for viral suppression for the target populations during 2020-2030 would increase the continuum of care to approximately 100% diagnosed (remaining residual undetectable cases), 98% treated, and 96% virologically suppressed. CONCLUSIONS: Planification, prioritization, and implementation of selected interventions based on the current HIV continuum of care could allow achievement of the 95-95-95 UNAIDS goals in Spain by 2030.
Subject(s)
HIV Infections , Sex Workers , Sexual and Gender Minorities , Male , Humans , Female , HIV Infections/drug therapy , Homosexuality, Male , Goals , Delivery of Health CareABSTRACT
INTRODUCTION: Spain was one of the most affected countries during the first wave of COVID-19, having the highest mortality rate in Europe. The aim of this retrospective study is to estimate the impact that remdesivir-the first drug for COVID-19 approved in the EU-would have had in the first wave. METHODS: This study simulated the impact that remdesivir could have had on the Spanish National Health System (SNHS) capacity (bed occupancy) and the number of deaths that could have been prevented, based on two scenarios: a real-life scenario (without remdesivir) and an alternative scenario (with remdesivir). It considered the clinical results of the ACTT-1 trial in hospitalized patients with COVID-19 and pneumonia who required supplemental oxygen. The occupancy rates in general wards and ICUs were estimated in both scenarios. RESULTS: Remdesivir use could have prevented the admission of 2587 patients (43.75%) in the ICUs. It could have also increased the SNHS capacity in 5656 general wards beds and 1700 ICU beds, showing an increase in the number of beds available of 17.53% (95% CI 3.98%-24.42%) and 23.98% (95% CI 21.33%-28.22%), respectively, at the peak of the occupancy rates. Furthermore, remdesivir use could have prevented 7639 deaths due to COVID-19, which implies a 27.51% reduction (95% CI 14.25%-34.07%). CONCLUSIONS: Remdesivir could have relieved the pressure on the SNHS and could have reduced the death toll, providing a better strategy for the management of COVID-19 during the first wave.
Subject(s)
COVID-19 Drug Treatment , Adenosine Monophosphate/analogs & derivatives , Alanine/analogs & derivatives , Antiviral Agents/therapeutic use , Europe , Humans , Retrospective Studies , SARS-CoV-2 , Spain/epidemiologyABSTRACT
OBJECTIVE: To explore the preferences of Spanish healthcare professionals (haematologists and hospital pharmacists) for the treatment selection of active Chronic Lymphocytic Leukaemia (CLL) patients at first relapse, condition that mainly afflicts older adults. METHODS: A discrete choice experiment (DCE) was conducted among haematologists and hospital pharmacists. A literature review and a focus group informed the DCE design. CLL treatment settings were defined by seven attributes: four patient/disease-related attributes (age, functional status, comorbidities, and risk of the disease) and three treatment-related attributes (efficacy [hazard ratio of progression-free survival, HR-PFS], rate of discontinuations due to adverse events and cost). A mixed-logit model was used to determine choice-based preferences. Relative importance (RI) of attributes was calculated and compared between stakeholders. Willingness-to-pay (WTP) was estimated through the DCE. Besides, nine ad-hoc questions were posed, to explore more in depth CLL treatment decision making. RESULTS: A total of 130 participants (72 haematologists and 58 hospital pharmacists) answered the DCE. All attributes were significant predictors of preferences (pâ¯<â¯0.05) in the multinomial model. Higher RI was obtained for treatment-related attributes: the highest rated being 'cost' (23.8%) followed by 'efficacy' (20.9%). Regarding patient-related attributes, the highest RI was obtained for 'age' (18.1%). No significant differences (pâ¯>â¯0.05) in RI between haematologists and pharmacists were found. WTP for the treatment was higher for younger CLL patients. Ad-hoc questions showed that patient age and functional status influence treatment decisions. CONCLUSIONS: For healthcare professionals, 'cost' and 'efficacy' (treatment-related attributes) and age (patient-related attribute) are the main factors that determine CLL treatment selection at first relapse. WTP decreases as patient's age increases.
Subject(s)
Leukemia, Lymphocytic, Chronic, B-Cell , Aged , Choice Behavior , Focus Groups , Humans , Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy , Logistic Models , Patient PreferenceABSTRACT
BACKGROUND: Maintenance therapy with rituximab for follicular lymphoma (FL) responding to induction at the first-line, significantly increases progression-free survival compared with observation. To estimate the efficiency of this therapeutic option, we performed a cost-effectiveness analysis of maintenance therapy of the follicular lymphoma (FL) that responds to induction in first line, with rituximab, compared with the option of "watch and wait" strategy. METHODS: We did a Markov model of the FL, with four health states (progression free survival in first or second line, progression and death). The transition probabilities between states were obtained from clinical trials PRIMA and EORTC 20981. Health state utilities were obtained from literature. The use of health resources, from the perspective of the National Health System was estimated by a panel of Spanish clinical experts. Unit costs (euros in 2011) were obtained from Spanish sources. Deterministic and probabilistic analyses were made. RESULTS: In the deterministic base case analysis, for a time horizon of 30 years, the cost per life year gained (LYG) and quality-adjusted life-years (QALYs) gained, was euros 5,663 and euros 6,253 respectively. The sensitivity analyses confirmed the stability of the base case for time horizons of 10 and 20 years and various statistical distributions (Weibull, exponential, log-logistic, log-normal, Gompertz, and gamma) ranging between euros 4,222 and euros 8,766. Rituximab maintenance is cost-effective from a time horizon of 5.7 years (cost per QALY gained of euros 29,998). CONCLUSION: Compared with observation, rituximab maintenance treatment of the FL that responds to induction therapy in first line, is cost-effective according to the present model.
Subject(s)
Antibodies, Monoclonal, Murine-Derived/therapeutic use , Antineoplastic Agents/therapeutic use , Lymphoma, Follicular/drug therapy , Maintenance Chemotherapy/economics , Antibodies, Monoclonal, Murine-Derived/economics , Antineoplastic Agents/economics , Cost-Benefit Analysis , Disease-Free Survival , Humans , Induction Chemotherapy , Lymphoma, Follicular/economics , Lymphoma, Follicular/mortality , Lymphoma, Follicular/therapy , Markov Chains , Models, Economic , Quality-Adjusted Life Years , Rituximab , Spain , Treatment Outcome , Watchful Waiting/economicsABSTRACT
Fundamentos: El tratamiento de mantenimiento con rituximab del linfoma folicular (LF) que responde a la inducción en primera línea, aumenta de manera significativa la supervivencia libre de progresión en comparación con la observación. Para evaluar económicamente esta opción terapéutica, se realizó un análisis de coste-efectividad del tratamiento de mantenimiento del LF tras la inducción en primera línea con rituximab frente a la observación de la enfermedad. Métodos: Se hizo un modelo de Markov del LF, con cuatro estados de salud (supervivencia libre de progresión en primera o segunda línea, progresión y muerte). Las probabilidades de transición entre los estados se obtuvieron de los ensayos clínicos PRIMA y EORTC 20981. Las utilidades de los estados se obtuvieron de la bibliografía. El uso de recursos sanitarios, desde la perspectiva del Sistema Nacional de Salud, fue estimado por un panel de expertos clínicos españoles. Los costes unitarios (€ del año 2011) se obtuvieron de fuentes españolas. Se efectuaron análisis determinísticos y probabilísticos. Resultados: En el caso base del análisis determinístico, para un horizonte temporal de 30 años, el coste por año de vida ganado (AVG) y por año de vida ajustado por calidad (AVAC) ganado, fue de 5.663 € y 6.253 €, respectivamente. Los análisis de sensibilidad confirmaron la estabilidad del caso base para horizontes temporales de 10 y 20 años y diversas distribuciones estadísticas (Weibull, exponencial, log-logística, log-normal, Gompertz y gamma) oscilando entre 4.222 y 8.766 €. El mantenimiento con rituximab es coste-efectivo a partir de un horizonte temporal de 5,7 años (coste por AVAC ganado de 29.998 €). Conclusión: En comparación con la observación, el tratamiento de mantenimiento con rituximab del LF que responde a la inducción en primera línea, es coste-efectivo de acuerdo con el presente modelo(AU)
Background: Maintenance therapy with rituximab for follicular lymphoma (FL) responding to induction at the first-line, significantly increases progression-free survival compared with observation. To estimate the efficiency of this therapeutic option, we performed a cost-effectiveness analysis of maintenance therapy of the follicular lymphoma (FL) that responds to induction in first line, with rituximab, compared with the option of "watch and wait" strategy. Methods:We did a Markov model of the FL, with four health states (progression free survival in first or second line, progression and death). The transition probabilities between states were obtained from clinical trials PRIMA and EORTC 20981. Health state utilities were obtained from literature. The use of health resources, from the perspective of the National Health System was estimated by a panel of Spanish clinical experts. Unit costs (€ in 2011) were obtained from Spanish sources. Deterministic and probabilistic analyses were made. Results: In the deterministic base case analysis, for a time horizon of 30 years, the cost per life year gained (LYG) and quality-adjusted lifeyears (QALYs) gained, was € 5,663 and € 6,253 respectively. The sensitivity analyses confirmed the stability of the base case for time horizons of 10 and 20 years and various statistical distributions (Weibull, exponential, log-logistic, log-normal, Gompertz, and gamma) ranging between € 4,222 and € 8,766. Rituximab maintenance is cost-effective from a time horizon of 5.7 years (cost per QALY gained of € 29,998). Conclusion: Compared with observation, rituximab maintenance treatment of the FL that responds to induction therapy in first line, is cost-effective according to the present model(AU)
