Standard and intensive lipid-lowering therapy with statins for the primary prevention of vascular diseases: a population-based study.

PURPOSE: To describe the clinical profile of the patients that initiate statin therapy for the primary prevention of vascular diseases and to investigate the extent to which clinicians use intensive vs. standard regimens. METHODS: A cross-sectional analysis of nationwide individual data regarding individuals ≥ 11 years with a first prescription of statin, recorded between 1 January 2007 and 31 December 2011. Subjects were defined as intensive therapy initiators if a statin dose superior to simvastatin 40 mg (or equivalent dose if different statin) was first prescribed. Multivariable logistic regression models were built for dependent summary variables to evaluate the strength of the association between them and the use of intensive therapy. RESULTS: Overall, 69,737 patients receiving a first prescription of statin for the primary prevention of vascular diseases were identified. Predictors for intensive therapy initiation were male gender (adjusted OR: 1.28; 95%CI: 1.10-1.48), history of hypothyroidism (1.47; 1.17-1.85), current treatment of diabetes (1.18; 1.00-1.41), proteinuria (1.87; 1.12-3.12), age, and year of statin prescription. Modifiable risk factors associated with intensive therapy were elevated tryglicerides (1.63; 1.39-1.91), elevated LDL-C (1.96; 1.69-2.28), obesity (1.25; 1.07-1.47), smoking (1.32; 1.14-1.55), comedication with ezetimibe (3.76; 1.87-7.55), fibrates (1.96; 1.43-2.70) and calcium antagonists in women (1.42; 1.02-1.98). CONCLUSIONS: The use of intensive therapy with statins in primary prevention was not very high in absolute terms, but is increasing considerably. The association between intensive therapy and previous hypothyroidism or its combination with fibrates may raise additional safety and tolerability concerns.

Evidencia clínica procedente de comparaciones indirectas y mixtas: algunas consideraciones prácticas / Clinical evidence from indirect and mixed-treatment comparisons: some practical considerations

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Measuring the burden of disease and injury in Spain using disability-adjusted life years: an updated and policy-oriented overview.

OBJECTIVE: To provide a comprehensive and detailed overview of the burden of disease in Spain for 2008. Implications for public health policies are discussed. STUDY DESIGN: Cross-sectional population-based study. METHODS: Disability-adjusted life years (DALYs) were calculated at country level using the methodology developed in the Global Burden of Disease study. DALYs were divided into years of life lost and years of life lived with disability. Results were obtained using Spanish mortality data for 2008 and morbidity data estimated previously by the World Health Organization for Euro-A. RESULTS: In 2008, DALYs lost due to all diseases and injuries were estimated at 5.1 million. Non-communicable diseases accounted for 89.2% of the total DALYs. The leading causes of DALYs were neurological and mental disorders (29.9%), malignant neoplasms (15.8%) and cardiovascular diseases (12.5%). The main specific causes included depression (5.5%), ischaemic heart disease (5.5%), lung cancer (5.3%) and alcohol abuse (4.7%) among males; and depression (11.7%), dementias (10.0%), hearing loss (4.2%) and cerebrovascular disease (3.5%) among females. CONCLUSIONS: Measuring DALYs specifically for Spain represents a systematic analysis of population health losses, and also provides an important measure to track the outcomes of future health interventions.

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

Objetivo Revisar los métodos utilizados para elaborar evaluaciones económicas de intervenciones en enfermedades oncológicas y comparar sus principales características con las de los estudios dirigidos a otras enfermedades. Métodos Revisión sistemática y análisis comparativo calculando odds ratios (OR). Se realizaron búsquedas bibliográficas para identificar las evaluaciones económicas sobre enfermedades oncológicas realizadas en España entre 1983 y 2008. Se revisaron y describieron sus características, incluyendo las siguientes 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 63 estudios. Principalmente, resultaron ser análisis coste-efectividad y evaluaban tratamientos (60,3%; n=38). Diecisiete estudios (27,0%) utilizaron un diseño observacional. Los trabajos sobre enfermedades oncológicas mostraron las siguientes asociaciones (respecto a los estudios en otras causas [n=411]) con: análisis de minimización de costes (OR=1,73; intervalo de confianza [IC] del 95%: 0,91-3,27), diagnóstico (OR=2,18; IC95%: 1,07-4,43), análisis de decisiones (OR=0,46; IC95%: 0,24-0,87), perspectiva social (OR=0,20; IC95%: 0,05-0,86) y fuente de financiación con ánimo de lucro (OR=0,52; IC95%: 0,30-0,93).Conclusiones El número de evaluaciones económicas es escaso a pesar del aumento progresivo producido en los últimos años. Los estudios identificados presentaron heterogeneidad en cuanto a los métodos y las fuentes de información utilizadas. Es necesario aumentar la evaluación de la eficiencia de intervenciones oncológicas y garantizar su calidad metodológica (AU)

Objective To review standard methods used to evaluate the efficiency of oncology interventions, comparing their main characteristics with those of the studies aimed for other conditions. Methods We performed a systematic review and comparative analysis calculating odds ratios (OR). We searched the biomedical literature to assess economic evaluation studies on malignant neoplasms in Spain published between 1983 and 2008. Their characteristics were reviewed and summarised, including the following variables: journal and year of publication, intervention, type and design of study, perspective, type of costs, financing source, and decision-making recommendations. Results Sixty-three studies were included. Main characteristics of the reports were: cost-effectiveness analysis and therapeutic interventions (60.3%; n=38). Seventeen studies (27.0%) used an observational design. Economic evaluations of malignant neoplasms showed the following associations (compared to those studies addressing other causes [n=411]): cost minimisation analysis (OR: 1.73; 95% confidence interval [CI]: 0.91-3.27), diagnostic interventions (OR: 2.18; 95% CI: 1.07-4.43), decision analysis design (OR: 0.46; 95% CI: 0.24-0.87), societal perspective (OR: 0.20; 95% CI: 0.05-0.86) and for-profit source of financing (OR: 0.52; 95% CI: 0.30-0.93). Conclusions Economic evaluations of interventions for malignant neoplasms are not common despite the gradual increase produced during recent years in Spain. Reports presented heterogeneity in the quality of the information regarding the methods and the data sources used. Further efficiency evaluations of oncology interventions are needed and methodological quality should be warranted (AU)

Economic evaluation of interventions for malignant neoplasms in Spain: systematic review and comparative analysis.

OBJECTIVE: To review standard methods used to evaluate the efficiency of oncology interventions, comparing their main characteristics with those of the studies aimed for other conditions. METHODS: We performed a systematic review and comparative analysis calculating odds ratios (OR). We searched the biomedical literature to assess economic evaluation studies on malignant neoplasms in Spain published between 1983 and 2008. Their characteristics were reviewed and summarised, including the following variables: journal and year of publication, intervention, type and design of study, perspective, type of costs, financing source, and decision-making recommendations. RESULTS: Sixty-three studies were included. Main characteristics of the reports were: cost-effectiveness analysis and therapeutic interventions (60.3%; n=38). Seventeen studies (27.0%) used an observational design. Economic evaluations of malignant neoplasms showed the following associations (compared to those studies addressing other causes [n=411]): cost minimisation analysis (OR: 1.73; 95% confidence interval [CI]: 0.91-3.27), diagnostic interventions (OR: 2.18; 95% CI: 1.07-4.43), decision analysis design (OR: 0.46; 95% CI: 0.24-0.87), societal perspective (OR: 0.20; 95% CI: 0.05-0.86) and for-profit source of financing (OR: 0.52; 95% CI: 0.30-0.93). CONCLUSIONS: Economic evaluations of interventions for malignant neoplasms are not common despite the gradual increase produced during recent years in Spain. Reports presented heterogeneity in the quality of the information regarding the methods and the data sources used. Further efficiency evaluations of oncology interventions are needed and methodological quality should be warranted.

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

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.

[Economic evaluation of neurological and mental disorders in Spain: systematic review and comparative analysis]. / Evaluacion economica sobre enfermedades neurologicas y mentales en Espana: revision sistematica y analisis comparativo.

AIM: We analyzed the trends over time and the characteristics of economic evaluation studies of neurological and mental disorders published in Spain between 1983 and 2008. MATERIALS AND METHODS: Systematic review and comparative analysis calculating odds ratios (OR). Electronic searches for literature were conducted in PubMed/Medline, Scopus, ISI Web of Knowledge, CRD, IME and IBECS, and manually in specialized journals and technical reports. RESULTS: The 52 studies included in the review showed heterogeneity in the quality of the information regarding methods of analysis and data sources. Economic evaluation studies of neurological and mental disorders showed the following associations, compared to a cohort of studies of other disease conditions (n = 425): cost-utility analysis (OR = 1.57; 95% confidence interval, 95% CI = 0.77-3.22), treatments (OR = 3.02; 95% CI = 1.33-6.88), simulation mathematics models (OR = 2.51; 95% CI = 1.30-4.87), and healthcare system perspective (OR = 1.43; 95% CI = 0.80-2.54). CONCLUSIONS: Findings suggested that there is little research on economic evaluation research on neurological and mental disorders in Spain. In the future, more and better quality economic evaluation studies -according to their burden generated- are expected.

Evaluación económica sobre enfermedades neurológicas y mentales en España: revisión sistemática y análisis comparativo / Economic evaluation of neurological and mental disorders in Spain: systematic review and comparative analysis

Objetivo. Analizar la evolución y las características metodológicas de los estudios de evaluación económica sobre enfermedades neurológicas y mentales publicados en España entre 1983 y 2008. Materiales y métodos. Revisión sistemática y análisis comparativo calculando odds ratios (OR). Se realizaron búsquedas de estudios publicados en PubMed/Medline, Scopus, ISI Web of Knowledge, CRD, IME e IBECS, y además manualmente en revistas especializadas e informes técnicos. Resultados. Los 52 estudios incluidos en la revisión combinan heterogeneidad en la calidad de la información comunicada respecto a los métodos de análisis y las fuentes de datos. Los trabajos sobre enfermedades neurológicas y mentales mostraron las siguientes asociaciones, respecto a los estudios en otras causas (n = 425): con análisis coste-utilidad (OR = 1,57; intervalo de confianza del 95%, IC 95% = 0,77-3,22), tratamientos (OR = 3,02; IC 95% = 1,33-6,88), modelos matemáticos de simulación (OR = 2,51; IC 95% = 1,30-4,87) y perspectiva del sistema sanitario (OR = 1,43; IC 95% = 0,80-2,54). Conclusiones. Se observa que hay poca investigación en evaluación económica sobre enfermedades neurológicas y mentales en España. Sería de esperar que en el futuro aumentara el número de estudios en enfermedades neurológicas y mentales –en relación con la carga de enfermedad que generan– y su calidad metodológica (AU)

Aim. We analyzed the trends over time and the characteristics of economic evaluation studies of neurological and mental disorders published in Spain between 1983 and 2008. Materials and methods. Systematic review and comparative analysis calculating odds ratios (OR). Electronic searches for literature were conducted in PubMed/Medline, Scopus, ISI Web of Knowledge, CRD, IME and IBECS, and manually in specialized journals and technical reports. Results. The 52 studies included in the review showed heterogeneity in the quality of the information regarding methods of analysis and data sources. Economic evaluation studies of neurological and mental disorders showed the following associations, compared to a cohort of studies of other disease conditions (n = 425): cost-utility analysis (OR = 1.57; 95% confidence interval, 95% CI = 0.77-3.22), treatments (OR = 3.02; 95% CI = 1.33-6.88), simulation mathematics models (OR = 2.51; 95% CI = 1.30-4.87), and healthcare system perspective (OR = 1.43; 95% CI = 0.80-2.54). Conclusions. Findings suggested that there is little research on economic evaluation research on neurological and mental disorders in Spain. In the future, more and better quality economic evaluation studies –according to their burden generated– are expected (AU)