Social/economic costs and health-related quality of life in patients with juvenile idiopathic arthritis in Europe.

OBJECTIVE: The aim of this study was to determine the economic burden from a societal perspective and the health-related quality of life (HRQOL) of patients with juvenile idiopathic arthritis (JIA) in Europe. METHODS: We conducted a cross-sectional study of patients with JIA from Germany, Italy, Spain, France, the United Kingdom, Bulgaria, and Sweden. Data on demographic characteristics, healthcare resource utilization, informal care, labor productivity losses, and HRQOL were collected from the questionnaires completed by patients or their caregivers. HRQOL was measured with the EuroQol 5-domain (EQ-5D-5L) questionnaire. RESULTS: A total of 162 patients (67 Germany, 34 Sweden, 33 Italy, 23 United Kingdom, 4 France, and 1 Bulgaria) completed the questionnaire. Excluding Bulgarian results, due to small sample size, country-specific annual health care costs ranged from €18,913 to €36,396 (reference year: 2012). Estimated direct healthcare costs ranged from €11,068 to €22,138; direct non-healthcare costs ranged from €7837 to €14,155 and labor productivity losses ranged from €0 to €8715. Costs are also shown to differ between children and adults. The mean EQ-5D index score for JIA patients was estimated at between 0.44 and 0.88, and the mean EQ-5D visual analogue scale score was estimated at between 62 and 79. CONCLUSIONS: JIA patients incur considerable societal costs and experience substantial deterioration in HRQOL in some countries. Compared with previous studies, our results show a remarkable increase in annual healthcare costs for JIA patients. Reasons for the increase are the inclusion of non-professional caregiver costs, a wider use of biologics, and longer hospital stays.

[Primary hip replacement: first year results and predictive factors of poor outcome]. / Artroplastia primaria de cadera: resultados en el primer año y factores predictores de mala evolución.

OBJECTIVE: To evaluate the results of total hip arthroplasty in patients with osteoarthritis and to identify predictors of poor functional outcome. MATERIAL AND METHODS: A prospective observational study in patients operated on in 2006 with total hip arthroplasty in 4 hospitals in Guipúzcoa, followed up for 1 year. OUTCOME VARIABLES: pain, physical function, complications, mortality, quality of life by WOMAC and SF-12 (at 0, 3, 6 and 12 months) and «Poor functional outcome¼ at one year (last quartile of the WOMAC in function area). Logistic regression was performed to examine predictors of poor functional outcome. RESULTS: A total of 166 patients were followed up. The incidence of systemic and local complications was 6.3% and 14.5%, respectively, 4.3% readmissions and no deaths related to surgery. Close to 40 points improvement in pain, stiffness and WOMAC functional limitation, mainly in the first 3 months after surgery. A similar trend was seen, but lower in the physical and mental component of the SF12 (12 and 8 points, respectively). The previous score on the WOMAC function area and the physical component of SF-12, and the existence of any complications, are predictors of poor functional recovery. DISCUSSION: The improvement experienced after the surgery is already very important before the third month. The functional and physical status before surgery and possible complications of surgery are significant determinants of the results.

Artroplastia primaria de cadera: resultados en el primer año y factores predictores de mala evolución / Primary hip replacement: first year results and predictive factors of poor outcome

Objetivo. Evaluar los resultados del primer año en la artroplastia total de cadera de pacientes con osteoartritis e identificar los factores predictores de mala evolución funcional. Material y método. Estudio observacional, prospectivo en pacientes intervenidos en 2006 con artroplastia total de cadera en 4 hospitales de Guipúzcoa, seguidos durante un año. Variables de resultado: dolor, función física, complicaciones, mortalidad, calidad de vida mediante WOMAC y SF-12 (a 0, 3, 6 y 12 meses) y «mal resultado funcional» al año (último cuartil del WOMAC en área de función). Mediante regresión logística se estudiaron los factores predictores de mal resultado funcional. Resultados. Se incluyeron 166 pacientes. La incidencia de complicaciones sistémicas y locales fue de 6,3 y 14,5%, respectivamente, con 4,3% de reingresos y sin fallecimientos relacionados con la cirugía. Mejoría cercana a 40 puntos en dolor, rigidez y limitación funcional del WOMAC, principalmente en los primeros tres meses postintervención. Evolución similar, pero inferior en el componente físico y mental del SF12 (12 y 8 puntos respectivamente). La puntuación previa en el área de función de WOMAC y en el componente físico del SF-12, así como la existencia de alguna complicación, son factores predictores de la mala recuperación funcional. Discusión. La mejoría experimentada tras la intervención es ya muy relevante antes del tercer mes. La situación funcional y física previa a la intervención y las posibles complicaciones de la cirugía son factores determinantes de los resultados (AU)

Objective. To evaluate the results of total hip arthroplasty in patients with osteoarthritis and to identify predictors of poor functional outcome. Material and methods. A prospective observational study in patients operated on in 2006 with total hip arthroplasty in 4 hospitals in Guipúzcoa, followed up for 1 year. Outcome variables: pain, physical function, complications, mortality, quality of life by WOMAC and SF-12 (at 0, 3, 6 and 12 months) and «Poor functional outcome» at one year (last quartile of the WOMAC in function area). Logistic regression was performed to examine predictors of poor functional outcome. Results. A total of 166 patients were followed up. The incidence of systemic and local complications was 6.3% and 14.5%, respectively, 4.3% readmissions and no deaths related to surgery. Close to 40 points improvement in pain, stiffness and WOMAC functional limitation, mainly in the first 3 months after surgery. A similar trend was seen, but lower in the physical and mental component of the SF12 (12 and 8 points, respectively). The previous score on the WOMAC function area and the physical component of SF-12, and the existence of any complications, are predictors of poor functional recovery. Discussion. The improvement experienced after the surgery is already very important before the third month. The functional and physical status before surgery and possible complications of surgery are significant determinants of the results (AU)

Risk factors for hospital readmissions in elderly patients: a systematic review.

Population ageing is associated with an increase in hospital admissions. Defining the factors that affect the risk of hospital readmission could identify individuals at high risk and enable targeted interventions to be designed. This aim of this study was to identify the risk factors for hospital readmission in elderly people. A systematic review of the literature published in English or Spanish was performed by electronically searching EMBASE, MEDLINE, CINAHL, SCI and SSCI. Some keywords were aged, elder, readmission, risk, etc. Selection criteria were: prospective cohort studies with suitable statistical analysis such as logistic regression, that explored the relationship between the risk of readmission with clinical, socio-demographic or other factors in elderly patients (aged at least 75 years) admitted to hospital. Studies that fulfilled these criteria were reviewed and data were extracted by two reviewers. We assessed the methodological quality of the studies and prepared a narrative synthesis. We included 12 studies: 11 were selected from 1392 articles identified from the electronic search and one additional reference was selected by manual review. Socio-demographic factors were only explanatory in a few models, while prior admissions and duration of hospital stay were frequently relevant factors in others. Morbidity and functional disability were the most common risk factors. The results demonstrate the need for increased vigilance of elderly patients who are admitted to hospital with specific characteristics that include previous hospital admissions, duration of hospital stay, morbidity and functional disability.

Costs of QuantiFERON-TB Gold versus tuberculin skin test in Spanish healthcare workers.

We compared the cost of the tuberculin skin test (TST) with the QuantiFERON-TB Gold (QFT-G) test when screening for latent tuberculosis in 134 healthcare workers in Spain. The QFT-G test cost euro42.5 per healthcare worker, while the TST cost euro39.5. The tests varied in cost structure; most (70%) TST costs were due to time demands on the participants, whereas the QFT-G was more expensive in terms of consumables (50% of the total cost). Accordingly, the results depend on the hourly wages of the participants and the time they must dedicate to the tests. In the Spanish healthcare system, the societal costs of QFT-G are comparable to those of the TST, although their cost structures are quite distinct.

A systematic review of specialised palliative care for terminal patients: which model is better?

There is evidence of improved effectiveness of specialised palliative care for terminally ill patients in comparison to conventional care. However, there is uncertainty about which model is better. The objective of this systematic review was to identify studies that compare specialised palliative care models between them assessing their effectiveness or cost-effectiveness. We searched studies published between 2003 and 2006 in several electronic databases and updated the search in MEDLINE up to 2008. Papers published before 2003 were identified by means of previous systematic reviews and manual search. Studies with broad designs comparing two or more specialised palliative care programmes in adults with terminal illness were selected. Six systematic reviews, three studies on effectiveness and one cost study were included. All systematic reviews drew the conclusion that specialised palliative care is more effective than conventional care. The methodological limitations of the original studies and the heterogeneity of programmes did not allow to draw conclusions about whether a specific model of specialised palliative care is more or less effective or cost-effective than other.