ABSTRACT
BACKGROUND AND OBJECTIVE: Multi-criteria decision analysis (MCDA) is a tool that systematically considers multiple factors relevant to health decision-making. The aim of this study was to use an MCDA to assess the value of dupilumab for severe atopic dermatitis compared with secukinumab for moderate to severe plaque psoriasis in Spain. METHOD: Following the EVIDEM (Evidence and Value: Impact on DEcision Making) methodology, the estimated value of both interventions was obtained by means of an additive linear model that combined the individual weighting (between 1 and 5) of each criterion with the individual scoring of each intervention in each criterion. Dupilumab was evaluated against placebo, while secukinumab was evaluated against placebo, etanercept and ustekinumab. A retest was performed to assess the reproducibility of weights, scores and value estimates. RESULTS: The overall MCDA value estimate for dupilumab versus placebo was 0.51 ± 0.14. This value was higher than those obtained for secukinumab: 0.48 ± 0.15 versus placebo, 0.45 ± 0.15 versus etanercept and 0.39 ± 0.18 versus ustekinumab. The highest-value contribution was reported by the patients' group, followed by the clinical professionals and the decision makers. A fundamental element that explained the difference in the scoring between pathologies was the availability of therapeutic alternatives. The retest confirmed the consistency and replicability of the analysis. CONCLUSIONS: Under this methodology, and assuming similar economic costs per patient for both treatments, the results indicated that the overall value estimated of dupilumab for severe atopic dermatitis was similar to, or slightly higher than, that of secukinumab for moderate to severe plaque psoriasis.
Subject(s)
Antibodies, Monoclonal , Clinical Decision-Making/methods , Decision Support Techniques , Dermatitis, Atopic/drug therapy , Psoriasis/drug therapy , Antibodies, Monoclonal/economics , Antibodies, Monoclonal/therapeutic use , Antibodies, Monoclonal, Humanized , Chronic Disease , Humans , Severity of Illness Index , Treatment OutcomeABSTRACT
BACKGROUND: It is well documented that obesity is strongly associated with mortality and morbidity, but less is known about its impact on functional status and health-related quality of life (HRQOL). The purpose of this study was to calculate the impact of the Body Mass Index (BMI) on the HRQOL of the Spanish adult population, with special emphasis on BMI ≥ 35. METHODS: We used the Spanish National Health Survey (SNHS) 2011-2012 to assess the statistical association between HRQOL, measured through the EuroQol-5D-5L questionnaire, and the BMI. We conducted linear regression analysis for the EuroQol-5D-5L Visual Analogue Scale (VAS) and probit regressions for each of the five dimensions of the EuroQol-5D-5L. RESULTS: Self-perceived problems in the five dimensions of the EuroQol-5D-5L increased along the BMI, especially in the mobility and pain/discomfort dimensions. Having a BMI ≥ 35 reduced HRQOL even in the absence of chronic diseases. After controlling for comorbidities, severe obesity decreased the VAS score by an average of 1.9 points and increased the probability of reporting any HRQOL problem in mobility (11.8%), self-care (2.2%), usual activities (4.3%) and pain/discomfort (7.4%). No association was found between obesity and mental problems. All the parameters analysed suggest that HRQOL in women and people aged 65 years and over was significantly worse than average. CONCLUSIONS: BMI is an explanatory factor of self-perceived quality of life. Obesity is associated with a worse HRQOL, especially in women and people aged over 64 years. These results may be useful for designing prevention or treatment health policies to target obesity among the Spanish population.
Subject(s)
Body Mass Index , Obesity/psychology , Quality of Life , Adult , Aged , Cohort Studies , Comorbidity , Cross-Sectional Studies , Female , Health Surveys , Humans , Male , Middle Aged , Obesity/epidemiology , Quality-Adjusted Life Years , Regression Analysis , Severity of Illness Index , Sex Factors , Spain/epidemiology , Visual Analog ScaleABSTRACT
Fundamentos: Enmarcado en los planteamientos de laEstrategia NAOS, en 2007 se puso en marcha en cincociudades piloto españolas el Programa THAO-Salud Infantil.Su objetivo es frenar la progresión de la obesidad infantila través de la promoción de una alimentación saludable ypráctica de actividad física regular, mediante un plan de accionesque implican transversalmente a toda la comunidady con gran refuerzo mediático.Objetivo: Establecer datos de prevalencia de sobrepesoy obesidad, de los escolares en Villanueva de la Cañada(Madrid), obtenidos durante el curso académico 2007-2008.Métodos: La evaluación de la efectividad del programa serealiza sobre la población escolar de 3-12 años del municipio.Fueron medidos y pesados 2347 escolares, se calcularon susIMC y se clasificaron según su estado ponderal (Orbegozo).Resultados: El 15.1% tiene sobrepeso u obesidad, siendomayor en niñas. Según edad, el 17.4% de los escolares entre3-5 años, el 14.9% de 6-9 y el 12.8% de 10-12 superansus recomendaciones. Existe una dependencia altamentesignificativa entre la prevalencia de sobrepeso y obesidad y eltipo de centro al que pertenecen los escolares, creciendo ensentido: privados, concertados y públicos, mayor en niñas.Conclusiones: Las prevalencias de sobrepeso, obesidad yconjunta son menores en los escolares de 3-12 años delmunicipio que a nivel nacional, y superior en niñas. Laprevalencia de sobrepeso disminuye conforme aumenta laedad. Existe una dependencia estadísticamente significativade las prevalencias de sobrepeso y obesidad y el tipo decolegio al que asisten los escolares(AU)
Background: In the context of the NAOS Strategy, in 2007the program THAO-Childhood health was pilot-tested in5 Spanish towns. The aim of the program is to stop theprogressive trend of childhood obesity through the promotionof healthier eating and regular physical activity bymeans of action plans which involve the whole communityand reinforced by mass media. The objective of this paperis to describe the prevalence of obesity and overweight inschoolchildren of Villanueva de la Cañada (Madrid), basedon data collected during the school ear 2007-2008.Methods: The effectiveness of the programs is evaluatedin school children aged 3-12 yr in the municipality. Bodyweight and height was individually measured in 2347children, BMI computed and classified according by weightdistribution (Orbegozo).Results: 15.1% was classified as being overweight or obese,a higher rate among girls. The prevalence by age groupwasas follows: 17.4% in the 3-5 yr olds; 14.9% in the 6-9 yrold group and 12.8% in the 10-12 yr old group. There isan association between overweight prevalence rates andthe type of school, increasing from private schools towardspublic schools, which show the highest rate, particularlyamong girls.Conclusions: The prevalence of overweight and obesity islower in school boys in the municipality under study comparedto the average national rate aged, but higher amonggirls. Prevalence of overweight decreases in older children.There is an association between the type of school andprevalence of obesity, with higher rates in public schools(AU)
