The importance of prevalence and pre-test probability on the microbiological diagnosis of SARS-CoV-2: the case of Spain in 2020.

OBJECTIVE: The aim of this work was to estimate the conditioned probability for the diagnosis of SARS-CoV-2 infection with reverse transcription polymerase chain reaction (RT-PCR), viral antigen rapid diagnostic tests (Ag-RDT), and antibody detection tests depending on the prevalence in the specific healthcare settings in Spain in 2020, and on the pre-test probability (PTP) according to the clinical situation, age and unknown or close contacts of the patient. METHODS: Performance parameters of tests were obtained from literature. Prevalence data and PTP were obtained from Spanish sources and a survey, respectively. The post-test probability is the positive predictive value (PPV) when test is positive. For negative result, we also calculated the probability of having the infection (false negatives). RESULTS: For both RT-PCR and viral Ag-RDT, the lowest PPV values were for the population screenings. This strategy proved to be useful in ruling out infection but generates a high number of false positives. At individual level, both tools provided high PPV (≥ 97%) when the PTP values are over 35%. In seroprevalence studies, though the specificity of IgG alone tests is high, under low seroprevalence, false positives cannot be avoided. Total antibodies tests are useful for diagnosis of COVID-19 in those doubtful cases with RT-PCR or Ag-RDT tests being repeatedly negative. CONCLUSIONS: The interpretating of results depends not only on the accuracy of the test, but also on the prevalence of the infection in different settings, and the PTP associated to the patient before performing the test.

[A pharmacoepidemiological study of antiepileptic drug consumption (1992-2004)]. / Estudio farmacoepidemiológico del consumo de fármacos antiepilépticos (1992-2004).

INTRODUCTION: Epilepsy and the epileptic syndromes are common neurological diseases and represent an important public health problem that has given rise to marked social and healthcare concerns. AIM: To analyse the changes in the consumption of antiepileptic drugs in the Basque Country Autonomous Community over a 13 year period (1992-2004). MATERIALS AND METHODS: The consumption of the N03 subgroup has been studied using data from the ECOM database of the Spanish Ministry of Health and Consumer Affairs, which records the number of drug packets dispensed on National Health Service prescription. The results are expressed as defined daily doses per 1,000 inhabitants per day (DID). RESULTS: A significant increase is observed in the consumption of antiepileptic drugs over the study period (5.53-9 DID). The most widely used drugs were phenobarbital, carbamazepine, valproic acid and phenytoin and, in recent years, the extensive use of gabapentin is of particular note. CONCLUSION: Epidemiological studies on epilepsy are difficult to perform due to a number of methodological problems which are caused fundamentally by the heterogeneity of the disease. Pharmacoepidemiological studies constitute a simple, effective, low-cost tool for estimating the prevalence of the disease, and furthermore enumerates the drugs used, thus contributing to a rational use of these drugs.

Estudio farmacoepidemiológico del consumo de fármacos antiepilépticos (1992-2004) / A pharmacoepidemiological study of antiepileptic drug consumption (1992-2004)

Las epilepsias y los síndromes epilépticos constituyen enfermedades neurológicas frecuentes y representanun importante problema de salud pública, que ha dado lugar a una gran preocupación sanitaria y social. Objetivo. Analizar la evolución del consumo de fármacos antiepilépticos en la Comunidad Autónoma del País Vasco en un período de 13 años (1992-2004). Materiales y métodos. Se ha estudiado el consumo del subgrupo N03 con datos procedentes de la base de datos ECOM del Ministerio de Sanidad y Consumo de España, que ofrece el número de envases de medicamentos dispensadosmediante recetas realizadas a cargo del Servicio Nacional de Salud. Los resultados se presentan en dosis definidas diarias por 1.000 habitantes y día (DHD). Resultados. Se ha producido un aumento significativo en la utilización de fármacos antiepilépticos en el período estudiado (5,53-9 DHD). Los fármacos más utilizados han sido el fenobarbital, la carbamacepina, el ácido valproico y la fenitoína, y destaca en los últimos años el amplio uso de la gabapentina. Conclusiones. Los estudios epidemiológicos sobre epilepsia son difíciles de realizar por diversos problemas metodológicos, que fundamentalmente parten de la heterogeneidad de la enfermedad. Los estudios farmacoepidemiológicos constituyen una herramienta eficaz, fácil y de bajo coste para estimar la prevalencia de la enfermedad, además de dar a conocer los fármacos utilizados y contribuir al uso racional de los mismos (AU)

Epilepsy and the epileptic syndromes are common neurological diseases and represent an importantpublic health problem that has given rise to marked social and healthcare concerns. Aim. To analyse the changes in the consumption of antiepileptic drugs in the Basque Country Autonomous Community over a 13 year period (1992-2004). Materials and methods. The consumption of the N03 subgroup has been studied using data from the ECOM database of theSpanish Ministry of Health and Consumer Affairs, which records the number of drug packets dispensed on National Health Service prescription. The results are expressed as defined daily doses per 1,000 inhabitants per day (DID). Results. A significant increase is observed in the consumption of antiepileptic drugs over the study period (5.53-9 DID). The most widely used drugs were phenobarbital, carbamazepine, valproic acid and phenytoin and, in recent years, the extensive use of gabapentin is of particular note. Conclusion. Epidemiological studies on epilepsy are difficult to perform due to a number of methodological problems which are caused fundamentally by the heterogeneity of the disease. Pharmacoepidemiological studies constitute a simple, effective, low-cost tool for estimating the prevalence of the disease, and furthermore enumerates the drugs used, thus contributing to a rational use of these drugs (AU)

Prevalencia y coste farmacológico de la enfermedad de Parkinson en España / The prevalence and pharmacological cost of Parkinson’s disease in Spain

Introducción. La enfermedad de Parkinson es la segundaenfermedad neurodegenerativa más frecuente. Objetivo. Analizar la dispensación de fármacos antiparkinsonianos en las diferentes comunidades autónomas españolas y estimar la prevalencia de la enfermedad en las mismas. Materiales y métodos. Se han estudiado las dispensaciones de antiparkinsonianos en España durante dos años (de octubre 1998 a septiembre de 2000), calculando lasdosis diarias definidas por mil habitantes y día (DHD). La DHD de levodopa ha permitido estimar la prevalencia de la enfermedad. El gasto se ha expresado en coste por mil habitantes y día (CHD) y en coste por tratamiento y día. Resultados. El fármaco más utilizado es levodopa, seguido de biperideno y selegilina. El coste total durante el período de estudio fue de 116.346.589,30 euros. El CHDse cifró en 4,14 euros. En el coste por tratamiento y día de los diferentes fármacos destaca el elevado coste de pramipexol y entacapona. La prevalencia de enfermedad de Parkinson en España se estima en 1,7‰; se observa una variabilidad geográfica importante, con cifras de prevalencia más altas en Castilla-León, Galicia y LaRioja, y cifras inferiores en Andalucía y Murcia. En cifras absolutas, el número de enfermos en España se puede estimar en 69.571 personas. Conclusión. Se encuentran diferencias en la utilización de fármacos antiparkinsonianos en las diferentes comunidades autónomas

Introduction. Parkinson’s disease is the second most frequent neurodegenerative disease. Aim. To analyze thedispensation of antiparkinsonian agents in Spain and to estimate the Parkinson’s disease prevalence. Materials and methods. Dispensation of antiparkinsonian agents were studied in Spain during two years (October 1998 to September 2000). Results were expressed in defined daily dosages per 1,000 inhabitants per day (DID). Levodopa’s DID was used to estimate the prevalence of the disease. The cost per 1,000 inhabitants per day (CID) and the daily treatment cost was also valued. Results. The most frequently used drugs are levodopa, biperiden and selegiline. The total cost reached values of 116,346,589.30 euros during the study period. The CID was 4,14 euros. It was very high the daily treatment cost of pramipexol and entacapone. The prevalence of Parkinson’s disease is considered in 1.7 per 1,000 inhabitants in Spain. There is an important geographical variability; regions as Castilla-Leon, Galicia and La Rioja have a higher prevalence than Andalucia or Murcia. The numberof patients in Spain can be considered in 69,571 people. Conclusion. There are some differences between the autonomous communities in the antiparkinsonian drugs’ utilization

[The prevalence and pharmacological cost of Parkinson's disease in Spain]. / Prevalencia y coste farmacológico de la enfermedad de Parkinson en España.

INTRODUCTION: Parkinson's disease is the second most frequent neurodegenerative disease. AIM: To analyze the dispensation of antiparkinsonian agents in Spain and to estimate the Parkinson's disease prevalence. MATERIALS AND METHODS: Dispensation of antiparkinsonian agents were studied in Spain during two years (October 1998 to September 2000). Results were expressed in defined daily dosages per 1,000 inhabitants per day (DID). Levodopa's DID was used to estimate the prevalence of the disease. The cost per 1,000 inhabitants per day (CID) and the daily treatment cost was also valued. RESULTS: The most frequently used drugs are levodopa, biperiden and selegiline. The total cost reached values of 116,346,589.30 euros during the study period. The CID was 4,14 euros. It was very high the daily treatment cost of pramipexol and entacapone. The prevalence of Parkinson's disease is considered in 1.7 per 1,000 inhabitants in Spain. There is an important geographical variability; regions as Castilla-Leon, Galicia and La Rioja have a higher prevalence than Andalucia or Murcia. The number of patients in Spain can be considered in 69,571 people. CONCLUSION: There are some differences between the autonomous communities in the antiparkinsonian drugs' utilization.

Prescripción de fármacos antiácidos y antiúlcera péptica en atención primaria / No disponible

El objetivo de este trabajo se centra en la valoración cuantitativa de la prescripción de fármacos antiácidosy antiúlcera péptica en un centro de salud durante tres años, la influencia del sexo y la edad, el coste económico asociado y el posible ahorro utilizando las alternativas más baratas existentes en el mercado. La muestra quedó compuesta por 13.248 pacientes. Los resultados se expresan en dosis definidas diarias por milhabitantes y día (DHD). También se ha analizado el coste total de las prescripciones y el coste por tratamientoy día, y se ha realizado un análisis minimizado de costes para estimar el posible ahorro que se podríahaber obtenido si se hubiera prescrito la alternativa más económica del mercado. Al 20,06% de los pacientesse les prescribió algún fármaco antiácido o antiúlcera péptica, habiendo más mujeres con prescripcionestanto en el total como en el grupo de edad de 45 a 64 años. La DHD total de estos fármacos asciende a 34,4140.Por principios activos el más prescrito fue ranitidina (DHD= 10,2327), seguida de omeprazol (DHD=7,4752). El coste total de la prescripción de este subgrupo se cifra en 487.288,42 € y el posible ahorro al elegir la alternativa más económica ascendería a 101.956,96 (el 20,92% del coste total)

The aim of the study is to monitor the prescription of the frequently employed antacid and peptic ulcer drugsin a health centre during a three year study period. The influence of sex, age, associated economic cost andconsequently possible savings, are also evaluated. The sample for the study consisted of 13248 patients. Theresults were expressed as Defined Daily Dosage per 1000 inhabitants per day (DID). The total prescriptioncost and the daily treatment cost were also evaluated. A cost-minimization analysis provided an estimationof the possible savings if the cheapest available active ingredient in the market was prescribed. Out of thetotal number of patients 20.06% were prescribed with antacid or peptic ulcer drugs. Women were prescribedmore when considering both the total amount of patients and the 45-64 year group. The total DID value forboth drug groups considered in the study reached 34.4140. When referring to the active ingredient, ranitidine (DID=10.2327) followed by omeprazole (DID= 7.4752) were the most prescribed drugs. The total cost for the prescription of antacids and peptic ulcer drugs amounted to 487,288.42 € and the potential saving by prescribing the cheapest commercial brand on the market could have been 101,956.96 € (20.92% of the total cost)

Dispensación y coste de antimicrobianos en España (1998-2000) / Dispensation and cost of antimicrobials in Spain (1998–2000)

El objetivo de este trabajo es analizar la dispensación de antiinfecciosos para uso sistémico, excluidos sueros e inmunoglobulinas y vacunas,realizada en las oficinas de farmacia de España en un periodo de dos años, y la valoración de su coste económico. Se realizó un estudio farmacoepidemiológicoretrospectivo en el cual se analizó la dispensación de los medicamentos pertenecientes a los subgrupos J01, J02, J04y J05. Se calcularon las dosis diarias definidas por mil habitantes y día (DHD), y el gasto se expresó en términos absolutos y en coste por milhabitantes y día (CHD). La DHD total asciende a 32,11 (30,70 de antibacterianos, 0,53 de antimicóticos, 0,72 de antimicobacterianos y 0,16de antivirales). Dentro del subgrupo J01, los más dispensados fueron penicilinas, macrólidos, cefalosporinas y quinolonas. Por principios activosdestacan amoxicilina y su asociación con ácido clavulánico, claritromicina, cefuroxima axetilo y ciprofloxacino. El coste total de la dispensaciónde antiinfecciosos es de 1.403.462.770 euros, y el coste por mil habitantes y día de 47,18 euros

The aim of this study was to analyze the dispensation of anti-infectives for systemic use, excluding immune sera and immunoglobulins andvaccines, made in all of Spain’s pharmaceutical offices in a two-year period and to analyze their pharmacological cost. A retrospective pharmacoepidemiologicalstudy was made of dispensations in Spain’s pharmaceutical offices for medicines belonging to the J01, J02, J04 andJ05 subgroups. The dispensations were quantified as defined daily doses per 1,000 inhabitants per day (DID). The economic cost of the dispensingwas expressed in absolute terms and as CID (cost per 1,000 inhabitants per day). The total DID of anti-infective drugs was 32.11(30.70 for antibacterials, 0.53 antimycotics, 0.73 for antimicrobacterials and 0.16 for antivirals). In the J01 subgroup the most frequentlyused were penicillins, macrolides, cephalosporins and quinolones. And the most frequently used drugs were amoxicillin, amoxicillin and clavulanicacid, clarithromycin, cefuroxime axetil and ciprofloxacin. The total cost was ;1,403,462,770, and the CID was ; 47.18

[Dispensation and cost of antimicrobials in Spain (1998-2000)]. / Dispensación y coste de antimicrobianos en España (1998-2000).

The aim of this study was to analyze the dispensation of anti-infectives for systemic use, excluding immune sera and immunoglobulins and vaccines, made in all of Spain's pharmaceutical offices in a two-year period and to analyze their pharmacological cost. A retrospective pharmacoepidemiological study was made of dispensations in Spain's pharmaceutical offices for medicines belonging to the J01, J02, J04 and J05 subgroups. The dispensations were quantified as defined daily doses per 1,000 inhabitants per day (DID). The economic cost of the dispensing was expressed in absolute terms and as CID (cost per 1,000 inhabitants per day). The total DID of anti-infective drugs was 32.11 (30.70 for antibacterials, 0.53 antimycotics, 0.73 for antimicrobacterials and 0.16 for antivirals). In the J01 subgroup the most frequently used were penicillins, macrolides, cephalosporins and quinolones. And the most frequently used drugs were amoxicillin, amoxicillin and clavulanic acid, clarithromycin, cefuroxime axetil and ciprofloxacin. The total cost was 1,403,462,770 euros, and the CID was 47.18 euros.

[Evolution of antimicrobial use during the years 1996-2000 in a general hospital. A detailed ICU study]. / Evolución de la utilización de antimicrobianos durante los años 1996-2000 en un hospital general. Estudio pormenorizado de la UCI.

PURPOSE: Antimicrobials are a mayor part of hospital pharmacy budgets and must be considered in resource planning and spending projections. This study describes the profile of antibiotic use at a medium-sized hospital (by examining the ICU separately) and analyses its evolution over the period 1996-2000. METHODS: Descriptive and retrospective study. Pharmacy records were reviewed to identify oral and parenteral antimicrobial agents administered to inpatients. Results were expressed in Daily Defined Doses (DDD) per 100 stays and day. RESULTS: During the five-year study period 176.162 DDD / 100 s-d of antibiotics were consumed in the ICU, whereas in the rest of the hospital usage was much lower (54.540 DDD / 100 s-d). Aminoglycosides, cephalosporins, penicillins, glycopeptides and carbapenems were the most commonly used groups of antimicrobials in the ICU, and penicillins, cephalosporins, trimethoprim/sulfonamide combinations, aminoglycosides and quinolones in the rest of the hospital. CONCLUSIONS: ICUs have some special features which make them different to the rest of inpatient areas. Because of that fact we consider important to study this specific patient-care area separately.

Evolución de la utilización de antimicrobianos durante los años 1996-2000 en un hospital general. Estudio pormenorizado de la UCI / Evolution of antimicrobial use during the years 1996-2000 in a general hospital. A detailed ICU study

Objetivo: Los antibióticos constituyen una parte importante dentro del presupuesto del hospital y por ello deben estar siempre presentes a la hora de plantear la gestión de los distintos recursos. Este estudio describe el perfil de consumo de antibióticos en un hospital de tamaño medio (examinando por separado la UCI) y analiza su evolución durante el periodo 1996-2000. Métodos: Estudio retrospectivo. Los archivos informatizados del Servicio de Farmacia fueron revisados para identificar los antibióticos orales y parenterales administrados a los pacientes. Los resultados se expresaron en dosis diarias definidas (DDD) por cada 100 estancias y día. Resultados: Durante los cinco años de estudio se consumieron en la UCI 176,162 DDD/100 e-d de antibióticos, mientras que en el resto del hospital la utilización de estos agentes fue mucho más baja (54,540 DDD / 100 e-d). Las familias de antibióticos más empleadas en la UCI fueron aminoglucósidos, cefalosporinas, penicilinas, glucopéptidos y carbapenems, y en el hospital, penicilinas, cefalosporinas, combinaciones de sulfamidas con trimetoprim, aminoglucósidos y quinolonas. Conclusiones: Las Unidades de Cuidados Intensivos presentan una serie de características peculiares que las hace diferentes al resto de servicios hospitalarios, por ello, consideramos adecuado estudiar esta Unidad de forma independiente (AU)