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.

Influenza vaccination coverage and related factors among Spanish children.

OBJECTIVES: To ascertain anti-influenza vaccination coverage and factors associated with anti-influenza vaccination among Spanish children. METHODS: We analyzed 6464 children (age under 16 years) included in the Spanish National Health Survey (ENS) for 2003. As a dependent variable, we used the reply ("yes" or "no") to the question: Was your child vaccinated against influenza during the last campaign? We calculated anti-influenza vaccine coverage for the whole population and depending on whether or not the vaccine is recommended due to the fact that the children present an associated chronic condition. We analyzed the influence of sociodemographic variables on vaccination. RESULTS: Vaccination coverage in the Spanish infant population was 5.1%, in children with associated conditions it was 17.5%, and 4.4% in healthy children. The only factor significantly associated with anti-influenza vaccination in children with associated conditions was household income: those from homes with a higher level of income were more likely to be vaccinated (OR=4.26). In children for whom vaccination is not recommended, the probability of being vaccinated against influenza is greater in those whose parents had a lower educational level (OR=2.22). CONCLUSIONS: Anti-influenza vaccination coverage in the Spanish infant population is very low. There seem to be socio-economic inequalities for receiving this vaccine in Spanish children.

Valoración del componente funcional que subyace al uso reiterado de un servicio de urgencias hospitalario y de sus repercusiones económicas / Psychosocial characteristics of non-organic frequent emergency department users and generated costs

Fundamento: Analizar las características psicosociales de los pacientes con un componente funcional relevante que utilizan reiteradamente nuestro servicio de urgencias hospitalario (SUH) y estimar los costes generados por su atención sanitaria. Métodos: Estudio descriptivo retrospectivo (enero 1996-junio 1997) de los pacientes hiperfrecuentadores (HF) del SUH definidos como 3 ó más visitas/semestre durante al menos dos semestres. Revisando sus historias y realizando una entrevista psiquiátrica identificamos a los HF funcionales (HFF). Posteriormente estimamos el coste generado por los episodios con destino alta durante el primer semestre de 1997. Resultados: De 220 HF identificados 66 fueron considerados HFF. La media de consultas fue 11,3ñ9,4. Clínicos y psiquiatras coincidieron en la existencia de funcionalidad en 40/55 (72,7 porciento). Los diagnósticos más frecuentes fueron: trastorno de personalidad (37,5 porciento) y ansiedad-depresión (35 porciento). Los HF psiquiátricos eran más jóvenes (51,7 vs 62,9 años) y consultaban más veces (17,6 vs 9,9). Las 240 asistencias a HFF en el semestre estudiado causaron un único ingreso. Coste promedio del episodio altado fue 8.682,9ñ6.633,8 ptas. El 25,06 porciento se atribuyó a coste variable. El coste del minuto de permanencia en urgencias se estimó en 19,26 ptas. El coste global de atención a HFF durante el semestre estudiado fue 1.903.775 ptas. (0,36 porciento del coste total). Conclusiones: Los HFF suponen proporcionalmente mayor carga en el SUH que el resto de población. Los pacientes con trastorno mental son más jóvenes y acuden más reiteradamente que el resto de HF al Servicio de Urgencias. Sólo un 25 porciento del coste por consulta se debe a material, tratamiento, pruebas o dietas (AU)

[Evaluation of the functional component underlying the frequent attendance to a hospital emergency service and its economic consequences]. / Valoración del componente funcional que subyace al uso reiterado de un servicio de urgencias hospitalario y de sus repercusiones económicas.

OBJECTIVE: To analyse the psychosocial characteristics of frequent emergency department (ER) users with a relevant non-organic component and estimate the generated costs. METHODS: Retrospective-descriptive study (Jan 1996-Jun 1997) about overusers (OU) defined as > = 3 visits/6 months during at least two 6 months periods, coming to our hospital's emergency department. Reviewing their medical records and making a psychiatric interview we identified Non-organic OU (NOU). Subsequently we estimated the cost generated by discharge visits during the first six months of 1997. RESULTS: Sixty six out of 220 OU were identified as NOU. The mean consultation rate was 11.3 +/- 9.4. Clinician-psychiatrist agreement on non-organicity was 72.7%. The most frequent diagnoses were: personality disorders (37.5%) and depression-anxiety (35%). Psychiatric OU were significantly younger (51.7 vs 62.5 years) and attended more often (17.6 vs. 9.9 times). In six months only one of 240 ER consultation cause admission. The mean cost of each discharge episode was 8682.9 +/- 6633.8 pta (25.06% due to variable costs). The cost per minute of emergency room stay was 19.26 ptas. Overall NOU attention cost during the six month period studied was 1,903,775 ptas (0.36% of overall ER costs). CONCLUSIONS: Compared with the rest of users, NOU entail a higher burden for the ER. Mentally-ill patients are younger and consult more frequently than the rest of OU. Only 25% of the cost per consultation is due to treatments, tests or diets.