A multicriteria decision analysis (MCDA) applied to three long-term prophylactic treatments for hereditary angioedema in Spain.

Introduction: Hereditary angioedema (HAE) is a rare genetic disease that impairs quality of life and could be life-threatening. The aim of this study was to apply a multicriteria decision analysis to assess the value of three long-term prophylactic (LTP) therapies for HAE in Spain. Methods: A multidisciplinary committee of 10 experts assessed the value of lanadelumab (subcutaneous use), C1-inhibitor (C1-INH; intravenous), and danazol (orally), using placebo as comparator. We followed the EVIDEM methodology that considers a set of 13 quantitative criteria. The overall estimated value of each intervention was obtained combining the weighting of each criterion with the scoring of each intervention in each criterion. We used two alternative weighting methods: hierarchical point allocation (HPA) and direct rating scale (DRS). A reevaluation of weightings and scores was performed. Results: Lanadelumab obtained higher mean scores than C1-INH and danazol in all criteria, except for the cost of the intervention and clinical practice guidelines. Under the HPA method, the estimated values were 0.51 (95% confidence interval [CI]: 0.44-0.58) for lanadelumab, 0.47 (95%CI: 0.41-0.53) for C1-INH, and 0.31 (95%CI: 0.24-0.39) for danazol. Similar results were obtained with the DRS method: 0.51 (95%CI: 0.42-0.60), 0.47 (95%CI: 0.40-0.54), and 0.27 (95%CI: 0.18-0.37), respectively. The comparative cost of the intervention was the only criterion that contributed negatively to the values of lanadelumab and C1-INH. For danazol, four criteria contributed negatively, mainly comparative safety. Conclusion: Lanadelumab was assessed as a high-value intervention, better than C1-INH and substantially better than danazol for LTP treatment of HAE.

Coverage and predictors of influenza vaccine uptake among adults aged 16 to 59 years suffering from a chronic condition in Madrid, Spain.

Based on data drawn from the 2007 Madrid Regional Health Survey (MRHS), we sought to: estimate influenza vaccination coverage among people ages 16-59 years old suffering from chronic conditions (cardiovascular diseases, diabetes, respiratory diseases, kidney diseases, malignant neoplasm and fibromyalgia) living in the region of Madrid and to determine which socio-demographic and health-related variables were associated with the likelihood of being vaccinated. We analyzed data from 8,337 subjects. The reply to the question "Were you vaccinated against influenza in the last vaccination campaign?" was taken as the dependent variable. Coverage was calculated for different specific diseases that constitute an indication for vaccination. Independent variables included socio-demographics, health-related and use of health care services variables. The proportion of vaccinated adults suffering from any chronic condition in 2007 was 23.5%. Very low coverages were found among kidney diseases (16.1%), malignant neoplasm (10.9%) and fibromyalgia (14.2%) sufferers. The variables which increased the likelihood of being vaccinated among adults suffering any chronic condition were: higher age, being Spanish, absence of a smoking habit and having primary studies. We conclude that influenza vaccination coverage among people living in Madrid and suffering from a chronic condition is unacceptably low, thereby making it necessary for strategies to be urgently implemented aimed at improving the use of influenza vaccine.