Economic impact of heart failure according to the effects of kidney failure.

INTRODUCTION AND OBJECTIVES: To evaluate the use of health care resources and their cost according to the effects of kidney failure in heart failure patients during 2-year follow-up in a population setting. METHODS: Observational retrospective study based on a review of medical records. The study included patients ≥ 45 years treated for heart failure from 2008 to 2010. The patients were divided into 2 groups according to the presence/absence of KF. Main outcome variables were comorbidity, clinical status (functional class, etiology), metabolic syndrome, costs, and new cases of cardiovascular events and kidney failure. The cost model included direct and indirect health care costs. Statistical analysis included multiple regression models. RESULTS: The study recruited 1600 patients (prevalence, 4.0%; mean age 72.4 years; women, 59.7%). Of these patients, 70.1% had hypertension, 47.1% had dyslipidemia, and 36.2% had diabetes mellitus. We analyzed 433 patients (27.1%) with kidney failure and 1167 (72.9%) without kidney failure. Patients with kidney failure were associated with functional class III-IV (54.1% vs 40.8%) and metabolic syndrome (65.3% vs 51.9%, P<.01). The average unit cost was €10,711.40. The corrected cost in the presence of kidney failure was €14,868.20 vs €9,364.50 (P=.001). During follow-up, 11.7% patients developed ischemic heart disease, 18.8% developed kidney failure, and 36.1% developed heart failure exacerbation. CONCLUSIONS: Comorbidity associated with heart failure is high. The presence of kidney failure increases the use of health resources and leads to higher costs within the National Health System.

Impacto económico de la insuficiencia cardiaca según la influencia de la insuficiencia renal / Economic impact of heart failure according to the effects of kidney failure

Introducción y objetivos Evaluar el uso de los recursos sanitarios y sus costes según la influencia de la insuficiencia renal en sujetos con insuficiencia cardiaca durante un periodo de seguimiento de 2 años en un ámbito poblacional. Métodos Se efectuó un diseño observacional-retrospectivo realizado a partir de la revisión de registros médicos. Se incluyó a sujetos ≥ 45 años que demandaron atención durante 2008-2010. Se constituyeron dos grupos según los pacientes tuvieran insuficiencia renal o no. Principales mediciones: comorbilidad, clínicas (clase funcional, etiología), síndrome metabólico, costes y nuevos casos de eventos cardiovasculares e insuficiencia renal. El modelo de costes incluyó los costes sanitarios directos e indirectos. El análisis estadístico incluyó modelos de regresión múltiple. Resultados Se reclutó a 1.600 sujetos (prevalencia, 4,0%; media de edad, 72,4 años; mujeres, 59,7%). El 70,1% tenía hipertensión; el 47,1%, dislipemia y el 36,2%, diabetes mellitus. Se analizó a 433 pacientes (27,1%) con insuficiencia renal y a 1.167 (72,9%) sin ella. Los pacientes con insuficiencia renal se asociaron a la clase funcional III-IV (el 54,1 frente al 40,8%) y síndrome metabólico (el 65,3 frente al 51,9%; p < 0,01). El promedio unitario del coste fue 10.711,4 euros. El coste corregido en presencia de insuficiencia renal fue 14.868,2 frente a 9.364,5 euros (p = 0,001). Durante el seguimiento, el 11,7% sufrió cardiopatía isquémica; el 18,8%, insuficiencia renal y el 36,1%, reagudización de la insuficiencia cardiaca. Conclusiones La comorbilidad asociada a la insuficiencia cardiaca es elevada. La presencia de insuficiencia renal ocasiona más utilización de recursos sanitarios y mayores costes para el Sistema Nacional de Salud (AU)

Introduction and objectives To evaluate the use of health care resources and their cost according to the effects of kidney failure in heart failure patients during 2-year follow-up in a population setting. Methods Observational retrospective study based on a review of medical records. The study included patients ≥ 45 years treated for heart failure from 2008 to 2010. The patients were divided into 2 groups according to the presence/absence of KF. Main outcome variables were comorbidity, clinical status (functional class, etiology), metabolic syndrome, costs, and new cases of cardiovascular events and kidney failure. The cost model included direct and indirect health care costs. Statistical analysis included multiple regression models. Results The study recruited 1600 patients (prevalence, 4.0%; mean age 72.4 years; women, 59.7%). Of these patients, 70.1% had hypertension, 47.1% had dyslipidemia, and 36.2% had diabetes mellitus. We analyzed 433 patients (27.1%) with kidney failure and 1167 (72.9%) without kidney failure. Patients with kidney failure were associated with functional class III-IV (54.1% vs 40.8%) and metabolic syndrome (65.3% vs 51.9%, P < .01). The average unit cost was €10 711.40. The corrected cost in the presence of kidney failure was €14 868.20 vs €9364.50 (P = .001). During follow-up, 11.7% patients developed ischemic heart disease, 18.8% developed kidney failure, and 36.1% developed heart failure exacerbation. Conclusions Comorbidity associated with heart failure is high. The presence of kidney failure increases the use of health resources and leads to higher costs within the National Health System (AU)

The effect of quitting smoking on costs and healthcare utilization in patients with chronic obstructive pulmonary disease: a comparison of current smokers versus ex-smokers in routine clinical practice.

PURPOSE: Chronic obstructive pulmonary disease (COPD) is a prevalent condition mainly related to smoking, which is associated with a substantial economic burden. The purpose was to compare healthcare resource utilization and costs according to smoking status in patients with COPD in routine clinical practice. METHODS: A retrospective cohort nested case-control study was designed. The cohort was composed of male and female COPD outpatients, 40 years or older, covered by the Badalona Serveis Assistencials (a health provider) health plan. Cases were current smokers with COPD and controls (two per case) were former smokers with COPD (at least 12 months without smoking), matched for age, sex, duration of COPD, and burden of comorbidity. The index date was the last visit recorded in the database, and the analysis was performed retrospectively on healthcare resource utilization data for the 12 months before the index date. RESULTS: A total of 930 COPD records were analyzed: 310 current and 620 former smokers [mean age 69.4 years (84.6 % male)]. Cases had more exacerbations, physician visits of any type, and drug therapies related to COPD were more common. As a consequence, current smokers had higher average annual healthcare costs: €3,784 (1,888) versus €2,302 (2,451), p < 0.001. This difference persisted after adjusting for severity of COPD. CONCLUSIONS: Current smokers with COPD had significantly higher use of healthcare resources, mainly COPD drugs and physician visits, compared with former smokers who had abstained for at least 12 months. As a consequence, current smokers had higher healthcare costs to the National Health System in Spain than ex-smokers.

Antimuscarinic persistence patterns in newly treated patients with overactive bladder: a retrospective comparative analysis.

INTRODUCTION AND HYPOTHESIS: Treatment persistence is low in patients with overactive bladder (OAB), but persistence may vary among antimuscarinic agents. This study compared treatment persistence in patients with OAB receiving fesoterodine, solifenacin, or tolterodine as their initial OAB prescription in a routine clinical practice setting. METHODS: This retrospective study used medical records from primary healthcare centers in three locations in Spain; records from patients aged ≥18 years with a diagnosis of OAB who initiated antimuscarinic treatment for OAB (fesoterodine, tolterodine, or solifenacin) were included. The first prescription of one of the OAB study medications was considered the index date; patients were followed for ≥52 weeks. Persistence was estimated using Kaplan-Meier curves and Cox proportional hazard regression models, adjusting for covariates. RESULTS: A total of 1,971 records of patients (58.3 % women; mean age 70.1 years) initiating treatment with fesoterodine (n = 302), solifenacin (n = 952), or tolterodine (n = 717) were included. Unadjusted mean (±SD) treatment duration was 31.5 ± 17.6 weeks for fesoterodine, 29.9 ± 21.4 for solifenacin and 29.0 ± 21.6 for tolterodine (p = 0.217). At week 52, 35.8 % of fesoterodine-treated patients remained on their initial therapy, versus 31.9 % of solifenacin-treated (hazard ratio [HR], 1.24; 95 % CI, 1.05-1.47; p = 0.011) and 30.9 % of tolterodine-treated (HR = 1.28; 95 % CI, 1.07-1.52; p = 0.006) patients. Findings were consistent when the definition for discontinuation was varied. CONCLUSIONS: Overall persistence at week 52 was low, but the cumulative probability of persisting with initial therapy was significantly higher for fesoterodine than for solifenacin or tolterodine in clinical practice in Spain.

Effect of smoking status on healthcare costs and resource utilization in patients with type 2 diabetes in routine clinical practice: a retrospective nested case-control economic study.

AIM: To compare healthcare resource utilization and costs according to smoking status in patients with type 2 diabetes in clinical practice. METHODS: A retrospective cohort nested case-control study was designed. Cases were current smokers, while 2 types of controls (former smokers and never smokers) were matched (2 controls per case) for age, sex, duration of diabetes and burden of comorbidity using data from medical records. Noninstitutionalized diabetics of both genders, aged>18 years and seen consecutively over a 5-year period before the index date, were enrolled. Analysis compared healthcare resource utilization, loss of productivity due to sick leave and corresponding costs. RESULTS: In total, 2,490 medical records were analyzed, i.e. 498 cases, 996 former smokers and 996 never smokers. Mean age was 63.4 years (64.9% male). Smokers had higher glycosylated hemoglobin levels (7.4 vs. 7.2 and 7.2%, respectively; p=0.013) and a lower degree of metabolic control (49.2 vs. 54.7 and 55.8%; p=0.036). Smokers had higher average annual costs (EUR 3,583) than former smokers (EUR 2,885; p<0.001) and never smokers (EUR 2,183; p<0.001). CONCLUSIONS: Diabetic smoker patients had lower metabolic control, higher health resource utilization and more sick leave, resulting in higher healthcare costs and lost productivity compared with both former and never smoker diabetics.

Caracterización y costes asociados al perfil del paciente con diabetes tipo 2 en tratamiento con metformina al que se le añade un segundo fármaco antidiabético oral: estudio de base poblacional / Characterization of and costs associated to the profile of patients with type 2 diabetes treated with metformin who are added a second oral antidiabetic drug: a population study

OBJETIVOS: Determinar el cumplimiento, control metabólico, complicaciones y costes sanitarios de los pacientes tratados con metformina que iniciaron un segundo fármaco antidiabético en pacientes con diabetes tipo 2 (DM2).Pacientes y métodos; Diseño observacional-multicéntrico de carácter retrospectivo. Se evaluaron pacientes de edad igual o superior a 30 años, en tratamiento con metformina y que iniciaron un segundo tratamiento antidiabético durante 2008-2009. Se establecieron 4 grupos de pacientes (metformina y otro antidiabético): a) inhibidores de la dipeptidil peptidasa 4 (IDPP4); b) sulfonilureas; c) glitazonas, y d) insulinas. Principales medidas: comorbilidad, control metabólico, cumplimiento y complicaciones. El seguimiento se realizó durante 2 años. El modelo de costes diferenció los costes sanitarios directos (atención primaria/especializada) e indirectos (productividad laboral). Análisis estadístico: modelos de regresión logística y ANCOVA, p < 0,05. RESULTADOS: Se seleccionaron 2.067 pacientes (edad media: 66,6 años; varones: 53,1%). Un 25,1% iniciaron un segundo tratamiento con IDPP4; 42,9% con sulfonilureas, 14,0% con glitazonas, y 18,0% con insulinas. A los 2 años de seguimiento, los pacientes tratados con IDPP4 mostraron un mayor cumplimiento terapéutico (70,3 vs. 59,9%, 60,3% y 58,4); mejor control de la DM2 (64,3 vs. 62,6%, 62,8 y 50,5%) y menor proporción de hipoglucemias (13,9 frente a 40,4%, 37,6% y 58,9%, respectivamente) (p < 0,001). El promedio/unitario de los costes totales fue de 2.321 € frente a 2.475 €, 2.724 €, y 3.164 €, respectivamente; p < 0,001. Las tasas de eventos cardiovasculares e insuficiencia renal fueron del 3,7; 6,4; 7,6, y 10,2%, respectivamente. CONCLUSIONES: Las sulfonilureas fueron los fármacos más utilizados. Los pacientes en tratamiento con IDPP4 presentaron mayor cumplimiento y control de la diabetes, con menores tasas de hipoglucemias y costes sanitarios

OBJECTIVES: To determine compliance, metabolic control, complications and healthcare costs of patients treated with metformin started a second antidiabetic drug in patients with type 2 diabetes (T2DM). PATIENTS AND METHODS: Design multicenter observational retrospective. Patients were evaluated ≥30 years (age), treated with metformin and started a second antidiabetic treatment during 2008-2009. There were 4 patient groups (metformin and another antidiabetic): a) dipeptidyl peptidase-4 inhibitors (IDPP4), b) sulfonylureas, c) glitazones and d) insulin. Main measures: comorbidity, metabolic control, compliance and complications. Patients were followed for 2 years. The cost model differed direct health costs (primary care / specialist) and indirect (labor productivity). Statistical analysis: logistic regression models and ANCOVA, p < 0.05. RESULTS: 2067 patients were included (mean age: 66.6 years male: 53.1%). 25.1% started a second treatment with IDPP4; 42.9% sulfonylureas, 14.0% glitazones and 18.0% insulin. At 2 years follow-up, patients treated with IDPP4 showed greater adherence vs. 70.3%. 59.9%, 60.3% and 58.4; better control of 64.3% vs. DM2. 62.6%, 62.8% and 50.5% and a decrease of 13.9% compared to hypoglycaemia 40.4%, 37.6% and 58.9% respectively (p < 0.001). The average / unit total costs was €2,321 vs. €2,475, €2,724 and €3,164, respectively, p < 0.001. Rates of cardiovascular events and renal failure were 3.7%, 6.4%, 7.6% and 10.2% respectively. CONCLUSIONS: Sulfonylureas were the most commonly used drugs. Patients treated with IDPP4 had higher compliance and control of diabetes, with lower rates of hypoglycaemia and healthcare costs

Health economics perspective of fesoterodine, tolterodine or solifenacin as first-time therapy for overactive bladder syndrome in the primary care setting in Spain.

BACKGROUND: Overactive bladder (OAB) is associated with high healthcare costs, which may be partially driven by drug treatment. There is little comparative data on antimuscarinic drugs with respect to resource use and costs. This study was conducted to address this gap and the growing need for naturalistic studies comparing health economics outcomes in adult patients with OAB syndrome initiating treatment with different antimuscarinic drugs in a primary care setting in Spain. METHODS: Medical records from the databases of primary healthcare centres in three locations in Spain were assessed retrospectively. Men and women ≥18 years of age who initiated treatment with fesoterodine, tolterodine or solifenacin for OAB between 2008 and 2010 were followed for 52 weeks. Healthcare resource utilization and related costs in the Spanish National Health System were compared. Comparisons among drugs were made using multivariate general linear models adjusted for location, age, sex, time since diagnosis, Charlson comorbidity index, and medication possession ratio. RESULTS: A total of 1,971 medical records of patients (58.3% women; mean age, 70.1 [SD:10.6] years) initiating treatment with fesoterodine (n = 302), solifenacin (n = 952) or tolterodine (n = 717) were examined. Annual mean cost per patient was €1798 (95% CI: €1745; €1848). Adjusted mean (95% bootstrap CI) healthcare costs were significantly lower in patients receiving fesoterodine (€1639 [1542; 1725]) compared with solifenacin (€1780 [€1699; €1854], P = 0.022) or tolterodine (€1893 [€1815; €1969], P = 0.001). Cost differences occurred because of significantly fewer medical visits, and less use of absorbent products and OAB-related concomitant medication in the fesoterodine group. CONCLUSIONS: Compared with solifenacin and tolterodine, fesoterodine was a cost-saving therapy for treatment of OAB in the primary care setting in Spain.

[Characterization of and costs associated to the profile of patients with type 2 diabetes treated with metformin who are added a second oral antidiabetic drug: a population study]. / Caracterización y costes asociados al perfil del paciente con diabetes tipo 2 en tratamiento con metformina al que se le añade un segundo fármaco antidiabético oral: estudio de base poblacional.

OBJECTIVES: To determine compliance, metabolic control, complications and healthcare costs of patients treated with metformin started a second antidiabetic drug in patients with type 2 diabetes (T2DM). PATIENTS AND METHODS: Design multicenter observational retrospective. Patients were evaluated ≥30 years (age), treated with metformin and started a second antidiabetic treatment during 2008-2009. There were 4 patient groups (metformin and another antidiabetic): a) dipeptidyl peptidase-4 inhibitors (IDPP4), b) sulfonylureas, c) glitazones and d) insulin. MAIN MEASURES: comorbidity, metabolic control, compliance and complications. Patients were followed for 2 years. The cost model differed direct health costs (primary care / specialist) and indirect (labor productivity). STATISTICAL ANALYSIS: logistic regression models and ANCOVA, p<0.05. RESULTS: 2067 patients were included (mean age: 66.6 years male: 53.1%). 25.1% started a second treatment with IDPP4; 42.9% sulfonylureas, 14.0% glitazones and 18.0% insulin. At 2 years follow-up, patients treated with IDPP4 showed greater adherence vs. 70.3%. 59.9%, 60.3% and 58.4; better control of 64.3% vs. DM2. 62.6%, 62.8% and 50.5% and a decrease of 13.9% compared to hypoglycaemia 40.4%, 37.6% and 58.9% respectively (p<0.001). The average / unit total costs was €2,321 vs. €2,475, €2,724 and €3,164, respectively, p<0.001. Rates of cardiovascular events and renal failure were 3.7%, 6.4%, 7.6% and 10.2% respectively. CONCLUSIONS: Sulfonylureas were the most commonly used drugs. Patients treated with IDPP4 had higher compliance and control of diabetes, with lower rates of hypoglycaemia and healthcare costs.

Relación entre la polimedicación y el control de la presión arterial: cumplimiento, persistencia, costes e incidencia de nuevos eventos cardiovasculares / Relationship of polymedication in controlling blood pressure: compliance, persistence, costs and incidence of new cardiovascular events

FUNDAMENTO Y OBJETIVO: Determinar la relación entre la polifarmacia y el control de la presión arterial (PA), el cumplimiento, la persistencia, el coste y la incidencia de episodios cardiovasculares (ECV) en pacientes con hipertensión moderada/grave. Pacientes y métodos: Diseño observacional-multicéntrico de carácter retrospectivo. Se evaluaron pacientes > 30 años que iniciaron un tercer tratamiento antihipertensivo durante 2004-2006. Según el número de medicamentos crónicos, se establecieron 3 grupos: consumo regular de 3-6 fármacos, entre 7-10 y ≥ 11. Principales-medidas: sociodemográficas, comorbilidad, presión arterial, cumplimiento y persistencia. Para cada grupo se determinaron la incidencia de nuevos ECV y los costes totales. El seguimiento se realizó durante 4 años. Resultados: Se evaluaron 1.906 pacientes; 765 tomaban entre 3-6 fármacos; 624 entre 7-10 y 517 ≥ 11 (p < 0,001). La edad media fue de 69,4 años y el 55,5% eran mujeres. El grupo de 3-6 fármacos mostró mejor control de la PA (51,8 frente a 47,0 y 41,1%; p < 0,001), cumplimiento (71,4 frente a 69,9 y 67,1%; p = 0,017), persistencia (50,1 frente a 45,5 y 46,2%; p = 0,044) y menor incidencia de ECV (12,2 frente a 19,7 y 30,2%; p < 0,001), respectivamente. El promedio/unitario de los costes totales fue de 3.369,1, frente a 4.362,1 y 4.902,3 € (p < 0,001). La presencia de ECV se asoció al incumplimiento terapéutico (odds ratio [OR] 1,9, intervalo desconfianza del 95% [IC 95%] 1,1-3,6) y al bajo control de la PA (OR 1,4, IC 95% 1,1-2,0) (p < 0,05). El uso de antihipertensivos a dosis fijas conlleva mayor cumplimiento (72,8 frente a 68,2%), persistencia (64,4 frente a 39,3%) y grado de control de la PA (52,6 frente a 43,8%) (p < 0,001). Conclusiones: La polifarmacia se asocia a menor cumplimiento y persistencia del tratamiento antihipertensivo, con aumento de ECV y costes sanitarios

BACKGROUND AND OBJECTIVE: To determine the relationship of polypharmacy on blood pressure (BP) control, compliance, persistence, the cost and incidence of cardiovascular events (CVD) in patients with moderate/severe hypertension. PATIENTS AND METHODS: An observational multicenter retrospective study. We evaluated patients > 30 years who started a third antihypertensive treatment during 2004-2006. Depending on the number of chronic medications, we established 3 groups: regular consumption of 3-6 drugs, including between 7-10 and ≥11. Top-measures: sociodemographic, comorbidity, BP, compliance and persistence. For each group we determined the incidence of new CVD totals and total costs. RESULTS: We evaluated 1,906 patients, 765 between 3-6 drugs, 624 between 7-10 and 517 in ≥ 11 (P < .001). Overage age: 69.4 years and 55.5% women. The group of 3-6 drugs showed better BP control (51.8 vs. 47.0 and 41.1%, P < .001), compliance (71.4 vs. 69.9 and 67.1%, P = .017), persistence (50.1 vs. 45.5 and 46.2%, P = .044) and lower incidence of CVD (12.2 vs. 19.7 and 30.2%, P < .001), respectively. The average/unit total costs was 3,369.1 vs. 4,362.1 and € 4,902.3 (P < .001). The presence of CVD was associated with therapy noncompliance (odds ratio [OR] 1.9, 95% confidence interval [95%CI] 1.1 to 3.6) and controlled by the lower BP control (OR 1.4 (95%CI 1.1-2.0) (P < .05). The use of antihypertensive fixed dose has greater compliance (72.8 vs. 68.2%), persistence (64.4 vs. 39.3%) and degree of BP control (52.6 vs. 43, 8%) (p < .001). CONCLUSIONS: Polypharmacy is associated with lower compliance and persistence to antihypertensive treatment, cardiovascular disease and increased health care costs

Uso de recursos e impacto económico de los pacientes con gota: estudio multicéntrico de ámbito poblacional / Resource use and economic impact of patients with gout: a multicenter, population-wide study

OBJETIVO: Determinar el uso de recursos y el impacto económico de los pacientes con gota en un ámbito poblacional. PACIENTES Y MÉTODOS: Diseño observacional (multicéntrico) realizado a partir de registros pertenecientes a 6 centros de atención primaria y 2 hospitales. Se incluyó a pacientes >= 18 años con un episodio agudo de gota durante los años 2003-2007. El seguimiento de los pacientes fue de 2 años. Se confeccionaron 2 grupos de estudio: pacientes con 1-2 ataques/recurrencias agudas y con 3 o más. PRINCIPALES VARIABLES: sociodemográficas, comorbilidad, síndrome metabólico (SM), y uso de recursos y costes sanitarios/no sanitarios. Análisis estadístico: regresión-logística, modelo de ANCOVA; p < 0,05. RESULTADOS: Se incluyó a 3.130 pacientes con gota. Prevalencia: 3,3%; edad media: 55,8 años; varones: 81,1%. Por grupos: el 68,4% presentó 1-2 ataques agudos y el 31,6%, 3 o más, p < 0,001. La prevalencia del SM fue del 28,8% (intervalo de confianza [IC] del 95%, 27,2-30,4%). El promedio/unitario del coste fue de 2.228,6 € (costes directos: 96,9%), el 90,8% en AP (visitas: 23,5%; medicamentos: 57,7%). Por grupos, en el modelo corregido el promedio/unitario de los costes totales por paciente fue de 2.130,6 € frente a 2.605,4 €, respectivamente (p < 0,001). En todos los componentes del coste los resultados fueron mayores en el grupo con >= 3 ataques. El subgrupo de pacientes diabéticos (N=641; 20,5%) presentó un mayor coste (3.124,8 € frente a 1.997,8 €; p < 0,001). CONCLUSIONES: La gota se asocia a una elevada morbilidad, presencia de SM y consumo de recursos. El estudio proporciona datos útiles sobre el coste de la enfermedad; siendo los costes de seguimiento ambulatorio los más elevados

OBJECTIVE: To determine the use of resources and economic impact of patients with gout at the population level. PATIENTS AND METHODS: Observational design analysing records belonging to 6 primary care centers and 2 hospitals. We included patients' >=18 years with an acute episode of gout over the years 2003-2007. Patient follow-up was 2 years. It produced two study groups: patients with 1-2 attacks/acute recurrences and 3 or more events. Main variables were: demographic, co-morbidity, metabolic syndrome (MS), and resource use and health/non-health costs. Statistical analysis: logistic regression-model ANCOVA, P<.05. RESULTS: 3,130 patients with gout were included. Prevalence: 3.3%, mean age: 55.8 years male: 81.1%. Groups were distributed as follows: 68.4% had 1-2 acute attacks and 31.6% with 3 or more, P<.001. The prevalence of MS was 28.8% (confidence interval [CI] 95% CI 27.2 to 30.4%). The average/unit cost was D 2,228.6 (direct costs: 96.9%), 90.8% in primary care (visits: 23.5%; drugs: 57.7%). For groups, the average corrected model/unit total cost per patient was D 2,130.6 vs. D 2,605.4, respectively (P<.001). In all cost components, the results were higher in the group with >= 3 attacks. The subgroup of diabetic patients (N = 641, 20.5%) had a higher cost (D 3,124.8D vs. D 1,997.8, P<.001). CONCLUSIONS: Gout is associated with substantial morbidity, presence of MS and resource consumption. The study provides useful data on the cost of the disease; the costs of outpatient follow up is the highest

Resource use and economic impact of patients with gout: a multicenter, population-wide study.

OBJECTIVE: To determine the use of resources and economic impact of patients with gout at the population level. PATIENTS AND METHODS: Observational design analysing records belonging to 6 primary care centers and 2 hospitals. We included patients' ≥18 years with an acute episode of gout over the years 2003-2007. Patient follow-up was 2 years. It produced two study groups: patients with 1-2 attacks/acute recurrences and 3 or more events. Main variables were: demographic, co-morbidity, metabolic syndrome (MS), and resource use and health/non-health costs. STATISTICAL ANALYSIS: logistic regression-model ANCOVA, P<.05. RESULTS: 3,130 patients with gout were included. Prevalence: 3.3%, mean age: 55.8 years male: 81.1%. Groups were distributed as follows: 68.4% had 1-2 acute attacks and 31.6% with 3 or more, P<.001. The prevalence of MS was 28.8% (confidence interval [CI] 95% CI 27.2 to 30.4%). The average/unit cost was € 2,228.6 (direct costs: 96.9%), 90.8% in primary care (visits: 23.5%; drugs: 57.7%). For groups, the average corrected model/unit total cost per patient was € 2,130.6 vs. € 2,605.4, respectively (P<.001). In all cost components, the results were higher in the group with ≥ 3 attacks. The subgroup of diabetic patients (N=641, 20.5%) had a higher cost (€ 3,124.8€ vs. € 1,997.8, P<.001). CONCLUSIONS: Gout is associated with substantial morbidity, presence of MS and resource consumption. The study provides useful data on the cost of the disease; the costs of outpatient follow up is the highest.

[Relationship of polymedication in controlling blood pressure: compliance, persistence, costs and incidence of new cardiovascular events]. / Relación entre la polimedicación y el control de la presión arterial: cumplimiento, persistencia, costes e incidencia de nuevos eventos cardiovasculares.

BACKGROUND AND OBJECTIVE: To determine the relationship of polypharmacy on blood pressure (BP) control, compliance, persistence, the cost and incidence of cardiovascular events (CVD) in patients with moderate/severe hypertension. PATIENTS AND METHODS: An observational multicenter retrospective study. We evaluated patients > 30 years who started a third antihypertensive treatment during 2004-2006. Depending on the number of chronic medications, we established 3 groups: regular consumption of 3-6 drugs, including between 7-10 and ≥ 11. Top-measures: sociodemographic, comorbidity, BP, compliance and persistence. For each group we determined the incidence of new CVD totals and total costs. RESULTS: We evaluated 1,906 patients, 765 between 3-6 drugs, 624 between 7-10 and 517 in ≥ 11 (P<.001). Overage age: 69.4 years and 55.5% women. The group of 3-6 drugs showed better BP control (51.8 vs. 47.0 and 41.1%, P<.001), compliance (71.4 vs. 69.9 and 67.1%, P=.017), persistence (50.1 vs. 45.5 and 46.2%, P=.044) and lower incidence of CVD (12.2 vs. 19.7 and 30.2%, P<.001), respectively. The average/unit total costs was 3,369.1 vs. 4,362.1 and € 4,902.3 (P<.001). The presence of CVD was associated with therapy noncompliance (odds ratio [OR] 1.9, 95% confidence interval [95%CI] 1.1 to 3.6) and controlled by the lower BP control (OR 1.4 (95%CI 1.1-2.0) (P < .05). The use of antihypertensive fixed dose has greater compliance (72.8 vs. 68.2%), persistence (64.4 vs. 39.3%) and degree of BP control (52.6 vs. 43, 8%) (p<.001). CONCLUSIONS: Polypharmacy is associated with lower compliance and persistence to antihypertensive treatment, cardiovascular disease and increased health care costs.

Retrospective epidemiological study for the characterization of community- acquired pneumonia and pneumococcal pneumonia in adults in a well-defined area of Badalona (Barcelona, Spain).

BACKGROUND: Community-acquired pneumonia (CAP) has large impact on direct healthcare costs, especially those derived from hospitalization. This study determines impact, clinical characteristics, outcome and economic consequences of CAP in the adult (≥18 years) population attended in 6 primary-care centers and 2 hospitals in Badalona (Spain) over a two-year period. METHODS: Medical records were identified by codes from the International Classification of Diseases in databases (January 1st 2008-December 31st 2009). RESULTS: A total of 581 patients with CAP (55.6% males, mean age 57.5 years) were identified. Prevalence: 0.64% (95% CI: 0.5%-0.7%); annual incidence: 3.0 cases/1,000 inhabitants (95% CI: 0.2-0.5). Up to 241 (41.5%) required hospitalization. Hospital admission was associated (p<0.002) with liver disease (OR=5.9), stroke (OR=3.6), dementia (OR=3.5), COPD (OR=2.9), diabetes mellitus (OR=1.9) and age (OR=1.1 per year). Length of stay (4.4±0.3 days) was associated with PSI score (ß=0.195), in turn associated with age (r=0.827) and Charlson index (r=0.497). Microbiological tests were performed in all inpatients but only in 35% outpatients. Among patients with microbiological tests, results were positive in 51.7%, and among them, S pneumoniae was identified in 57.5% cases. Time to recovery was 29.9±17.2 days. Up to 7.5% inpatients presented complications, 0.8% required ICU admission and 19.1% readmission. Inhospital mortality rate was 2.5%. Adjusted mean total cost was €2,332.4/inpatient and €698.6/outpatient (p<0.001). Patients with pneumococcal CAP (n=107) showed higher comorbidity and hospitalization (76.6%), higher PSI score, larger time to recovery and higher overall costs among inpatients. CONCLUSIONS: Strategies preventing CAP, thus reducing hospital admissions could likely produce substantial costs savings in addition to the reduction of CAP burden.

[Use of resources and costs associated to fractures in Spanish women]. / Uso de recursos y costos asociados a las fracturas en mujeres Españolas.

The objective of the study was to determine the use of resources and costs due to bone fractures in Spanish women above 50 years of age in the population scope. An observational and retrospective study was conducted in six primary care centers and two urban hospitals in Spain. Socio-demographic and co-morbidity data, use of resources (primary care consultations, complementary tests, medications, specialized care, hospitalizations, visits, urgencies), costs and productivity losses were registered. Records of 19 022 women were included, 7% showed some type of fracture between 2003 and 2007. Fractures were mostly associated with osteoporosis (OR: 3.2), fibromyalgia (OR: 2.4) and thyroid changes (OR: 2.2). In the corrected model, the total cost for patients who had a fracture was USD 3727 compared to USD 2705.5 (p<0.001) for those who did not have it. Patients with a fracture generate a greater use of resources, sanitation costs and work productivity losses.

[Incidence, resource use and costs associated with postherpetic neuralgia: a population-based retrospective study]. / Incidencia, uso de recursos y costes asociados a la neuralgia postherpetica: estudio retrospectivo de base poblacional.

AIM: To determine the incidence rate, the treatment administered and the use of health resources and health, and their respective costs in patients with postherpetic neuralgia (PHN). PATIENTS AND METHODS: We performed an observational design, made from retrospective review of patient records from six primary care centers and one hospital. All patients > 30 years consulting for PHN between 1/1/2007 and 31/12/2010 were included. Prepared two study groups according to presence / absence of PHN. Follow up was for one year. MAIN MEASURES: socio-demographic, treatment and co-morbidity. The cost model differed direct healthcare costs (primary care/specialist) and indirect (productivity). STATISTICAL ANALYSIS: logistic regression models and analysis of covariance (p < 0.05). RESULTS: 1506 patients were recruited, age: 61.2 years female: 59.2%. 15.1% (n = 228, 95% CI = 8.1-22.1%) had a PHN (incidence rate: 0.8/1,000 inhabitants/year; 95% CI = 0.7-0.9/1,000 population/year), and increased with age (≥ 65 years: 19.7%). The PHN was principally associated with: psychosis (OR = 3.9), dementia (OR = 2.3), depression (OR = 1.8) and age (OR = 1.1), p < 0.03. Drugs use was higher (5.3 vs. 3.3; p < 0.001). The cost in primary care was 63.1% and 24.7% indirect. Total cost €1827.1 vs. €457.5 (p = 0.003), respectively, due to higher labour productivity losses (€692.2 vs. €62.4) and health costs (€1135 vs. €395.1); p < 0.001. All cost components maintained these differences. CONCLUSIONS: PHN is a frequent complication. These patients have a significant economic burden. The cost increases with age.

Incidencia, uso de recursos y costes asociados a la neuralgia postherpética: estudio retrospectivo de base poblacional / Incidence, resource use and costs associated with postherpetic neuralgia: a population-based retrospective study

Objetivo. Determinar la tasa de incidencia, los tratamientos administrados y la utilización de recursos sanitarios y no sanitarios, y sus costes respectivos, en pacientes con neuralgia postherpética (NPH). Pacientes y métodos. Se efectuó un estudio observacional, realizado a partir de la revisión retrospectiva de registros de pacientes de seis centros de atención primaria y un hospital. Se incluyeron todos los pacientes mayores de 30 años que demandaron atención por NPH entre el 1 de enero de 2007 y el 31 de diciembre de 2010. Se elaboraron dos grupos de estudio según la presencia/ausencia de NPH. El seguimiento fue durante un año, y las principales medidas fueron sociodemográficas, tratamientos y comorbilidad. El modelo de costes diferenció los costes sanitarios directos (atención primaria/ especializada) e indirectos (productividad laboral). Se realizó un análisis estadístico con modelos de regresión logística y análisis de la covarianza (p < 0,05). Resultados. Se reclutaron 1.506 pacientes, con una edad media de 61,2 años, de los cuales el 59,2% eran mujeres. El 15,1% (n = 228; intervalo de confianza al 95%, IC 95% = 8,1-22,1%) presentó NPH (tasa de incidencia: 0,8/1.000 habitantes/ año; IC 95% = 0,7-0,9/1.000 habitantes/año) y el porcentaje aumentó con la edad (≥ 65 años: 19,7%). La NPH se asoció principalmente a psicosis (odds ratio, OR = 3,9), demencia (OR = 2,3), depresión (OR = 1,8) y edad (OR = 1,1); p < 0,03. El uso de medicamentos fue superior (5,3 frente a 3,3; p < 0,001). El coste en atención primaria fue del 63,1% y los costes indirectos del 24,7%. Los costes totales fueron de 1.827,1 frente a 457,5 euros (p = 0,003), respectivamente, debido a mayores pérdidas de productividad laboral (692,2 frente a 62,4 euros) y costes sanitarios (1.135 frente a 395,1 euros; p < 0,001). Todos los componentes del coste mantuvieron estas diferencias. Conclusiones. La NPH es una complicación frecuente. Estos pacientes presentan una importante carga económica y el coste aumenta con la edad (AU)

Aim. To determine the incidence rate, the treatment administered and the use of health resources and health, and their respective costs in patients with postherpetic neuralgia (PHN). Patients and methods. We performed an observational design, made from retrospective review of patient records from six primary care centers and one hospital. All patients > 30 years consulting for PHN between 1/1/2007 and 31/12/2010 were included. Prepared two study groups according to presence / absence of PHN. Follow up was for one year. Main measures: socio-demographic, treatment and co-morbidity. The cost model differed direct healthcare costs (primary care/ specialist) and indirect (productivity). Statistical analysis: logistic regression models and analysis of covariance (p < 0.05). Results. 1506 patients were recruited, age: 61.2 years female: 59.2%. 15.1% (n = 228, 95% CI = 8.1-22.1%) had a PHN (incidence rate: 0.8/1,000 inhabitants/year; 95% CI = 0.7-0.9/1,000 population/year), and increased with age (≥ 65 years:19.7%). The PHN was principally associated with: psychosis (OR = 3.9), dementia (OR = 2.3), depression (OR = 1.8) and age (OR = 1.1), p < 0.03. Drugs use was higher (5.3 vs. 3.3; p < 0.001). The cost in primary care was 63.1% and 24.7% indirect. Total cost €1827.1 vs. €457.5 (p = 0.003), respectively, due to higher labour productivity losses (€692.2 vs. €62.4) and health costs (€1135 vs. €395.1); p < 0.001. All cost components maintained these differences. Conclusions. PHN is a frequent complication. These patients have a significant economic burden. The cost increases with age (AU)

Uso de recursos y costos asociados a las fracturas en mujeres españolas / Use of resources and costs associated to fractures in spanish women

El objetivo del estudio fue determinar el uso de recursos y costos debidos a fracturas óseas en mujeres españolas mayores de 50 años en un ámbito poblacional. Se realizó un estudio observacional y retrospectivo, en seis centros de atención primaria y dos hospitales urbanos de España. Se registró datos sociodemográficos, de comorbilidad, uso de recursos (consultas médicas en atención primaria, pruebas complementarias, medicación, atención especializada, hospitalizaciones, visitas, urgencias), costos y pérdida de productividad. Se incluyeron los registros de 19 022 mujeres de los cuales el 7% presentó algún tipo de fractura entre el 2003 y 2007. Las fracturas se asociaron mayoritariamente con osteoporosis (OR: 3,2), fibromialgia (OR: 2,4) y alteraciones tiroideas (OR: 2,2). En el modelo corregido, el costo total para las pacientes que tuvieron fractura fue de USD 3727 mientras que en las que no la tuvieron fue USD 2705,5 (p<0,001). Las pacientes con fractura generan un mayor uso de recursos, costos sanitarios, y pérdidas de productividad laboral.

The objective of the study was to determine the use of resources and costs due to bone fractures in Spanish women above 50 years of age in the population scope. An observational and retrospective study was conducted in six primary care centers and two urban hospitals in Spain. Socio-demographic and co-morbidity data, use of resources (primary care consultations, complementary tests, medications, specialized care, hospitalizations, visits, urgencies), costs and productivity losses were registered. Records of 19 022 women were included, 7% showed some type of fracture between 2003 and 2007. Fractures were mostly associated with osteoporosis (OR: 3.2), fibromyalgia (OR: 2.4) and thyroid changes (OR: 2.2). In the corrected model, the total cost for patients who had a fracture was USD 3727 compared to USD 2705.5 (p<0.001) for those who did not have it. Patients with a fracture generate a greater use of resources, sanitation costs and work productivity losses.

Pasado, presente y futuro de la interculturalidad médica en los servicios de urgencias / No disponible

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Hemorragia subaracnoidea y clopidogrel. Repuesta / Subarachnoid hemorraghe and clopidogrel. Reply

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