Antonio Olry de Labry Lima

Características clínicas y psicosociales de personas con fibromialgia: Repercusión del diagnóstico sobre sus actividades

Fundamento: Actualmente se sabe muy poco de las caracteristicas de las personas diagnosticadas de fibromialgia, su grado de incapacidad y la respuesta del sistema sanitario. Los objetivos de este trabajo son: conocer el perfil sociodemografico, clinico y psicosocial de las y los pacientes con fibromialgia; describir la respuesta que obtienen del sistema sanitario, y estudiar la repercusion de este sindrome en las actividades habituales de las personas que lo padecen, incluyendo las del ambito laboral. Metodos: Estudio descriptivo transversal. La informacion se recogio mediante encuesta telefonica realizada a personas diagnosticadas de fibromialgia en el Hospital Universitario Virgen de las Nieves de Granada durante el ano 2003. Resultados: El 92,1% de las personas entrevistadas eran mujeres. La fibromialgia causo baja laboral en el 31,4% de los casos. El 64% percibia su salud como mala o muy mala. La fibromialgia se asocio a otras enfermedades en un 52,3% de los casos. El medico de familia es el especialista consultado antes del diagnostico en el 92,1%. El 50,5% tenia antecedentes de trastorno psiquiatrico, presentandolo en el momento de la entrevista el 36,4%. El 71% de la muestra recibia apoyo familiar, senalando un fuerte impacto del sindrome en su entorno un 70,1% de los casos. Conclusiones: La fibromialgia fue diagnosticada mayoritariamente en mujeres. Causa una mala percepcion del estado de salud y situaciones de incapacidad laboral, afectando negativamente al entorno familiar de la persona que la padece.

HTA and decision-making processes in Central, Eastern and South Eastern Europe: results from a survey

OBJECTIVE To gain knowledge and insights on health technology assessment (HTA) and decision-making processes in Central, Eastern and South Eastern Europe (CESEE) countries. METHODS A cross-sectional study was performed. Based on the literature, a questionnaire was developed in a multi-stage process. The questionnaire was arranged according to 5 broad domains: (i) introduction/country settings; (ii) use of HTA in the country; (iii) decision-making process; (iv) implementation of decisions; and (v) HTA and decision-making: future challenges. Potential survey respondents were identified through literature review-with a total of 118 contacts from the 24 CESEE countries. From March to July 2014, the survey was administered via e-mail. RESULTS A total of 22 questionnaires were received generating an 18.6% response rate, including 4 responses indicating that their institutions had no involvement in HTA. Most of the CESEE countries have entities under government mandates with advisory functions and different responsibilities for decision-making, but mainly in charge of the reimbursement and pricing of medicines. Other areas where discrepancies across countries were found include criteria for selecting technologies to be assessed, stakeholder involvement, evidence requirements, use of economic evaluation, and timeliness of HTA. CONCLUSIONS A number of CESEE countries have created formal decision-making processes for which HTA is used. However, there is a high level of heterogeneity related to the degree of development of HTA structures, and the methods and processes followed. Further studies focusing on the countries from which information is scarcer and on the HTA of health technologies other than medicines are warranted. CLASSIFICATION Reviews/comparative analyses.

Analysis of changes in trends in the consumption rates of benzodiazepines and benzodiazepine-related drugs

BackgroundTo analyse trends in the rates of consumption of benzodiazepine (BZD) anxiolytics, BZD hypnotics and non-BZD hypnotics and the association with contextual factors.MethodsDescriptive time series study. Units of analysis were monthly dose per inhabitant per day (DID) and dose per medical card per day(DCD) of benzodiazepine(BZD anxiolytics(BZD-A), BZD hypnotics(BZD-H) and non-BZD hypnotics(Non-BZD-H) between January 2006-December 2015. We analysed 6 primary healthcare districts(PHD) and used defined daily doses (DDDs) to calculate the monthly DIDs(overall and by ATC group). Trends and monthly percentage change (MPC) were analysed through joinpoint regression.ResultsThe annual DID increased by 26% overall, the trend was different across ATC groups. Consumption in BZD-A and BZD-H increased (27.1%,61.9%), consumption in Non-BZD-H decreased by 35%. There was high variability in DCD across the PHD, with an overall increase of 10.2%(5.7%-22.9%). By ATC, DCD increased by 10.4% in BZD-A(4.2%-22.2%) and by 44.2% in BZD-H(33.2%-76.5%). The overall DCD in the Non-BZD-H decreased by 42.1%(19.7%-50.8%). We found an initial upward trend in consumption of BZD-A until April/2008(monthly percentage change –MPC- +0.5%), followed by a slightly slower increase (+0.1%). No changes in trend were detected in BZD-H. In Non-BZD-H, we observed an upward trend until February/2013(+0.1%), followed by a sharp decrease until August/2013(−6.3%), and finally a slight decrease(−0.3%).ConclusionsBZD consumption has increased in the last decade, with variability across areas. The changes in trends do not coincide with the financial crisis, introduction of prescriptions by active ingredient, electronic prescriptions or copayment. The only decrease in the Non-BZD-H may be linked to an intervention.

Adoption of the HPV vaccine: a case study of three emerging countries

BACKGROUND The human papillomavirus (HPV) vaccine has recently attracted considerable attention in emerging countries, due to its potential to reduce the impact of HPV-related diseases. This case study sheds new light about the variety of HTA arrangements, methods and processes involved in the adoption and use of HPV vaccines in a selected sample of central, eastern and southern Europe and Latin America and the Caribbean, all of them emerging in the use of HTA. MATERIALS & METHODS A multi-country case study was designed. Mixed methods, document review, semi-structured surveys and personal communication with experts, were used for data collection and triangulation. RESULTS This study shows that common elements of good practice exist in the processes and methods used, with all countries arriving at the same appraisal recommendations. However, the influence of socio-politico-economic factors appears to be determinant on the final decisions and restrictions to access made. CONCLUSION This case study intends to draw useful lessons for policymakers in emerging settings interested in the adoption of the HPV vaccine supported by evidence-informed processes, such as those offered by institutionalized HTA. Future studies are also recommended to elucidate the specific roles that social values and uncertainties play in vaccine decision-making across different societies.BACKGROUND The human papillomavirus (HPV) vaccine has recently attracted considerable attention in emerging countries, due to its potential to reduce the impact of HPV-related diseases. This case study sheds new light about the variety of HTA arrangements, methods and processes involved in the adoption and use of HPV vaccines in a selected sample of central, eastern and southern Europe and Latin America and the Caribbean, all of them emerging in the use of HTA. MATERIALS & METHODS A multi-country case study was designed. Mixed methods, document review, semi-structured surveys and personal communication with experts, were used for data collection and triangulation. RESULTS This study shows that common elements of good practice exist in the processes and methods used, with all countries arriving at the same appraisal recommendations. However, the influence of socio-politico-economic factors appears to be determinant on the final decisions and restrictions to access made. CONCLUSION This case study intends to draw useful lessons for policymakers in emerging settings interested in the adoption of the HPV vaccine supported by evidence-informed processes, such as those offered by institutionalized HTA. Future studies are also recommended to elucidate the specific roles that social values and uncertainties play in vaccine decision-making across different societies.

Systematic review of economic evaluation studies and budget impact on ambulatory monitoring of capillary glucose in type 2 diabetics

OBJECTIVE Realise a review of studies of economic evaluation about the ambulatory monitoring of capillary glucose (AMGC) in diabetic type II persons. METHODOLOGY A review of the literature was conducted, in MedLine, various websites, referenced paper and provided by experts persons. RESULTS Five studies concluded that the AMGC was a cost-effective strategic, of this papers use Kaiser Permanente data base, its make that these studies could be considered a solely one study. The rest of the papers did not find difference in the AMGC use. CONCLUSIONS The use of AMGC has an uncertainty efficiency. More studies are needed.

Health technology assessment process of a cardiovascular medical device in four different settings

AIM Health technology assessment (HTA) is a tool to help the decision-making process. The aim is to describe methods and processes used in the reimbursement decision making for drug-eluting stents (DES) in four different settings. METHODS DES as a technology under study was selected according to different criteria, all of them agreed by a working group. A survey of key informants was designed. RESULTS DES was evaluated following well-structured HTA processes. Nonetheless, scope for improvement was observed in relation to the data considered for the final decision, the transparency and inclusiveness of the process as well as in the methods employed. CONCLUSION An attempt to describe the HTA processes of a well-known medical device.