David Vivas-Consuelo

Is Health Related Quality of Life (HRQoL) a valid indicator for health systems evaluation

The purpose of this review is to do a discussion about the use of the HRQoL as a health measure of the populations that enable to analyze its potential use as a measure of development and efficiency of health systems. The principal use of the HRQoL is in health technologies economics evaluation; however this measure can be use in public health when need to know the health state of population. The WHO recognizes its potential use but its necessary to do a discussion about your difficulties for its application and restrictions for its use as a performance indicator for the health systems.The review show the different aspects about the use of HRQoL how a measure of efficiency ot the health system, each aspect identified in the literature is analyzed and discussed, developing the pros and cons of their possible use, especially when it comes as a cardinal measure.The analysis allows recognize that measuring HRQoL in countries could serve as a useful indicator, especially when it seeks to measure the level of health and disease, as do most of the indicators of current use. However, the methodological constraints that do not allow comparability between countries especially when you have large socioeconomic differences have yet to be resolved to allow comparison between different regions.

Estudo Delphi: atores sociais e tendências do sistema de saúde brasileiro

Este artigo sintetiza o Informe Final publicado pelo Instituto de Pesquisa Economica Aplicada contendo os resultados do Estudo Delphi, realizado no ano 2000, com o objetivo de identificar as principais tendencias da saude no Brasil para a primeira decada do seculo XXI, segundo o entendimento de formadores de opiniao selecionados entre diversos segmentos sociais mais diretamente envolvidos nas questoes setoriais. Foram ouvidos 138 painelistas, dos quais 105 (76,1%) participaram das duas etapas do estudo (1o e 2o questionarios). A primeira grande conclusao de ordem geral do estudo e a improbabilidade de qualquer cenario de ruptura com o modelo atual. A segunda se refere a presenca do contraditorio nas opinioes dos diferentes grupos em inumeras questoes. A salutar ausencia do pensamento unico e evidenciada mesmo quando todos os segmentos representados no painel apontam na mesma direcao, ja que o grau de otimismo (ou pessimismo) difere em cada grupo.

Predictability of pharmaceutical spending in primary health services using Clinical Risk Groups

BACKGROUND Risk adjustment instruments applied to existing electronic health records and administrative datasets may contribute to monitoring the correct prescribing of medicines. OBJECTIVE We aim to test the suitability of the model based on the CRG system and obtain specific adjusted weights for determined health states through a predictive model of pharmaceutical expenditure in primary health care. METHODS A database of 261,054 population in one health district of an Eastern region of Spain was used. The predictive power of two models was compared. The first model (ATC-model) used nine dummy variables: sex and 8 groups from 1 to 8 or more chronic conditions while in the second model (CRG-model) we include sex and 8 dummy variables for health core statuses 2-9. RESULTS The two models achieved similar levels of explanation. However, the CRG system offers higher clinical significance and higher operational utility in a real context, as it offers richer and more updated information on patients. CONCLUSIONS The potential of the CRG model developed compared to ATC codes lies in its capacity to stratify the population according to specific chronic conditions of the patients, allowing us to know the degree of severity of a patient or group of patients, predict their pharmaceutical cost and establish specific programmes for their treatment.

Pharmaceutical cost management in an ambulatory setting using a risk adjustment tool

BackgroundPharmaceutical expenditure is undergoing very high growth, and accounts for 30% of overall healthcare expenditure in Spain. In this paper we present a prediction model for primary health care pharmaceutical expenditure based on Clinical Risk Groups (CRG), a system that classifies individuals into mutually exclusive categories and assigns each person to a severity level if s/he has a chronic health condition. This model may be used to draw up budgets and control health spending.MethodsDescriptive study, cross-sectional. The study used a database of 4,700,000 population, with the following information: age, gender, assigned CRG group, chronic conditions and pharmaceutical expenditure. The predictive model for pharmaceutical expenditure was developed using CRG with 9 core groups and estimated by means of ordinary least squares (OLS). The weights obtained in the regression model were used to establish a case mix system to assign a prospective budget to health districts.ResultsThe risk adjustment tool proved to have an acceptable level of prediction (R2 ≥ 0.55) to explain pharmaceutical expenditure. Significant differences were observed between the predictive budget using the model developed and real spending in some health districts. For evaluation of pharmaceutical spending of pediatricians, other models have to be established.ConclusionThe model is a valid tool to implement rational measures of cost containment in pharmaceutical expenditure, though it requires specific weights to adjust and forecast budgets.

A cost and performance comparison of Public Private Partnership and public hospitals in Spain

Public-private partnership (PPP) initiatives are extending around the world, especially in Europe, as an innovation to traditional public health systems, with the intention of making them more efficient.There is a varied range of PPP models with different degrees of responsibility from simple public sector contracts with the private, up to the complete privatisation of the service. As such, we may say the involvement of the private sector embraces the development, financing and provision of public infrastructures and delivery services.In this paper, one of the oldest PPP initiatives developed in Spain and transferred to other European and Latin American countries is evaluated for first time: the integrated healthcare delivery Alzira model.Through a comparison of public and PPP hospital performance, cost and quality indicators, the efficiency of the PPP experience in five hospitals is evaluated to identify the influence of private management in the results.Regarding the performance and efficiency analysis, it is seen that the PPP group obtains good results, above the average, but not always better than those directly managed. It is necessary to conduct studies with a greater number of PPP hospitals to obtain conclusive results.

Methods to control the pharmaceutical cost impact of chronic conditions in the elderly

Multimorbidity is the main cause of polypharmacy in elderly people, with the consequent increment in cost and use of inappropriate medication. To control cost, specific strategies have been implemented in healthcare services to reduce potentially inappropriate prescription. Many interventions are applied online during the prescription process using computerized decision support systems, for example, therapeutic algorithms and alerts. Other interventions can be categorized as offline due to their application before or after the prescription process, the main strategies being financial incentives, medication reviews and organizational change. All these strategies are complementary and multifaceted. There is evidence that some of these interventions are effective, but further research should be directed in this field, including investigation of patient cost and outcomes.

Cost-effectiveness analysis of the human recombinant epidermal growth factor in the management of patients with diabetic foot ulcers

ABSTRACT Introduction: Diabetic foot ulcers are one of the most frequent complications of diabetes; such ulcers cause an increase in the costs of the health care of the diabetic patient and can even cause disability due to amputation in the patient. Although a proportion of patients achieve a spontaneous closure of ulcers, others require medical or surgical treatment. Objective: To determine the cost-effectiveness of the intra- and perilesional application of recombinant human epidermal growth factor (rhEGF), as opposed to conventional therapy for the management of patients diagnosed with Wagner’s 3 or 4 diabetic foot ulcer in Colombia. Methodology: Using a Markov model, the process of care of a diabetic patient with diagnosis of Wagner’s 3 or 4 ulcer receiving conventional treatment, or intra- and perilesional rhEGF, is configured. The evaluation cycles of the treatments are weekly over a 5-year horizon and the outcomes evaluated are quality-adjusted life years (QALYs) and the number of amputations avoided by each treatment scheme, in addition to the total costs for treatments. Results: For the analysed base case, in the outcome of amputations, it was found that the factor presents 39 fewer amputations, in a cohort of 100 patients, compared with conventional treatment. Likewise, QALYs are 0.65 more with the use of rhEGF in an average patient. The estimated cost-utility ratio for the base case would be below the threshold established for Colombia. Conclusions: The intra- and perilesional application of rhEGF is a more effective therapeutic option than conventional therapy in the treatment of patients with Wagner’s 3 or 4 diabetic foot ulcers and is cost-effective, taking as an outcome the QALYs for Colombia from the perspective of the health system.

Correction to: Budget Impact Analysis of Brivaracetam Adjunctive Therapy for Partial-Onset Epileptic Seizures in Valencia Community, Spain

In the original publication, the abstract, conclusion was incorrectly published.

Erratum to: Pharmaceutical cost management in an ambulatory setting using a risk adjustment tool

Background: Pharmaceutical expenditure is undergoing very high growth, and accounts for 30% of overall healthcare expenditure in Spain. In this paper we present a prediction model for primary health care pharmaceutical expenditure based on Clinical Risk Groups (CRG), a system that classifies individuals into mutually exclusive categories and assigns each person to a severity level if s/he has a chronic health condition. This model may be used to draw up budgets and control health spending. Methods: Descriptive study, cross-sectional. The study used a database of 4,700,000 population, with the following information: age, gender, assigned CRG group, chronic conditions and pharmaceutical expenditure. The predictive model for pharmaceutical expenditure was developed using CRG with 9 core groups and estimated by means of ordinary least squares (OLS). The weights obtained in the regression model were used to establish a case mix system to assign a prospective budget to health districts. Results: The risk adjustment tool proved to have an acceptable level of prediction (R ≥ 0.55) to explain pharmaceutical expenditure. Significant differences were observed between the predictive budget using the model developed and real spending in some health districts. For evaluation of pharmaceutical spending of pediatricians, other models have to be established. Conclusion: The model is a valid tool to implement rational measures of cost containment in pharmaceutical expenditure, though it requires specific weights to adjust and forecast budgets.

Erratum to: ‘A cost and performance comparison of Public Private Partnership and public hospitals in Spain’

Unfortunately, the original version of this article [1] contained an error. The author list was included incorrectly. Antonio Clemente-Collado was included as one of the authors by mistake. This author has now been removed from the author list as there was a conflict of interest. There will also be an update to correct this.