Fernando Antoñanzas

Propuesta de guía para la evaluación económica aplicada a las tecnologías sanitarias

Over the last few years, economic evaluation of health technologies has become a major tool used by European health policy decision-makers to create strategies for prioritizing the allocation of health resources and the approval of new technologies. Spain was a pioneer in proposing the standardization of methodology applicable to economic evaluation studies. However, because health policy decision-makers refused to support the initiative, the methodology was never put into practice. In the medium term, evidence of the economic value of new health technologies financed by the national health system will probably be increasingly required. At that time, stakeholders and decision-makers will have to agree upon a clear and concise set of rules on the technical and methodological issues that must be followed by economic evaluations of health technologies. Consequently, we have provided guidelines and recommendations for producing first-rate economic evaluations. The recommendations appear under seventeen headings or sections. In each case, the recommended requirements to be satisfied by an economic evaluation of health technologies are provided and each recommendation is followed by a commentary, providing a justification and comparing and contrasting the proposal with other available alternatives.

El coste de la diabetes tipo 2 en España: El estudio CODE-2

Objetivo: Estimar el coste de la atencion sanitaria al paciente diabetico tipo 2, diferenciando el gasto derivado del control de la enfermedad, de la atencion de sus complicaciones y de otros costes directos asociados. Metodos: Recogida retrospectiva del consumo de recursos a partir de la historia clinica y la entrevista personal en 29 centros de atencion primaria de todo el territorio nacional de una muestra de pacientes seleccionados de forma aleatoria a partir del registro de diabeticos de cada centro. Resultados: Se evaluo a 1.004 pacientes (561 mujeres) con una media de edad de 67,42 anos y una media de evolucion de la enfermedad de 10,07 anos. El 50,9% no presentaba complicaciones, el 17,7% solo macrovasculares, el 19,5% solo microvasculares y el 11,9% ambas. El coste anual sanitario por paciente fue de 1.305,15 euros. De este coste el 28,6% (373,27 euros) estaba relacionado directamente con el control de la diabetes, el 30,51% (398,20 euros) con sus complicaciones y el 40,89% (533,68 euros) no estaba relacionado. El coste medio de un paciente sin complicaciones fue de 883 euros frente a 1.403 de un paciente con complicaciones microvasculares, 2.022 cuando existian complicaciones macrovasculares y 2.133 cuando coexistian ambos tipos de complicaciones. Conclusiones: El elevado coste del tratamiento de la diabetes tipo 2 y sus complicaciones, sugiere la posibilidad de que la mejora del control de la enfermedad pueda no solo mejorar la supervivencia y la calidad de vida, sino reducir los costes asociados con las complicaciones cronicas.

Spanish recommendations on economic evaluation of health technologies

The economic evaluation of health technologies has become a major tool in health policy in Europe for prioritizing the allocation of health resources and the approval of new technologies. The objective of this proposal was to develop guidelines for the economic evaluation of health technologies in Spain. A group of researchers specialized in economic evaluation of health technologies developed the document reported here, following the initiative of other countries in this framework, to provide recommendations for the standardization of methodology applicable to economic evaluation of health technologies in Spain. Recommendations appear under 17 headings or sections. In each case, the recommended requirements to be satisfied by economic evaluation of health technologies are provided. Each recommendation is followed by a commentary providing justification and compares and contrasts the proposals with other available alternatives. The economic evaluation of health technologies should have a role in assessing health technologies, providing useful information for decision making regarding their adoption, and they should be transparent and based on scientific evidence.

Economic evaluation of vaccination programmes: a consensus statement focusing on viral hepatitis

The methods that have been used to estimate the clinical and economic impact of vaccination programmes are not always uniform, which makes it difficult to compare results between economic analyses. Furthermore, the relative efficiency of vaccination programmes can be sensitive to some of the more controversial aspects covered by general guidelines for the economic evaluation of healthcare programmes, such as discounting of health gains and the treatment of future unrelated costs. In view of this, we interpret some aspects of these guidelines with respect to vaccination and offer recommendations for future analyses.These recommendations include more transparency and validation, more careful choice of models (tailored to the infection and the target groups), more extensive sensitivity analyses, and for all economic evaluations (also nonvaccine related) to be in better accordance with general guidelines.We use these recommendations to interpret the evidence provided by economic evaluation applied to viral hepatitis vaccination. We conclude that universal hepatitis B vaccination (of neonates, infants or adolescents) seems to be the most optimal strategy worldwide, except in the few areas of very low endemicity, where the evidence to enable a choice between selective and universal vaccination remains inconclusive. While targeted hepatitis A vaccination seems economically unattractive, universal hepatitis A vaccination strategies have not yet been sufficiently investigated to draw general conclusions.

Transferability of Economic Evaluation Results

ds on many others that can hardly be controlled. If Physicians take their decisions about the managethis is the case, every economic evaluation should be ment and use of health technologies based on scienrepeated in each setting where it is to be applied. tific knowledge as well as on their own experience. This would mean an enormous effort and, most During the last century, clinical trials have become likely, the practical paralysation of health decisions more common and have constituted the best apif efficiency criteria must be considered. proach to demonstrate the outcomes of health techThe concept of transferability appeared at the nologies. Most of the clinical trials are performed horizon as a bridge to facilitate the accumulation of under special (ideal) conditions that control for general knowledge and to avoid repeatedly starting many parameters. Clinicians have access to the refrom zero. However, this concept has to be defined sults of the trials, frequently carried out in a few and its many issues must be analysed prior to applicountries, and believe that by applying the same cation. In this issue of PharmacoEconomics, Welte technologies to their patients they will achieve simiet al.[1] elaborate and propose a guide for assessing lar results. Significant departures from those entry the transferability of economic evaluations. They requirements to the clinical trials usually change argue with three real-world examples that by investhealth outcomes; the concept of effectiveness being a small effort on an economic evaluation, its comes relevant at this point. Recently, and thanks to results can also be transferred to other settings and information technology, many records from the used in the decision-making process. This paper is application of such technologies in real world condiwelcome; it will certainly be quoted many times in tions are available (Cochrane Library, for instance). the near future and will constitute a milestone in the Consequently physicians can learn about the applispread of economic evaluation studies and their use cation of technologies in different settings, and idenin health decision making. tify those which seem to be more appropriate (more Fernando Antoñanzas effective) for their patients and health systems.

[The cost of type 2 diabetes in Spain: the CODE-2 study].

OBJECTIVE To estimate the cost of providing health care to patients with type 2 diabetes, by differentiating costs of the disease, costs of complications, and other unrelated health costs. METHODS Data on resource use were retrospectively collected from medical records and personal interviews in 29 primary health care centers in Spain. Patients were randomly selected from each centers diabetes registry. RESULTS We evaluated 1004 patients (561 women) with a mean age of 67.42 years and a mean disease duration of 10.07 years. A total of 50.9% had no complications, 17.7% had macrovascular complications only, 19.5% had microvascular complications only and 11.9% presented both types of complication. The annual health cost per patient was 1305.15 euros. Of this cost, 28.6% (373.27 euros) was directly related to diabetes control, 30.51% (398.20 euros) was related to complications of the disease, and 40.89% (533.68 euros) was unrelated. The mean cost of patients with no complications was 883 euros compared with 1403 euros for those with microvascular complications, 2022 euros for those with macrovascular complications and 2133 euros for patients with both types of complication. CONCLUSIONS Because of the high cost of treating type 2 diabetes and its complications, preventive measures should be implemented and control of the disease should be improved to reduce the costs associated with chronic complications.

A proposed guideline for economic evaluation of health technologies

Over the last few years, economic evaluation of health technologies has become a major tool used by European health policy decision-makers to create strategies for prioritizing the allocation of health resources and the approval of new technologies. Spain was a pioneer in proposing the standardization of methodology applicable to economic evaluation studies. However, because health policy decision-makers refused to support the initiative, the methodology was never put into practice. In the medium term, evidence of the economic value of new health technologies financed by the national health system will probably be increasingly required. At that time, stakeholders and decision-makers will have to agree upon a clear and concise set of rules on the technical and methodological issues that must be followed by economic evaluations of health technologies. Consequently, we have provided guidelines and recommendations for producing first-rate economic evaluations. The recommendations appear under seventeen headings or sections. In each case, the recommended requirements to be satisfied by an economic evaluation of health technologies are provided and each recommendation is followed by a commentary, providing a justification and comparing and contrasting the proposal with other available alternatives.

Análisis de costes y resultados en la evaluación económica de las intervenciones sanitarias

El objetivo fundamental de cualquier sistema sanitario esmaximizar el nivel de salud de la poblacion a la que da co-bertura. Desgraciadamente, los recursos economicos dispo-nibles para tal fin no suelen ser suficientes para cubrir todaslas necesidades que en este ambito se presentan. Por estarazon, los agentes que toman las decisiones deben estable-cer que acciones resultan prioritarias para poder maximizarel beneficio producido con los recursos disponibles

Smoking Risks in Spain: Part III - Determinants of Smoking Behavior

Using original survey data from Spain, this paper assesses the determinants of smoking behavior. This study examines the effect on smoking of the most diverse set of risk measures ever considered: lung cancer, relative lung cancer risks, lung disease, heart disease, relative heart disease risks, lost life expectancy to smokers, and various risk measures for passive smoking. Smoking measures include cigarette smoking, the number of cigarettes smoked, and pipe and cigar smoking. Primary smoking risks have a more consistent negative effect on smoking than perceived passive smoking risks.

Análisis coste-efectividad en la evaluación económica de intervenciones sanitarias

, la evaluacion economica de las intervenciones sanita-rias es un termino generico que engloba varias tecnicas oprocedimientos que pueden emplearse para comparar in-formacion sobre la relacion que existe entre el coste y losresultados de las intervenciones destinadas a la mejora dela salud de los individuos. El analisis coste-efectividad (ACE) es, en la actualidad, laforma mas comun de llevar a cabo cualquier evaluacioneconomica de las intervenciones sanitarias destinada a de-terminar que intervenciones resultan prioritarias para maxi-mizar el beneficio producido por los recursos economicosdisponibles