Jm Hernandez

Willingness to pay and conjoint analysis to determine women's preferences for ovarian stimulating hormones in the treatment of infertility in Spain

BACKGROUND Despite many advances in assisted reproductive techniques (ART), little is known about preferences for technological developments of women undergoing fertility treatments. The aims of this study were to investigate the preferences of infertile women undergoing ART for controlled ovarian stimulation (COS) treatments; to determine the utility values ascribed to different attributes of COS treatments; and to estimate womens willingness to pay (WTP) for COS. METHODS A representative sample of ambulatory patients ready to receive, or receiving, COS therapies for infertility were recruited from seven specialized private centres in six autonomous communities in Spain. Descriptive, inferential and conjoint analyses (CA) were used to elicit preferences and WTP. Attributes and levels of COS treatments were identified by literature review and two focus groups with experts and patients. WTP valuations were derived by a combination of double-bounded (closed-ended) and open questions and contingent ranking methods. RESULTS In total, 160 patients [mean (standard deviation; SD) age: 35.8 (4.2) years] were interviewed. Over half of the participants (55.0%) had a high level of education (university degree), most (78.8%) were married and half (50.0%) had an estimated net income of >€1502 per month and had paid a mean (SD) €1194.17 (€778.29) for their most recent hormonal treatment. The most frequent causes of infertility were related to sperm abnormalities (50.3%). In 30.6% of cases, there were two causes of infertility. The maximum WTP for COS treatment was €800 (median) per cycle; 35.5% were willing to pay an additional €101–€300 for a 1–2% effectiveness gain in the treatment. Utility values (CA) showed that effectiveness was the most valued attribute (39.82), followed by costs (18.74), safety (17.75) and information sharing with physicians (14.93). CONCLUSIONS WTP for COS therapies exceeds current cost. Additional WTP exists for 1–2% effectiveness improvement. Effectiveness and costs were the most important determinants of preferences, followed by safety and information sharing with physicians.

Colestasis intrahepática del embarazo: diagnóstico y manejo

Resumen La colestasis intrahepatica del embarazo es una forma reversible no obstructiva de colestasis intrahepatica. Los acidos biliares son eliminados de forma incompleta por el higado de las gestantes, lo que aumenta sus concentraciones en sangre y liquido amniotico. Es una patologia benigna para la gestante que se asocia con un incremento de la muerte fetal intrautero.

Prognostic Factors in Chronic Lymphoid Leukemia and Identification of New Clinically Relevant Molecular Markers

Chronic lymphocytic leukemia (CLL) is a hematological malignancy with significant clinical heterogeneity, due in part to the genetic alterations that leukemic cells present in each patient (Chiorazzi et al, 2005). CLL has a highly variable clinical course. Traditionally, it has been considered that about one-third of patients will never require treatment, as they will have prolonged survival and they will die from causes unrelated to the disease. In another third of cases, after an indolent phase disease progression occurs. In the remaining third of patients early treatment is required because of the aggressiveness of the disorder. However, due to the routine performance of blood counts in the population, the number of asymptomatic patients is increasing and, conversely, those who require initial treatment account for fewer than 15% of cases (Hernandez et al, 2010). Since the first descriptions of the disease, researchers have attempted to establish prognostic factors with which to make a risk assessment of disease progression and probability of death. The ultimate aim is to try and apply a targeted and early treatment that increases overall survival and quality of life in patients with more aggressive forms, and to determine reliably the cases who do not need further treatment. (Dighiero & Hamblin, 2008).

Cerclaje abdominal: nuestro primer caso

Resumen El cerclaje istmicocervical por via abdominal es una tecnica escasamente utilizada, de mayor riesgo que el cerclaje convencional, pero que puede constituir la unica opcion terapeutica en determinados casos de insuficiencia istmicocervical. En este trabajo presentamos nuestra primera experiencia con esta tecnica, realizada en la semana 11 a una paciente con mala historia obstetrica y que permitio una evolucion favorable del embarazo.

Infarto agudo de miocardio durante el primer trimestre del embarazo

El infarto agudo de miocardio durante el embarazo y posparto es una afeccion poco descrita en la bibliografia porque no es una enfermedad frecuente en esta clase de pacientes. Sus correctos diagnostico y tratamiento son de gran importancia, por el riesgo de mortalidad materna y fetal que comporta. Presentamos un caso de infarto agudo de miocardio en el primer trimestre del embarazo, del cual mostramos como se trato y siguio y la actitud respecto al momento del parto.