Jose Luis Pinto

Qué es una tecnología sanitaria eficiente en España

Introduccion: A pesar del creciente reconocimiento de la potencial utilidad de los estudios de coste-efectividad, en Espana no existe ningun criterio que permita establecer si una determinada tecnologia sanitaria puede considerarse rentable o no. El objetivo de este trabajo es describir cuales han sido los limites y criterios utilizados en Espana para recomendar la adopcion o el rechazo de intervenciones sanitarias en funcion de su coste-efectividad. Metodo: Se realizo una revision de las evaluaciones economicas de intervenciones sanitarias publicadas en Espana desde 1990 hasta 2001. Se seleccionaron las evaluaciones economicas completas en las que el cociente coste-efectividad se habia expresado como coste por ano de vida ganado (AVG), como coste por ano de vida ajustado por calidad (AVAC) o como coste por vida salvada. Se analizaron las intervenciones sobre las que los autores establecieron algun tipo de recomendacion (de adopcion o rechazo), asi como los criterios utilizados. Resultados: Veinte (20%) de las 100 evaluaciones economicas completas publicadas cumplieron con los criterios senalados. En 16 de los estudios, los resultados se expresaron como coste por AVG, en 6 como coste por AVAC y en 1 como coste por vida salvada. Se evaluaron un total de 82 intervenciones sanitarias, en 44 de las cuales se realizo algun tipo de recomendacion. Los autores recomendaron la adopcion de todas las intervenciones sanitarias con un coste-efectividad inferior a 30.000 euros (5 millones de pesetas) por AVG. Por encima de esa cifra no se aprecio ninguna tendencia. Conclusiones: Si bien los resultados deben ser interpretados con mucha precaucion, dadas las limitaciones del estudio, los limites de coste-efectividad presentados en este trabajo podrian constituir una primera referencia a lo que podria considerarse como una intervencion sanitaria eficiente en Espana.

What is an efficient health technology in Spain

INTRODUCTION Despite the growing recognition of the potential applications of cost-effectiveness assessments, a criterion to establish what is an efficient health technology does not exist in Spain. The objective of this work is to describe the limits and the criteria used in Spain to recommend the adoption of health interventions. METHOD A review of the economic evaluations of health technologies published in Spain from 1990 to 2001 was conducted. Complete economic assessments in which the cost-effectiveness ratio was expressed as cost per life-year gained (LYG), cost per quality-adjusted-life-year (QALY) or cost per saved live were selected. Those interventions in which the authors established recommendations (adoption or rejection) and the criteria used were analyzed. RESULTS Twenty (20%) of the 100 complete economic evaluations fulfilled the selection criteria. In16 studies, the results were expressed as cost per LYG, in 6 studies as cost per QALY and in 1 as cost per saved live. A total of 82 health interventions were assessed and some kind of recommendation was established in 44 of them. All technologies with a cost-effectiveness ratio lower than 30,000 euros (5 million pesetas) per LYG were recommended for adoption by the authors. Up to that limit there was no a clear tendency. CONCLUSIONS Although the results must be interpreted with much precaution, given the limitations of the study, the limits of cost-effectiveness presented in this work could be a first reference to which would be an efficient health intervention in Spain.

A Consistency Test of the Time Trade-Off

This paper tests the internal consistency of time trade-off utilities. We find significant violations of consistency in the direction predicted by loss aversion. The violations disappear for higher gauge durations. We show that loss aversion can also explain that for short gauge durations time trade-off utilities exceed standard gamble utilities. Our results suggest that time trade-off measurements that use relatively short gauge durations, like the widely used EuroQol algorithm (Dolan 1997), are affected by loss aversion and lead to utilities that are too high.

The Social Value of Health Programs: Is Age a Relevant Factor?

In cost-effectiveness analysis (CEA) it is usually assumed that a quality-adjusted life-year (QALY) is of equal value to everybody, irrespective of the patients age. However, it is possible that society assigns different social values to a QALY, according to who gets it. In this paper, we discuss the possibility of weighting health benefits for age in CEA. We also examine the possibility that age-related preferences depend on the size of the health gain. An experiment was performed to test these hypotheses. The assessment of results suggests that the patients age is a relevant factor when assessing health gains.

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

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

Priorización de pacientes en lista de espera para cirugía de cataratas: diferencias en las preferencias entre ciudadanos

Objetivos: Estimar y comparar las preferencias de los ciudadanos sobre la priorizacion de pacientes en lista de espera para cirugia de cataratas. Metodo: Analisis de conjunto. Identificacion y seleccion de criterios de priorizacion: 4 grupos focales/nominales de poblacion general, pacientes/familiares, profesionales relacionados, y especialistas de Catalunya (n = 36). Estimacion de las preferencias (puntuaciones de los criterios): entrevista a una muestra representativa de los 4 grupos (n = 771) y aplicacion del modelo del rank-ordered logit. Las diferencias se estudiaron mediante analisis separado por grupo y su comparacion. Resultados: Los criterios seleccionados y su importancia relativa fueron: incapacidad visual (45%), limitacion de las actividades (15%), limitacion para trabajar (14%), tener alguna persona que le cuide (11%), ser cuidador (8%) y probabilidad de recuperacion (7%). Existieron diferencias entre grupos en la puntuacion de los criterios. La poblacion general y los pacientes/familiares valoraron mas la incapacidad visual que los otros grupos (p 0,9), la ordenacion final de estos en la lista de espera podia variar hasta 27 posiciones al aplicar las preferencias obtenidas de un grupo o de otro. Conclusiones: Se considero relevantes los criterios clinicos y los sociales. La existencia de diferencias sobre como deberian priorizarse los pacientes en espera recomienda tener en cuenta las preferencias de todas las partes afectadas.

Prioritizing patients on waiting list for cataract surgery: preference differences among citizens

OBJECTIVES To estimate and compare citizen preferences regarding patient prioritization for cataract surgery. METHOD A conjoint analysis was performed. Priority criteria were identified and selected using 4 focus/nominal groups consisting of the general public, patients/relatives, allied health-professionals and specialists from Catalonia (n=36). Preferences elicitation (score of criteria): representative sample survey of the above mentioned groups (n=771) and rank-ordered logit model application. Differences were assessed by group analysis and their comparison. RESULTS The criteria selected and their relative importance were: visual impairment (45%), difficulty in performing activities of daily living (ADL) (15%), limitation of ability to work (14%), being looked after by someone (11%), being a caregiver (8%), and recovery probability (7%). Differences in scores were observed among groups. Visual impairment was scored more highly by the general public and patients/relatives than by other groups (p<0.001). These two groups also assigned less importance to difficulty in performing ADL (p<0.001). The probability of recovery was the least scored criterion by most groups. Correlations among the order of hypothetical patient scenarios were high (r>0.9). However, the final order of patients on the waiting list could differ by up to 27 positions when different group scores were applied. CONCLUSIONS Social and clinical criteria were considered important. The observed differences among citizens regarding how to prioritize patients on the waiting lists indicates the need to take into account the preferences of all groups of citizens.

Equity Considerations in Health Care: An Axiomatic Bargaining Approach

The general issues of equity and efficiency are placed at the center of the analysis of resource allocation problems in health care. We examine them using axiomatic bargaining theory. We study different solutions that have been proposed and relate them to previous literature on health care allocation. In particular, we focus on the solutions based on axiomatic bargaining with claims and suggest that they may be particularly appealing as distributive criteria in health policy. Finally, we present the results of a survey that tries to elicit moral intuitions of people about resource allocation problems and their different solutions.

The Significance of Distributive Effects in Social Assessment of Health Care

In this paper we address the importance of distributive effects in the social valuation of QALYs. We propose a social welfare function that generalises the functions traditionally used in the health economic literature. The novelty is that, depending on the individual health gains, our function can represent either preferences for concentrating or preferences for spreading total gain or both together, an issue which has not been addressed until now. Based on an experiment, we observe that this generalisation provides a suitable approximation to the sampled social preferences.