Marta Trapero-Bertran

The Valuation of Informal Care in Cost-of-Illness Studies: A Systematic Review

BackgroundThere is a growing interest in incorporating informal care in cost-of-illness studies as a relevant part of the economic impact of some diseases.ObjectiveThe aim of this paper was to review the recent literature valuating the costs of informal care in a group of selected diseases from 2005 to 2015.MethodsWe carried out a systematic review on the economic impact of informal care, focusing on six selected diseases: arthritis or osteoarthritis, cancer, dementia, mental diseases, multiple sclerosis and stroke.ResultsWe selected 91 cost-of-illness articles. The average weight attributed to the informal care cost over the total cost was highly relevant for dementia, stroke, mental diseases, cancer and multiple sclerosis. The most frequent valuation method applied was the opportunity cost method, followed by the proxy good method. The annual cost of informal care presented a high variability depending on the disease and geographic location. Distinguishing by type of illness, the disease with the highest annual value of informal caregiving was dementia, followed by mental illness and multiple sclerosis. The average hourly unit cost was €11.43 (2015 values), varying noticeably depending on the geographic location.ConclusionThis paper identifies several aspects that should be enhanced to promote comparability between studies and countries, and it sends key messages for incorporating informal care costs to adequately measure the economic impact of diseases.

Economic impact of HIV/AIDS: a systematic review in five European countries.

The HIV/AIDS disease represent a priority for all health authorities in all countries and it also represents serious added socioeconomic problems for societies over the world. The aim of this paper is to analize the economic impact associated to the HIV/AIDS in an European context. We conducted a systematic literature review for five different countries (France, Germany, Italy, Spain and United Kingdom) and searched five databases. Three types of analyses were undertaken: descriptive statistics; quantitative analysis to calculate mean costs; and comparison across countries. 26 papers were included in this study containing seventy-six cost estimates. Most of the studies analyzed the health care cost of treatment of HIV/AIDS. Only 50% of the cost estimates provided mean lymphocyte count describing the patients’ disease stage. Approximately thirty percent of cost estimates did not indicate the developmental stage of the illness in the patients included. There is a high degree of variability in the estimated annual cost per patient of the treatments across countries. There is also a great disparity in total healh care costs for patients with lymphocyte counts between 200CD4+/mm3 and 500 CD4/mm3, although the reason of variation is unclear. In spite of the potential economic impact in terms of productivity losses and cost of formal and informal care, few studies have set out to estimate the non-medical costs of HIV/AIDS in the countries selected. Another important result is that, despite the low HIV/AIDS prevalence, its economic burden is very relevant in terms of the total health care costs in this five countries. This study also shows that there are relatively few studies of HIV costs in European countries compared to other diseases. Finally, we conclude that the methodology used in many of the studies carried out leaves ample room for improvement and that there is a need for these studies to reflect the economic impact of HIV/AIDS beyond health care including other components of social burden.

Analysis of three strategies to increase screening coverage for cervical cancer in the general population of women aged 60 to 70 years: the CRICERVA study

BackgroundCervical cancer is a frequently diagnosed cancer in women worldwide. Despite having easy preventive and therapeutic approaches, it is an important cause of mortality among women.MethodsThe CRICERVA study is a cluster clinical trial which assigned one of three interventions to the target population registered in Cerdanyola, Barcelona. Among the 5,707 resident women aged 60 to 70 years in the study area, women with no record of cervical cytology over the last three years were selected. The study included four arms: three interventions all including a pre-assigned date for screening visit and i) personalized invitation letter; ii) adding to i) an informative leaflet; and, iii) in addition to ii) a personalized appointment reminder phone call, and iv) no specific action taken (control group). Participants were offered a personal interview about social-demographic characteristics and about screening attitudes. Cervical cytology and HPV DNA test (HC2) were offered as screening tests. In the case of screening positive in any of these tests, the women were followed up until a full diagnosis could be obtained. The effect size of each study arm was estimated as the absolute gain in coverage between the original coverage and the final coverage.ResultsFrom the intervention groups (4,775 women), we identified 3,616 who were not appropriately screened, of which 2,560 women answered the trial call and 1,376 were amenable to screening. HPV was tested in 920 women and cervical cytology in all 1,376. Overall, there was an absolute gain in coverage of 28.8% in the intervention groups compared to 6% in the control group. Coverage increased from 51.2% to 76.0% in strategy i); from 47.4% to 79.0% in strategy ii) and from 44.5% to 74.6% in strategy iii). Lack of information about the relevance of screening was the most important factor for not attending the screening program.ConclusionsThe study confirms that actively contacting women and including a date for a screening visit, notably increased participation in the screening program. Efforts to improve health education in preventative activities are warranted.Trial registrationClinical Trials.gov Identifier NCT01373723. Registered 14 June 2011.

Endoscopic requirements of colorectal cancer screening programs in average-risk population. Estimation according to a Markov model

BACKGROUND Although colorectal cancer (CRC) screening strategies are quite common in the United States, their systematic introduction in Europe has been delayed until the year 2008. To estimate endoscopic requirements of four different CRC screening strategies (annual and biennial fecal occult blood testing (FOBT), flexible sigmoidoscopy every 5 years, and colonoscopy every 10 years) in an average-risk population. METHODS A long-term Markov process model was designed combining three adherence rates for the four above-mentioned screening strategies in individuals aged from 50 to 74. Estimations included endoscopic procedures performed for both screening and surveillance purposes. Models were adjusted for age-related adenoma and CRC incidence rates, life expectancy, and cancer-related survival. RESULTS The mean number of annual colonoscopies per 100,000 individuals aged 50-74 ranged from 100 to 271 for annual FOBT, from 75 to 203 for biennial FOBT, from 222 to 601 for sigmoidoscopy, and from 903 to 2,449 for colonoscopy-based strategies, depending on the adherence rate. According to these estimations, annual and biennial FOBT strategies would generate a slight decrease of current endoscopic activity (1.4-3.8% and 2.7-7.2%, respectively), whereas sigmoidoscopy and colonoscopy-based strategies would induce a 4.7-12.8% and 32-87% increase, respectively, with respect to a non-screening scenario. The model confirmed a 3-16% mean reduction of CRC incidence depending on the strategy and adherence rate. CONCLUSION Whereas endoscopic capacity exists for widespread CRC screening with annual or biennial FOBT, implementation of potentially more effective strategies, such as flexible sigmoidoscopy or colonoscopy, would result in a significant increase of current endoscopic resources.

Development and Application of an Economic Model (EQUIPTMOD) to assess the Impact of Smoking Cessation

Abstract Background and Aims Although clear benefits are associated with reducing smoking, there is increasing pressure on public health providers to justify investment in tobacco control measures. Decision‐makers need tools to assess the Return on Investment (ROI)/cost‐effectiveness of programmes. The EQUIPT project adapted an ROI tool for England to four European countries (Germany, the Netherlands, Spain and Hungary). EQUIPTMOD, the economic model at the core of the ROI tool, is designed to assess the efficiency of packages of smoking cessation interventions. The objective of this paper is to describe the methods for EQUIPTMOD and identify key outcomes associated with continued and cessation of smoking. Methods EQUIPTMOD uses a Markov model to estimate life‐time costs, quality‐adjusted life years (QALYs) and life years associated with a current and former smoker. It uses population data on smoking prevalence, disease prevalence, mortality and the impact of smoking combined with associated costs and utility effects of disease. To illustrate the tools potential, costs, QALYs and life expectancy were estimated for the average current smoker for five countries based on the assumptions that they continue and that they cease smoking over the next 12 months. Costs and effects were discounted at country‐specific rates. Results For illustration, over a life‐time horizon, not quitting smoking within the next 12 months in England will reduce life expectancy by 0.66, reduce QALYs by 1.09 and result in £4961 higher disease‐related health care costs than if the smoker ceased smoking in the next 12 months. For all age–sex categories, costs were lower and QALYs higher for those who quit smoking in the 12 months than those who continued. Conclusions EQUIPTMOD facilitates assessment of the cost effectiveness of smoking cessation strategies. The demonstrated results indicate large potential benefits from smoking cessation at both an individual and population level.

A SYSTEMATIC REVIEW AND META-ANALYSIS OF WILLINGNESS-TO-PAY VALUES: THE CASE OF MALARIA CONTROL INTERVENTIONS

The increasing use of willingness to pay (WTP) to value the benefits of malaria control interventions offers a unique opportunity to explore the possibility of estimating a transferable indicator of mean WTP as well as studying differences across studies. As regression estimates from individual WTP studies are often assumed to transfer across populations it also provides an opportunity to question this practice. Using a qualitative review and meta analytic methods, this article determines what has been studied and how, provides a summary mean WTP by type of intervention, considers how and why WTP estimates vary and advises on future reporting of WTP studies. WTP has been elicited mostly for insecticide-treated nets, followed by drugs for treatment. Mean WTP, including zeros, is US

Economic evaluation of three populational screening strategies for cervical cancer in the county of Valles Occidental: CRICERVA clinical trial

2.79 for insecticide-treated nets, US

[Economic evaluation of smoking cessation interventions: have we overlooked something].

6.65 for treatment and US

Changing Current Practice in Urology: Improving Guideline Development and Implementation Through Stakeholder Engagement

2.60 for other preventive services. Controlling for a limited number of sample and design effects, results can be transferred to different countries using the value function. The main concerns are the need to account for a broader range of explanators that are study specific and the ability to transfer results into malaria contexts beyond those represented by the data. Future studies need to improve the reporting of WTP.

Coste-utilidad del consejo médico para dejar de fumar en la Región de Murcia

BackgroundA high percentage of cervical cancer cases have not undergone cytological tests within 10 years prior to diagnosis. Different population interventions could improve coverage in the public system, although costs will also increase. The aim of this study was to compare the effectiveness and the costs of three types of population interventions to increase the number of female participants in the screening programmes for cancer of the cervix carried out by Primary Care in four basic health care areas.Methods/DesignA cost-effectiveness analysis will be performed from the perspective of public health system including women from 30 to 70 years of age (n = 20,994) with incorrect screening criteria from four basic health care areas in the Valles Occidental, Barcelona, Spain. The patients will be randomly distributed into the control group and the three intervention groups (IG1: invitation letter to participate in the screening; IG2: invitation letter and informative leaflet; IG3: invitation letter, informative leaflet and a phone call reminder) and followed for three years. Clinical effectiveness will be measured by the number of HPV, epithelial lesions and cancer of cervix cases detected. The number of deaths avoided will be secondary measures of effectiveness. The temporal horizon of the analysis will be the life expectancy of the female population in the study. Costs and effectiveness will be discounted at 3%. In addition, univariate and multivariate sensitivity analysis will be carried out.DiscussionIG3 is expected to be more cost-effective intervention than IG1 and IG2, with greater detection of HPV infections, epithelial lesions and cancer than other strategies, albeit at a greater cost.Trial RegistrationClinical Trials.gov IdentifierNCT01373723