Nuria García-Agua Soler

Cost-effectiveness of omalizumab in severe persistent asthma in Spain: a real-life perspective.

Abstract Objectives: To determine the cost-effectiveness of omalizumab compared with routine clinical practice in the treatment and control of severe persistent asthma. Methods: Cost-effectiveness analysis using pre- and post-treatment with omalizumab after 10 months of 47 patients diagnosed with uncontrolled severe persistent asthma attended by the Pneumology Service, Hospital Universitario Virgen de la Victoria, Malaga. Effectiveness was assessed by the number of emergency room (ER) visits for exacerbations and quality-adjusted life years (QALY) gained. The costs of treatment with omalizumab and ER visits were analyzed using the National Health System perspective. Results are expressed in cost per QALY gained and cost per ER visit avoided (costs €2012). Results: Exacerbations with ER visits decreased significantly (p < 0.001) after 10 months of omalizumab treatment compared with the previous 10 months [7.94 (6.52–9.37) vs 0.19 (0.03–0.35)]. Health utilities increased significantly (p < 0.001) during the same period [0.5967 (0.5722–0.6212) vs 0.7566 (0.7232–0.7900)], representing 0.1333 (0.1053–0.1612) QALYs gained (p < 0.001).The mean cost per patient was €1850.78 (1519.46–2182.10) in the 10 months before treatment and €5431.87 (4930.72–5933.02) after 10 months of omalizumab treatment. The incremental cost-effectiveness ratios (ICERs) were €462.08/exacerbation avoided (347.65–606.22) and €26 864.89/QALY gained (21 632.07–33 859.49). Conclusions: Our results confirm that adding omalizumab to the treatment of patients with uncontrolled severe persistent asthma reduces the number of exacerbations with ER visits and increases health-related quality of life after 10 months of treatment and produces ICERs favorable to omalizumab and acceptable from the health system perspective.

Effectiveness of glatiramer acetate compared to other multiple sclerosis therapies.

To assess the effectiveness of glatiramer acetate (GA) compared to other multiple sclerosis (MS) therapies in routine clinical practice.

A study of the graduates of health economics masters programs in Spain

OBJECTIVE To identify the characteristics, motivations and employment implications ç among graduates of Masters programmes in health-economics (MPHE). METHOD The most renowned MPHE in Spain were contacted to assist in this research study. Participants submitted an online survey comprising 30 items designed specifically for the purpose. Our sample consisted of 439 graduates. Different statistical analysis, including a logistic model, were performed to describe the sample. RESULTS The main motivation for undertaking an MPHE is academic, and to acquire new or enhance previous knowledge. The general profile of graduates is that of a woman aged 37.8 and a health professional. Those looking for a job in Health Economics generally found employment in the first (54.9%) or second year (29.7%). MPHE were very highly assessed. The most useful subject was health management (46.3%). CONCLUSIONS Undertaking an MPHE is a good investment because most of the graduates believed that their training enabled them to find a job. The graduates showed a high degree of confidence in the usefulness of the training. MPHE are highly evaluated irrespective of consequent employment. The subjects in which the curriculum vitae of the health professionals were weaker, such as those concerning management, were evaluated the highest as they were assumed to enhance promotion opportunities.

Efficacy of the Treatments Used in Multiple Sclerosis: From Meta-analysis to Number Needed to Treat.

The aim of this study was to analyze the efficacy of drugs used in relapsing-remitting multiple sclerosis, first- and second-line drugs, using the number needed to treat (NNT) as a measure of efficacy. Methods Data from randomized clinical trials were analyzed for 3 categories of clinical efficacy outcomes: relapse, change in Expanded Disability Status Scale, and number of new lesions in magnetic resonance imaging. Meta-analysis results are expressed as odds ratios. Results The global odds ratio was 0.41 (95% confidence interval [CI], 0.34–0.49). For analyzed clinical outcomes, the odds ratio was less for second-line drugs (odds ratio, 2.0). For all studied clinical conditions, in the control group, 47 of 100 patients do not get benefits, compared with 25 (95% CI, 18–32 patients) of 100 for the active treatment group. The NNT was 5 patients (95% CI, 4–7 patients). For the proportion of patients free of relapses, in the control group, 56 of 100 patients had a relapse at 2 years, compared with 37 of 100 patients in the treatment group, with an NNT of 6 patients (95% CI, 5–8 patients). Conclusions Active treatments produced statistically significant improvements compared with placebo.

Gasto económico del tratamiento del dolor irruptivo

Resumen A continuacion se exponen 2 estudios farmacoeconomicos que comparan el comprimido oral de fentanilo con aplicador para administracion bucofaringea (Actiq ® ), el comprimido de fentanilo sublingual (Abstral ® ), el comprimido bucal efervescente de fentanilo (Effentora ® ) y el fentanilo por via nasal, con 2 tecnologias: una formulacion en gel con pectina (fentanilo intranasal con pectina, PecFent ® ) y otra en solucion acuosa sin pectina (Instanyl ® ). El estudio de Lopez et al buscaba analizar los ahorros potenciales derivados de la introduccion progresiva del fentanilo intranasal con pectina, para el tratamiento de pacientes mayores de edad con dolor irruptivo oncologico. El estudio de Blanco et al tenia como objetivo conocer la efectividad y eficiencia del fentanilo intranasal con pectina comparado con los otros tratamientos transmucosos comercializados en ese momento. El primer estudio mostro una disminucion del coste sanitario con la introduccion progresiva del fentanilo intranasal con pectina en el Sistema Sanitario Espanol para el tratamiento del dolor irruptivo. El segundo estudio demostro que la opcion mas eficiente (mayor efectividad y menor coste) en todos los casos analizados fue el espray intranasal de fentanilo con pectina.

Accidentes laborales en la provincia de Málaga: Participación del alcohol etílico y las drogas de abuso

espanolEl presente trabajo se corresponde con un estudio observacional descriptivo de los accidentes de trabajo ocurrido en la provincia de Malaga entre Octubre de 2003 y Diciembre de 2006, con resultado de muerte y que fueron autopsiados en el Instituto de Medicina Legal de Malaga. En el hemos analizado todas aquellas variables circunstanciales que, de una forma u otra, desempenan algun papel en la etiopatogenia de este tipo de lesiones, haciendo hincapie en la participacion del alcohol etilico y las drogas de abuso. Se describen 17 casos positivos a alcohol etilico, cannabis o cocaina y destaca la ausencia de medidas de seguridad en el trabajador. Todo ello con la finalidad de establecer unas pautas de conducta que permitan, en la medida de lo posible, ayudar a prevenir e incluso a disminuir el numero de estos accidentes que, por desgracia, en pleno siglo XXI se vienen cobrando todos los anos un numero no desechable de vidas humanas, con la tragedia que ello supone. EnglishThis work corresponds to a descriptive observational study of work accidents occurred in the province of Malaga between October 2003 and December 2006, resulting in death and which were autopsied in the Institute of Legal Medicine of Malaga. We have analyzed all those circumstantial variables that, in one way or another, play a role in the pathogenesis of these lesions, emphasizing in the participation of ethyl alcohol and drug abuse. We described 17 cases positive to ethylic alcohol, cannabis or cocaine and the absence of safety measures in the worker. All this with the purpose of establishing a few behavior guidelines which as far as possible, may help to anticipate, and even to diminish the number of this type of accidents that, unfortunately, in full 21st century are still very high.

Gasto en medicamentos y políticas

ResumenObjetivo: Valorar la influencia de las políticas farmacéuticas y la ideología política de las Comunidades Autónomas sobre el gasto farmacéutico público (GF) y su control. Métodos: Horizonte temporal: 2003–07. Las políticas farmacéuticas seguidas en las Comunidades Autónomas fueron: ninguna, EFG, PPAyS y PPA + EFG. Se clasificaron en conservadoras o progresistas, de acuerdo con la ideología de las fuerzas políticas gobernantes. Los datos del GF se han obtenido del MSC y los de población del INE. El análisis estadístico incluyó: media ±DE, IC 95%, frecuencia y proporción. La relación entre variables se analizó con el coeficiente de Pearson. El análisis inferencial empleó el ANOVA y las pruebas de Kruskal-Wallis y ?2. La influencia de las políticas farmacéuticas y el signo político sobre el gasto farmacéutico por habitante (GFpc) se analizó con una regresión para datos categóricos. Resultados: Durante el periodo 2003-07, el GF total se incrementó en más del 27% y el GFpc en casi el 21%. Las CC.AA. con política de EFG son las que presentan menor gasto, y éstas sólo fueron estadísticamente significativas respecto a ninguna política activa de control y frente a las que emplean EFG+PPA durante los últimos 4 años de estudio (p < 0,05). Las CC.AA. progresistas presentaron un GF mayor que las conservadoras (n.s.). Las políticas de control del gasto y el signo político predominante explicaron cerca del 45% del GFpc, predominando la política de control sobre el signo político de la CC.AA. Conclusiones: Las políticas de control del GF y las fuerzas políticas gobernantes, tienen influencia en el GFpc, pero no son determinantes ni duraderas.AbstractAims: To assess the influence of pharmaceutical policies and political ideology of the Autonomous Communities (ACs) in Spain on the public pharmaceutical expenditure (PPE) and its control. Method: Time horizon: 2003–07. Pharmaceutical policies followed in the AR were: no policy to help control spending, generic drug policy (GDP), international non-proprietary name (INN) — the prescription was based on the name of the active ingredient — and INN+GDP. ACs were classified as conservative or progressive, according to the ideology of political leaders. PPE data were obtained from NHS and population data from National Institute of Statistics. Statistical analysis included: mean±SD, 95%CI, frequency and proportion. The relationship between variables was analyzed with Pearson’s coefficient. Inferential ANOVA, Kruskal-Wallis and Chi-square tests were used for analyses. The influence of pharmaceutical policies and political ideology on the public pharmaceutical expenditure per capita (PPEpc) was analyzed with a regression analysis for categorical data. Results: During 2003-07 total PPE increased by over 27% and PPEpc by almost 21%. The ACs with a GDPs policy had a lower expense, and this was statistically significant only versus no active control policy and versus those ACs using INN+GDP over the past 4 study years (p < 0.05). PPE was higher in progressive ACs than in conservative ones (n.s.). The policies of expenditure control and the dominant political sign explained about 45% of GFpc; control policies are more important than the political trends in CAs. Conclusion: PPE control policies and the political leaders have an influence on PPEpc, but this is not significant and durable over time.