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Mari-Dell'Olmo M.,CIBER ISCIII | Mari-Dell'Olmo M.,Biomedical Research Institute Sant Pau | Martinez-Beneito M.A.,CIBER ISCIII | Martinez-Beneito M.A.,Centro Superior Of Investigacion En Salud Publica Csisp Fisabio | And 4 more authors.
Stochastic Environmental Research and Risk Assessment | Year: 2014

Smoothed analysis of variance (SANOVA) has recently been proposed for carrying out disease mapping. The main advantage of this approach is its conceptual simplicity and ease of interpretation. Moreover, it allows us to fix the combination of diseases of particular interest in advance and to make specific inferences about them. In this paper we propose a reformulation of SANOVA in the context of ecological regression studies. This proposal considers the introduction in a non-parametric way of one (or several) covariate(s) into the model, explaining some pre-specified combinations of the outcome variables. In addition, random effects are also incorporated in order to model geographical variation in the combinations of outcome variables not explained by the covariate. Lastly, the model permits the decomposition of the variance in the set of outcome variables into different orthogonal components, quantifying the contribution of every one of them. The proposed model is applied to the geographical analysis of mortality due to malignant stomach neoplasm among women resident in the city of Barcelona (Spain). The available outcome variables are deaths grouped into two time periods, and a socioeconomic deprivation index is included as a covariate. The model has been implemented through INLA, a novel inference tool for Bayesian statistics. © 2013 Springer-Verlag Berlin Heidelberg. Source


Artells J.J.,Fundacion Salud | Peiro S.,Centro Superior Of Investigacion En Salud Publica Csisp Fisabio | Meneu R.,Fundacion Institute Investigacion En Servicios Of Salud
Revista Espanola de Salud Publica | Year: 2014

Background: To identify difficulties, obstacles and limitations to establish an organizational structure devoted to the evaluation of healthcare technologies for incorporation, maintenance or removal from the services portfolio of the Spanish National Health System (sNHS). Methods: Panel of 14 experts, structured according to processes adapted from brainstorming, nominal group, and Rand consensus method techniques. Results: The panel proposed 77 items as potential obstacles to the establishment of an official and independent "agency" able to inform on sNHS healthcare benefits funding or selective disinvestment. These items were focused on: 1) lack of political motivation to introduce the cost-effectiveness analysis from the state and regional governments and lack of independence and transparency of the evaluation processes, 2) the tension between a decentralized health system and evaluation activities with significant scale economies, 3) technical difficulties of the evaluation processes, including their ability to influence decision making and 4) social and professional refusal to the exclusion of healthcare benefits when it is perceived as indiscriminate. Conclusion: Although there is a different number and type of obstacles for developing the capacity of the sNHS to include or exclude healthcare benefits based on the evaluation of their effectiveness and efficiency, experts place in the political arena (political motivation, transparency, governance) the main difficulties to advance in this field. Source


Background: Self-monitoring of blood glucose (SMBG) in noninsulintreated type 2 diabetes patients (T2DM) is a controversial topic. We aimed to describe the SMBG prevalence in noninsulin-treated (NIT) T2DM patients in the Valencia Community (VC) and to analyze factors associated with their use. Method: Cross-sectional studywith 573 NIT-T2DM patients from 83 primary care surgeries. Electronic medical records and patient interview were used. We examine associations among patient, doctors and organizational characteristics, and the SMBG indication. Results: 289 (50.4%) of the 573 NIT-T2DM patients used SMBG. In the multivariable analysis SMBG use was associated with age (OR:2.3 for 65-84 and 6.0 for <65 years vs 85+ years old)) the length from diagnosis (OR:2.2 for 10-15 years vs 0-5 years), the number of OAAs prescribed (OR:2.5, 4.1 and 5.7 for 1, 2 or 3+ OAAs vs no treatment with OAAs) and type (with more SMBG prescribed in patients with sulfonylureas and glitazones), glycated haemoglobin figures (OR: 1.9 y 1.6 for 7-8 and >8, vs <7), sedentary behaviour (OR:1.6), obesity (OR:1.5), and housewife status, and chronic respiratory disease antecedents (OR:0.5). After controlling these factors, SMBG use was also associated with the length of doctor's professional practice and some healthcare departments. Conclusions: In the Valencia Community the SMBG use in noninsulintreated T2DM patients is strongly associated with clinic patient' characteristics, but some non-clinical factors explain part of the variance in their utilization. Source


Catala-Lopez F.,Centro Superior Of Investigacion En Salud Publica Csisp Fisabio | Sanfelix-Gimeno G.,Centro Superior Of Investigacion En Salud Publica Csisp Fisabio | Ridao M.,Centro Superior Of Investigacion En Salud Publica Csisp Fisabio | Ridao M.,Instituto Aragones Of Ciencias Of La Salud Ics | Peiro S.,Centro Superior Of Investigacion En Salud Publica Csisp Fisabio
PLoS ONE | Year: 2013

Background:We examined sponsorship of published cost-effectiveness analyses of statin use for cardiovascular (CV) prevention, and determined whether the funding source is associated with study conclusions.Methods and Findings:We searched PubMed/MEDLINE (up to June 2011) to identify cost-effectiveness analyses of statin use for CV prevention reporting outcomes as incremental costs per quality-adjusted life years (QALY) and/or life years gained (LYG). We examined relationships between the funding source and the study conclusions by means of tests of differences between proportions. Seventy-five studies were included. Forty-eight studies (64.0%) were industry-sponsored. Fifty-two (69.3%) articles compared statins versus non-active alternatives. Secondary CV prevention represented 42.7% of articles, followed by primary CV prevention (38.7%) and both (18.7%). Overall, industry-sponsored studies were much less likely to report unfavourable or neutral conclusions (0% versus 37.1%; p<0.001). For primary CV prevention, the proportion with unfavourable or neutral conclusions was 0% for industry-sponsored studies versus 57.9% for non-sponsored studies (p<0.001). Conversely, no statistically significant differences were identified for studies evaluating secondary CV prevention (0% versus 12.5%; p=0.222). Incremental costs per QALY/LYG estimates reported in industry-sponsored studies were generally more likely to fall below a hypothetical willingness-to-pay threshold of US $50,000.Conclusions:Our systematic analysis suggests that pharmaceutical industry sponsored economic evaluations of statins have generally favored the cost-effectiveness profile of their products particularly in primary CV prevention. © 2013 Catalá-López et al. Source


Pla A.B.,Fundacion Of Investigacion Del Hospital Clinico Universitario Institute Investigacion Sanitaria | Soler V.G.,Fundacion Of Investigacion Del Hospital Clinico Universitario Institute Investigacion Sanitaria | Ridao-Lopez M.,Instituto Aragones Of Ciencia Of La Salud Institute Investigacion Sanitaria Aragon | Ridao-Lopez M.,Centro Superior Of Investigacion En Salud Publica Csisp Fisabio | And 3 more authors.
Revista Espanola de Salud Publica | Year: 2013

Background: To Estimate, in the context of a Health Department of the Valencia HealthAgency, the budgetary impact ofthe widespread use of dabigatran at doses of 110 and 150 mg in patients with non-valvular atrial fibrillation (AF), regarding the current scenario with acenocoumarol the-rapy. Methods: Budget impact analysis of three scenarios of oral anticoa-gulation use inAF: a) current treatment with acenocoumarol, b) widespre-ad replacement of acenocoumarol for Dabigatran 110 mg and, c) idem at doses of 150 mg. The analysis was conducted from the perspective of the Valencia HealthAgency with a time horizon of one year (2009). The effec-tiveness and adverse effects were extrapolated from the RE-LY study, whi-le prevalence and cost data correspond tothe Health Department estimates in 2009. Results: We included 5889 patients (2.4% of the population > 18 years) diagnosed with AF, of which 3726 (63.2%) were treated with ace-nocoumarol. The total costs of each scenario were € 1,119,412 (€ 300 patient/year) for acenocoumarol, € 4,985,095 (€ 1,337 patient/year) for dabigatran 110 and € 4,981,226 (€ 1,336 patient/year) for dabigatran 150, with a budget impact of 1,037 euros/year per patient shifted from aceno-cumarol to dabigatran-150 . Conclusions: The high budgetary impact of moving to a scenario of widespread substitution of warfarin for Dabigatran supports the restriction of this therapeutic strategy to subgroups of patients at high risk or difficult control. Source

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