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Catala-Lopez F.,Centro Superior Of Investigacion En Salud Publica Csisp | Catala-Lopez F.,Fundacion Institute Investigacion En Servicios Of Salud | Genova-Maleras R.,Servicio de Informes de Salud y Estudios | Alvarez-Martin E.,Rey Juan Carlos University | Morant-Ginestar C.,Subdireccion General de Servicios de Sistemas de Informacion
Revista de Psiquiatria y Salud Mental | Year: 2013

Objective: This article analyses the burden of disease in adolescents and young people in Spain in 2008. Material and methods: A cross-sectional population-based study. We estimated disability-adjusted life years (DALYs) by sex and cause for subjects aged 15-29 years. Data sources were used: 1) National death records by age, sex and cause; 2) Population data (both in July 2008); and 3) Estimates of the disability pattern for European countries with very low mortality. Results: In 2008, adolescents and young people lost 786,479 DALYs (414,346 in males). Non-communicable diseases generated 661,282 DALYs (84% of the total). The main specific causes of disease burden were: unipolar depression (16% of DALYs), alcohol use disorders (11%), migraine (9%), bipolar disorder (7%), schizophrenia (6%), road traffic accidents (5%) and drug addiction disorders (5%). Conclusions: The burden of disease expressed in DALYs can define the loss of health in adolescents and young people. At these ages, health promotion and protection are essential to prevent the onset of disease in adulthood. © 2012 SEP y SEPB. Published by Elsevier España, S.L. All rights reserved.


Sanfelix-Genoves J.,Superior Services | Arana E.,Fundacion Institute Investigacion En Servicios Of Salud | Sanfelix-Gimeno G.,Superior Services | Peiro S.,Superior Services | And 2 more authors.
Osteoporosis International | Year: 2012

Summary Semi-automatic morphometry is highly reproducible and not time intensive; however, no study has evaluated agreement between semi-automated morphometric methods and the Genant semi-quantitative method performed as a rule by radiologists. Our study shows substantial agreement between both methods; however, semi-automatic morphometry upgrades mild deformities and overestimates the prevalence of fractures. Introduction The aim of this study was to evaluate the agreement between radiologists using the Genant semiquantitative (SQ) method and semi-automated morphometry in the diagnosis of vertebral fractures in postmenopausal women. Methods Cross-sectional study was conducted in 2006-2007 in an age-stratified population-based sample of 824 postmenopausal women over the age of 50. From this population two sets of 95 and 50 X-ray were randomly extracted to test inter-rater agreement and agreement between SQ and semiautomated morphometry, and vertebral fractures were classified according to both methods. The Genant method was used to homogenise the diagnosis of fractures. Agreement was evaluated with weighted kappa. We evaluated each vertebral body independently and also the whole vertebral column (T4- L4) classifying women into the worst grade of fracture. For the qualitative interpretation of the agreement, we used the criteria described by Landis and Koch (Biometrics 33:159- 174, 1977). Results The radiologists' agreement was 98.4% (Kappa, 0.75; 95% CI, 0.42-0.89). Agreement between semiautomated morphometry and SQ reached 97.6% and Kappa was 0.86 (95% CI, 0.66-0.94). In the whole evaluation of the spine semi-automated morphometry overestimates, the prevalence of fractures compared with the radiologists were 15.8% of women with fractures and 7.4% of women with moderate-severe fractures by semiautomated morphometry vs. 8.4% and 3.2% by the SQ method. The negative predictive value for MorphoXpress was 99% while the positive was 40%. Conclusions Semi-automated morphometry shows high reliability and a substantial agreement with the SQ approach but overestimates the prevalence of fractures. Its role in routine clinical practice is limited because positive results should be reassessed by qualitative or semiquantitative methods. © International Osteoporosis Foundation and National Osteoporosis Foundation 2011.


Lopez-Bastida J.,CIBER ISCIII | Oliva J.,University of Castilla - La Mancha | Antonanzas F.,University of La Rioja | Garcia-Altes A.,Fundacion Institute Investigacion En Servicios Of Salud | And 3 more authors.
European Journal of Health Economics | Year: 2010

The economic evaluation of health technologies has become a major tool in health policy in Europe for prioritizing the allocation of health resources and the approval of new technologies. The objective of this proposal was to develop guidelines for the economic evaluation of health technologies in Spain. A group of researchers specialized in economic evaluation of health technologies developed the document reported here, following the initiative of other countries in this framework, to provide recommendations for the standardization of methodology applicable to economic evaluation of health technologies in Spain. Recommendations appear under 17 headings or sections. In each case, the recommended requirements to be satisfied by economic evaluation of health technologies are provided. Each recommendation is followed by a commentary providing justification and compares and contrasts the proposals with other available alternatives. The economic evaluation of health technologies should have a role in assessing health technologies, providing useful information for decision making regarding their adoption, and they should be transparent and based on scientific evidence. © 2010 Springer-Verlag.


Catala-Lopez F.,Spanish Medicines and Healthcare Products Agency AEMPS | Catala-Lopez F.,Fundacion Institute Investigacion En Servicios Of Salud | Alonso-Arroyo A.,University of Valencia | Hutton B.,Ottawa Hospital Research Institute | And 2 more authors.
BMC Medicine | Year: 2014

Background: Research collaboration contributes to the advancement of knowledge by exploiting the results of scientific efforts more efficiently, but the global patterns of collaboration on meta-analysis are unknown. The purpose of this research was to describe and characterize the global collaborative patterns in meta-analyses of randomized trials published in high impact factor medical journals over the past three decades.Methods: This was a cross-sectional, social network analysis. We searched PubMed for relevant meta-analyses of randomized trials published up to December 2012. We selected meta-analyses (including at least randomized trials as primary evidence source) published in the top seven high impact factor general medical journals (according to Journal Citation Reports 2011): The New England Journal of Medicine, The Lancet, the BMJ, JAMA, Annals of Internal Medicine, Archives of Internal Medicine (now renamed JAMA Internal Medicine), and PLoS Medicine. Opinion articles, conceptual papers, narrative reviews, reviews without meta-analysis, reviews of reviews, and other study designs were excluded.Results: Overall, we included 736 meta-analyses, in which 3,178 authors, 891 institutions, and 51 countries participated. The BMJ was the journal that published the greatest number of articles (39%), followed by The Lancet (18%), JAMA (15%) and the Archives of Internal Medicine (15%). The USA, the UK, and Canada headed the absolute global productivity ranking in number of papers. The 64 authors and the 39 institutions with the highest publication rates were identified. We also found 82 clusters of authors (one group with 55 members and one group with 54 members) and 19 clusters of institutions (one major group with 76 members). The most prolific authors were mainly affiliated with the University of Oxford (UK), McMaster University (Canada), and the University of Bern (Switzerland).Conclusions: Our analysis identified networks of authors, institutions and countries publishing meta-analyses of randomized trials in high impact medical journals. This valuable information may be used to strengthen scientific capacity for collaboration and to help to promote a global agenda for future research of excellence. © 2014 Catalá-López et al.; licensee BioMed Central Ltd.


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.


Peiro S.,Centro Superior Of Investigacion En Salud Publica Csisp | Peiro S.,Fundacion Institute Investigacion En Servicios Of Salud | Artells J.J.,Fundacion Salud | Meneu R.,Fundacion Institute Investigacion En Servicios Of Salud
Gaceta Sanitaria | Year: 2011

Objectives: To identify a significant number of interventions to improve efficiency and reduce waste in the Spanish National Health System (NHS), to prioritize these interventions according to their impact, and to assess the measures recently adopted by the Spanish government. Material and methods: A meeting was held with 13 healthcare experts, structured according to a mixed method adapted from brainstorming, nominal group and Rand consensus methods. Results: The panel proposed 101 possible actions to improve the efficiency of the Spanish NHS. The 11 measures announced by the Government in the Royal Decrees-Laws 4 and 8 of 2010 increased the total number of measures assessed to 112. The panel's proposals centered on accountability and good governance, the concentration of hospital equipment and services, reduction of preventive services of little value, utilization management (including copayments, but not as a sole element), management of the incorporation of new medicines and technologies, strengthening the role of primary care, reforming workforce policies, and a series of regulatory and managerial interventions. Government measures received an intermediate overall score, but scores of their financial impact were high. Conclusions: There are several opportunities to improve the efficiency of the Spanish NHS beyond the " anticrisis" measures recently adopted by the Spanish Government. Most of these opportunities require feasible structural reforms, although their financial impact is less immediate than that of government measures. © 2010 SESPAS.


Garcia-Altes A.,Fundacion Institute Investigacion En Servicios Of Salud
Vaccine | Year: 2013

Introduction: During the twentieth century, vaccination has been one of the measures of greatest public health impact. Vaccine administration has helped reduce the burden of disease and mortality from infectious diseases. At present, there is increasing concern about infectious diseases and the ability of health systems to control them, highlighting the need for evaluation of vaccination programs. The aim of this study was to conduct a systematic review of economic evaluation studies carried out regarding Spain on vaccines. Methods: Systematic review. Search of articles in major bibliographic databases available online from January 1983 to June 2011. References identified were limited to full economic evaluations carried out regarding Spain that evaluated vaccination programs. For each of the selected papers, a set of predefined variables were extracted. Results: A total of 46 studies met inclusion criteria. The topics studied were pneumococcal vaccination, influenza vaccination, Hepatitis B vaccination and varicella vaccination. Cost-minimization analysis, perspective of society, long time horizon, use of modeling techniques, and the inclusion of direct and indirect costs were the most common methodological characteristics. The results of the studies reviewed showed, in most cases, net savings or cost-effectiveness ratios below €30,000/QALY. Conclusions: Although there has been an improvement in the methodological quality of studies, they still show shortcomings that should be addressed. From a public health perspective, it would be relevant to evaluate vaccines targeted to major health problems in Spain, including all relevant costs and benefits. In order to obtain a more efficient use of health resources, economic evaluation methods should be applied more rigorously and results should be used consistently in decision-making processes. © 2013 Elsevier Ltd.


Garcia-Altes A.,Fundacion Institute Investigacion En Servicios Of Salud | Peiro S.,Centro Superior Of Investigacion En Salud Publica Csisp
European Journal of Vascular and Endovascular Surgery | Year: 2011

Objective: Greater saphenous vein harvest for coronary and lower extremity bypass requires the longest incision of any surgical procedure. Endoscopic vein harvest allows better results in some clinical variables compared to open harvesting techniques. The objective of this study is to present the results of a systematic review of the scientific evidence about the efficiency of endoscopic saphenous vein harvest. Methods: We performed a systematic review in the bibliographical databases Pubmed, National Health Service Economic Evaluation Database, and NHS Health Technology Assessment Database. The search strategy was "endoscopic AND harvesting", in the period January 1970-December 2009. Results: We identified only 3 economic evaluation studies, 2 cost analyses with some methodological limitations, and 1 cost-utility analysis. All of them suggest lower hospital costs for endoscopic harvesting. Conclusions: Available evidence does not allow recommendations to be made based on the efficiency of endoscopic saphenous vein harvest, although it suggests lower costs for endoscopic harvesting. More scientific evidence about the long-term efficacy and the effectiveness of this technique is necessary, with studies measuring final outcomes, and carrying out complete and rigorous economic evaluations. © 2011 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.


Catala-Lopez F.,Agencia Espanola de Medicamentos y Productos Sanitarios | Garcia-Altes A.,Fundacion Institute Investigacion En Servicios Of Salud
Revista Espanola de Salud Publica | Year: 2010

Background: Economic evaluation has been promoted as a tool to guide decision-making processes regarding healthcare resources' allocation and in the adoption of healthcare technologies. We analyzed the evolution and the main characteristics of economic evaluations of healthcare interventions done during the period 1983-2008 in Spain. Methods: Observational descriptive study. We performed A systematic review in the main bibliographic databases (PubMed/MEDLINE, SCOPUS, ISI Web of Knowledge, CRD, IME, IBECS) and manually through Internet in journals and public reports. There were predefined inclusion and exclusion criteria, and a set of variables to analyze the characteristics of the selected reports. Results: In total, 477 studies fulfilled the inclusion criteria. Some of the studies characteristics were: cost-effectiveness analysis (62.5%), decision analysis techniques (34.0%), healthcare system perspective (42.1%), therapeutic interventions (70.0%) and non explicit financing (44.0%). The geographical distribution for Spanish regions of the first authors was: Catalonia (29.3%), Community of Madrid (23.7%), Andalusia (6.7%) and Region of Valencia (6.3%). A total of 50.9% of the principal authors were employed at hospital centers. The most common disease conditions were: cardiovascular diseases (15.7%), infectious and parasitic diseases (15.3%) and malignant neoplasms (13.2%). A total of 82.2 % of the reports provided recommendations for decision making. Conclusions: An increasing number of studies was observed. Identified reports combined heterogeneity in the quality of the information brought with regard to analysis methods, data sources, type of interventions, or disease conditions. It is suggested to do more efforts for improving the quantity and quality of reports in public health interventions.


Background and objective: We evaluated and quantified by meta-analysis techniques the incidence of contrast-induced nephropathy (CIN) in patients at risk undergoing computed tomography (CT). Material and methods: We conducted a systematic review of randomized controlled clinical trials designated to evaluate the nephrotoxicity related to iso-osmolar contrast media (IOCM) compared to low-osmolar contrast media (LOCM). Main electronic databases searched included PubMed/MEDLINE, EMBASE, ISI Web of Knowledge and Virtual Health Library (BVS-BIREME), as well as abstracts presented at related scientific societies meetings. Prior to data extraction, definitions of nephrotoxicity and risk population were established. Besides meta-analysis, the global agreement between CIN definitions was evaluated with Mantel-Haenszel stratified test. Results: Five studies were included with 716 randomized patients. When CIN was defined as increased serum creatinine (SCr) <25%, the relative risk (RR) was 0.71 (CI95%: 0.401.26)in favor of IOCMand when it was defined as SCr <0.5 mg/dL it showed a RR 1.48 (CI95%: 0.375.87)favoring LOCMin the four studies used this criterion. Mantel-Haenszel stratified test was χ2=2.51 (p=0.8). Conclusion: In patients with renal failure undergoing CT there is a similar risk of CIN with the administration of any contrast media studied. CIN incidence depends on the chosen criteria and is lower with the definition of SCr <0.5 mg/dL at 2472 h. No agreement was found between CIN definitions were adopted. © 2009 Elsevier España, S.L. All rights reserved.

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