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Garcia-Altes A.,Fundacion Institute Investigacion En Servicios Of Salud

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. Source

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

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. 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

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

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

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. Source

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

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. Source

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