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Biomedical subjects

F Antoñanzas

Publications and source records attributed to F Antoñanzas.

16 recordsLinked to original sources
PubMed2003

[Theoretical model of a cost-effectiveness analysis of combined enalapril-nitrendipine therapy for treating hypertension].

OBJECTIVE: Cost-effectiveness analysis of combined enalapril-nitrendipine therapy (E/N), as second-line therapy for light or moderate hypertension. DESIGN: Theoretical model of cost-effectiveness, based on the norms of hypertension treatment in primary care, the considered view of a panel of experts and the direct costs of health resources and purchase of medication. SETTING: Spanish National Health system. PARTICIPANTS: Simulation of 1000 patients with hypertension, with a time horizon of one year. INTERVENTIONS: After a prior failure of the first-line treatment with either enalapril or nitrendipine, an evaluation was made of the possibilities of increasing dosage of the first-line treatment, changing the drug or administering the E/N combination. MAIN MEASUREMENT: The likelihoods, in the primary care context, of controlling diastolic pressure, of abandonment and of using the two strategies or not were measured, as were the use of health resources in each situation, and costs of resource use and of medication. RESULTS: The cost-effectiveness quotient of the combined E/N treatment was consistently more efficient than the increase in dose or change to another drug. This was so, whether the treatment was started with enalapril (301.06 euros vs 337.97 euros and 588.42 euros) or with nitrendipine (331.5 euros vs 469.88 euros and 579.76 euros). CONCLUSIONS: Combined therapy (E/N) is, on the basis of the assumptions made in the model, an efficient therapy option. Therefore, it can be recommended for prescription.

Cost-Benefit Analysis↗
PubMed1997

Hospital care for persons with AIDS in the European Union.

This study estimates the current and future hospital resources for AIDS patients in the European Union (EU), using multinational scenario analysis (EU Concerted Action BMH1-CT-941723). In collaboration with another EU-project ('Managing the Costs of HIV Infection'), six national European studies on the utilization of hospital care for AIDS have been selected to provide the data for our analysis. The selection criteria involve recentness, quality, comparability, accessibility and representativeness. Baseline hospital resource utilization is estimated for hospital inpatient days and outpatient contracts, using a standardized approach controlling for two severity stages of AIDS (chronic stage and late stage). The epidemiological part of the study is based on standard models for backcalculating HIV incidence and projecting AIDS incidence, prevalence and mortality. In the next step, baseline resource utilization is linked to epidemiological information in a mixed prevalence and mortality-based approach. Several scenarios render different future epidemiological developments and hospital resource needs. For the year 1999, hospital bed needs of 10,000-12,700 in the EU are indicated, representing an increase of 20-60% compared to the estimated current (1995) level. The projected range for 1999 corresponds to a maximum of 0.65% of all hospital beds available in the EU. The growth in the number of outpatient hospital contacts is projected to possibly exceed that of inpatient days up to 1.82 million in 1999. Our methodology illustrates that estimation of current and future hospital care for AIDS has to be controlled for severity stages, to prevent biases. Further application of the multinational approach is demonstrated through a 'what-if' analysis of the potential impact of combination triple therapy for HIV/AIDS. Estimation of the economic impact of other diseases could as well benefit from the severity-stages approach.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Vaccination against hepatitis B virus in Spain: a cost-effectiveness analysis.

A cost-effectiveness analysis was made to determine the effectiveness of the following strategies of mass immunization with the new recombinant vaccine against the hepatitis B virus in Spain: vaccination of adolescents, newborns, both populations, and vaccination plus passive immunization of newborns of HBsAg positive mothers. Decision trees supported on Markov models with Monte Carlo simulation have been used for the calculation of costs of the disease, and a mathematical model of differential equations was used for the simulation of the potential effectiveness of vaccination. The costs considered were those associated with the vaccination and travel of subjects, diagnosis, and treatment of the disease. The results are presented as additional cost or saving per case of infection prevented. In all assumptions, results showed that the most effective strategy for mass vaccination was the combination of vaccinating all adolescents together with active and passive immunization of children born to HBsAg positive mothers.

Adolescent↗
PubMed1997

Cost effectiveness of hepatitis A virus immunisation in Spain.

The aim of this study was to evaluate, in economic terms, the recently launched hepatitis A vaccine in comparison with the use of nonspecific immune globulin, for the prevention of hepatitis A. A cost-effectiveness analysis was performed, comparing mass and selective strategies for both active and passive immunisation in children, adolescents and the high-risk adult population. Direct costs of diagnosis, treatment and immunisation, and travelling expenses of the individuals, were considered. The alternative of mass vaccination for children and adolescents cost 2679 to 6394 European Currency Units (ECU) [$US 3040 to $US 8312; 1994 values] per case prevented. Selective vaccination of high-risk individuals cost ECU205 per case prevented for young adults (those aged about 20 years) when the annual risk of contracting the disease was 0.7%, while there were net savings for all age groups when there was a 2 to 3% risk. The most sensitive variables affecting the cost of mass-vaccination strategies were incidence of hepatitis A, vaccine coverage and vaccine cost; for the various high-risk groups, these were vaccine cost, incidence of hepatitis A and costs of treating infection. Selective vaccination, depending on the age of high-risk patients [mainly travellers to endemic areas for periods of over 6 months, or those under 'precarious' conditions (e.g. backpackers, even for short periods)], is the most efficient alternative; in fact, the cost-effectiveness ratio has not been calculated, since there were net savings. For occasional travellers (as above, and those travelling for periods of under 6 months in 10 years), passive immunisation is more efficient. Selective vaccination for package-tour, short-stay travellers (infection risk around 0.3%) and strategies for mass vaccination of children and adolescents are not justified from an efficiency point of view.

Adult↗
PubMed1995

Cost-effectiveness analysis of hepatitis B vaccination strategies in Catalonia, Spain.

Hepatitis B virus (HBV) infection is an important public health problem all over the world. Vaccination is one way to prevent it, and several strategies can be used depending on endemicity, the main pattern of HBV transmission and the demographic structure of the population. In this study, an economic comparison of 3 vaccination strategies (mass adolescent vaccination, mass infant vaccination and mass combined vaccination) was performed in Catalonia, Spain. Screening pregnant women for HBV infection in combination with these strategies was also evaluated. Epidemiological models to analyse patterns of HBV infection with and without vaccination and to calculate HBV-associated costs were designed. Comparison between strategies was done using cost-effectiveness analysis from the perspective of the healthcare system. Epidemiological model results indicate that implementation of HBV vaccination could prevent as many as 104,778 new acute infections, and avoid up to 5239 chronic infections, 2096 cases of cirrhosis and 419 cases of hepatocarcinoma over a 20-year period in Catalonia. Cost-effectiveness analysis shows that mass adolescent vaccination is the most efficient strategy, with lower costs per avoided case than the other 2 strategies. When any of these strategies is complemented by screening for HBV in pregnant women, the number of avoided cases is always higher and the cost per avoided case decreases or remains unchanged.

Adolescent↗
PubMed1992

[Economic evaluation of prophylaxis with recombinant granulopoiesis stimulating factor].

BACKGROUND: The aim of the study was to economically evaluate the prophylactic use of the recombinant factor of the stimulation of granulocyte colonies (rG-CSF) for the prevention of episodes of febrile neutropenia (EFN) following antineoplasic chemotherapy. METHODS: The methods of economic evaluation used were those of cost analysis and cost-effectivity analysis. The probability of occurence of EFN was estimated by the application of the Delphi method and the costs were calculated. RESULTS: The costs of EFN for the patients with solid tumors is situated between 236,000-377,000 pesetas according to hospitalary centers. For patients with acute leukemia the value was estimated as between 391,000-667,000 pesetas. The results of the cost analysis indicate that the net cost per patient prophylactically treated is between 4,000-64,000 pesetas. The results of the cost-effectivity analysis indicate that the cost per case of no incidence of EFN is between 20,000-320,000 pesetas. CONCLUSIONS: Episodes of febrile neutropenia carry expansive hospital and antibiotic clinical treatment. The prophylactic use of new medication for patients between the first and second cycle of chemotherapy, in agreement with the estimates calculated, does not save health care costs but may improve the quality of life in these patients and permit the continuation of a therapeutic schedule without interruption which may improve the life expectancy of the patient.

Antineoplastic Agents↗
PubMed1992

[A cost-effectiveness analysis of vaccination against the hepatitis B virus].

BACKGROUND: The incidence of hepatitis B is on the increase despite immunization of people susceptible to risk populations. After the introduction of a recombinant vaccine in 1986, it has become possible to evaluate different alternatives of immunization, from the point of view of efficacy, with the aim of controlling the disease. METHODS: A cost-effectiveness analysis was performed with the use of decision trees and calculation of the cost per avoided case of infection in the different strategies evaluated, vaccination to risk groups, pubescent youth, newborns, and communicated accidental exposure. An evaluation of the different alternatives was carried out in a simple model associated to a passive and active immunization program of newborns of mothers who are carriers of HbsAg and finally, the possibility of revaccination is added. RESULTS: Costs and future profits are presented in pesetas for 1990 and rates of social discounts of 4% and 7% are applied actualizing the same. For the prevalence estimated in the bibliography consulted, the cost per avoided case oscillated between 115,000 and 310,000 ptas in the most numerous risk groups (those living with carriers and ADVP) with lower covering; in massive immunization of pubescent youth the costs are from 30,000 to 130,000 ptas; the costs for newborns is of about 400,000 ptas; and accidental exposure rises to 500,000 ptas per avoided case. CONCLUSIONS: In vaccination versus the hepatitis B virus systematic vaccination of adolescents is proposed as most efficient and with the aim of disease control a program of passive and active immunization of newborns of carrier mothers should be included.

Cost-Benefit Analysis↗
PubMedDate not supplied

[Health care resources utilization in HIV-infected patients: creation of a data base and cost results].

OBJECTIVES: To make and validate a data base that allows to collect information about clinical characteristics and use of health care services by HIV-infected patients. An additional purpose is to obtain some data about costs of health care services utilization. METHODS: We have designed an informatic data base that includes: demographic data, clinical data and health care services utilization during the follow up. One hundred and nine patients were selected from 5 different hospitals in Spain and they were followed for 6 months (from January to June 1997). Analytic accounting of one hospital and official tariffs were used to calculate costs of the health care services. RESULTS: The informatic data base designed is useful and appropriate to collect the information of these patients. The annual average cost is 2.5 millions dollars, ranging from 1 million dollars for asymptomatic patients to 3.8 millions for AIDS patients. The comparison of our results with previous studies shows an increased cost of asymptomatic patients. CONCLUSIONS: These results give a preliminary information about health care services utilization by HIV-infected patients and confirm the possibility of using the designed instrument in the future. Since HIV-infection presents an uncertain evolution and a variable prognosis, to implant a tracking system is a necessary requirement in order to obtain a fast and accurate information system about the evolution of clinical variables and their economic repercussions.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[Primary care: decentralization and efficiency].

OBJECTIVE: The purpose of this study was to evaluate whether the productive behavior of health centers in autonomous communities with competence in health is more efficient than that among centers belonging to Spanish public health system (INSALUD). METHODS: The technical efficiency of 66 health centers in Alava, Navarre and La Rioja was analyzed. Centers in autonomous communities that in 1997 had been granted complete authority from the central government to manage their healthcare services were compared with centers whose administration, in the same year, was still in the hands of INSALUD. The method used to measure and quantify the efficiency of these centers was data envelopment analysis. RESULTS: Nonparametric contrast of the health centers' mean efficiency rates revealed no significant differences in the (in)efficiency of centers from La Rioja, Navarre and Alava. CONCLUSIONS: The results obtained from the model of efficiency measurement used did not indicate that decentralization improves the productive efficiency of primary care centers.

Efficiency, Organizational↗
PubMedDate not supplied

[The cost of type 2 diabetes in Spain: the CODE-2 study].

OBJECTIVE: To estimate the cost of providing health care to patients with type 2 diabetes, by differentiating costs of the disease, costs of complications, and other unrelated health costs. METHODS: Data on resource use were retrospectively collected from medical records and personal interviews in 29 primary health care centers in Spain. Patients were randomly selected from each center's diabetes registry. RESULTS: We evaluated 1004 patients (561 women) with a mean age of 67.42 years and a mean disease duration of 10.07 years. A total of 50.9% had no complications, 17.7% had macrovascular complications only, 19.5% had microvascular complications only and 11.9% presented both types of complication. The annual health cost per patient was 1305.15 euros. Of this cost, 28.6% (373.27 euros) was directly related to diabetes control, 30.51% (398.20 euros) was related to complications of the disease, and 40.89% (533.68 euros) was unrelated. The mean cost of patients with no complications was 883 euros compared with 1403 euros for those with microvascular complications, 2022 euros for those with macrovascular complications and 2133 euros for patients with both types of complication. CONCLUSIONS: Because of the high cost of treating type 2 diabetes and its complications, preventive measures should be implemented and control of the disease should be improved to reduce the costs associated with chronic complications.

Aged↗
PubMedDate not supplied

[Economic evaluation of pharmacotherapies for smoking cessation].

INTRODUCTION: Public policies for smoking cessation are mainly based on advice from the primary care physician and group therapy. Several pharmacological treatments to reduce tobacco addiction are currently available. One of these treatments, bupropion, has remarkable efficacy (30% over 1 year) compared with nicotine replacement therapies (chewing gum 8%, patches 17% over 1 year). The objective of this study was to assess the efficiency of three smoking cessation strategies based on pharmacotherapies in Spain. MATERIAL AND METHODS: The current situation of methods for smoking cessation in Spain includes a mixture of primary care physician advice, group therapy and willpower, combined with the use of drugs in a small proportion of individuals. This situation was compared with three scenarios in which the use of the available pharmacotherapies was increased (by up to 10%) for 1 year. A cost-effectiveness evaluation was used to calculate the cost per death prevented and per year of life saved in each scenario. The analysis used a time horizon of 20 years and was based on an adaptation of the HECOS model, sponsored by WHO-Euro, which enables comparison of distinct pharmacotherapy interventions. Epidemiological data were based on the National Health Survey (1997) and the National Institute of Statistics (1999). RESULTS: The cost-effectiveness ratio of bupropion at 5 years was 70,939 euros per death prevented and was 37,305 euros per year of life saved. When the time horizon was increased to 20 years, these figures became net savings of 28,166 and 3,265 euros, respectively. The cost-effectiveness ratios for both nicotine gums and patches were higher than that for bupropion: 171,834 euros per death prevented at 5 years and 90,362 euros per year of life saved for patches and 513,004 euros per death prevented and 269,772 euros per year of life saved at 5 years. Furthermore, bupropion treatment for 1 year would prevent a greater number of deaths than the alternative strategies (approximately 3,000 deaths in a time horizon of 20 years) due to the decrease in the number of smokers. CONCLUSIONS: The cost of some tobacco cessation methods, such as primary care physician advice and group therapy, is low but their efficacy is also low. New drug treatments increase costs and also achieve higher efficacy rates. When assessing interventions and their costs economic evaluation shows that in the long run greater use of bupropion generates net savings in tobacco-related health costs.

Administration, Cutaneous↗