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Gómez Maldonado L, de Mora-Figueroa R, López-Angarita A, Maravilla-Herrera P, Merino M. Cost of Patients with Alzheimer's Disease in Spain According to Disease Severity. Pharmacoecon Open 2024; 8:103-114. [PMID: 37966711 PMCID: PMC10781927 DOI: 10.1007/s41669-023-00451-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/29/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND Alzheimer's disease (AD) has been associated with great healthcare and non-healthcare resource consumption. The aim of this study was to estimate the burden of AD in Spain according to disease severity from a societal perspective. METHODS A self-administered questionnaire was designed by the researchers and completed by the informal caregivers of patients with AD, reporting data on themselves as caregivers and on the AD patients for whom they care. The patients' sociodemographic and clinical data, their healthcare and non-healthcare resource consumption in the previous 12 months, and the impact of the disease on labor productivity were compiled. Data collected on informal caregivers included sociodemographic data and the impact of caring for a person with AD on their quality of life and labor productivity. Costs were estimated by multiplying the number of consumed resources by their unit prices. The cost of informal care was assessed using the proxy good method, and labor productivity losses were estimated using the human capital method. Costs were estimated by disease severity and are presented per patient per year in 2021 euros (€). RESULTS The study sample comprised 171 patients with AD aged 79.1 ± 7.4 years; 68.8% were female, time from diagnosis was 5.8 ± 4.1 years, diagnosis delay was 1.8 ± 2.3 years, and the mean Cumulative Illness Rating Scale-Geriatric (CIRS-G) total was score 8.2 ± 6.0. According to disease severity, 14% had mild cognitive impairment or mild AD, 43.9% moderate AD, and 42.1% severe AD. The average annual cost per patient was €42,336.4 in the most conservative scenario. The greatest proportion of this cost was attributed to direct non-healthcare costs (86%, €36,364.8), followed by direct healthcare costs (8.6%, €3647.1), social care costs (4.6%, €1957.1), and labor productivity losses (less than 1%, €367.4). Informal care was the highest cost item, representing 80% of direct non-healthcare costs and 69% of the total cost. The total direct non-healthcare cost and total cost were significantly higher in moderate to severe disease severities, compared to milder disease severity. CONCLUSIONS AD poses a substantial burden on informal caregivers, the national healthcare system, and society at large. Early diagnosis and treatment to prevent disease progression could reduce this economic impact.
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Affiliation(s)
| | | | | | | | - María Merino
- Vivactis Weber, C/ Moreto, 17-5º dcha, 28014, Madrid, Spain.
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Merino M, Maravilla-Herrera P, Lorenzo TM, Arance JA, Bobes J, Corrales M, Guzmán F, Morales M, Mur C. The socioeconomic burden of adult attention-deficit/hyperactivity disorder in Spain. Glob Reg Health Technol Assess 2024; 11:82-93. [PMID: 38601072 PMCID: PMC11005448 DOI: 10.33393/grhta.2024.2697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 03/15/2024] [Indexed: 04/12/2024] Open
Abstract
Introduction The symptoms of attention-deficit/hyperactivity disorder (ADHD) in adults highly interfere with function in multiple dimensions, increasing the economic burden associated with ADHD. The aim of this study was to explore the impact of ADHD in Spanish adults and estimate the associated economic burden within the healthcare, social, economic, and legal domains. Methods An economic model was developed from a social perspective using a bottom-up approach, based on the scientific literature and a multidisciplinary expert group. Results The cost incurred per diagnosed adult patient with ADHD included an annual cost of €15,652 and a one-time cost of €7,893 (3,035 M€ and 1,531 M€ for Spain, respectively). Regarding the annual cost, 50% was attributed to costs within the economic domain, of which 53% were work-absenteeism-related. Moreover, 28% was attributed to costs within the social domain, of which 74% were substance-abuse-related. Regarding the one-time cost, 52% was attributed to costs within the healthcare domain, of which approximately 50% were hospitalization-related costs. Moreover, 42% was attributed to costs within the legal domain, of which 62% were imprisonment-related costs. Conclusions This is the first report on the socioeconomic burden of ADHD in Spanish adults, shedding light on the large burden that adult ADHD poses on the healthcare system and society at large, as symptoms have been shown to impact almost every aspect of life. This is particularly important for undiagnosed/untreated patients with ADHD in Spain, as appropriate treatments have shown positive results in these areas and may reduce its associated socioeconomic burden.
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Affiliation(s)
| | | | | | | | - Julio Bobes
- Department of Medicine, Oviedo University, Oviedo - Spain
- Network Biomedical Research Centre on Mental Health—CIBERSAM, Oviedo - Spain
| | - Montse Corrales
- Department of Psychiatry, Vall d’Hebron University Hospital, Barcelona - Spain
| | | | - María Morales
- Department of Psychiatry, Puerta de Hierro University Hospital, Majadahonda - Spain
| | - Carlos Mur
- Department of Psychiatry, Hospital Nostra Senyora de Meritxell, Escaldes-Engordany - Andorra
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Marcos-Vidal JM, González R, Merino M, Higuera E, García C. Sedation for Patients with Sepsis: Towards a Personalised Approach. J Pers Med 2023; 13:1641. [PMID: 38138868 PMCID: PMC10744994 DOI: 10.3390/jpm13121641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/17/2023] [Accepted: 11/21/2023] [Indexed: 12/24/2023] Open
Abstract
This article looks at the challenges of sedoanalgesia for sepsis patients, and argues for a personalised approach. Sedation is a necessary part of treatment for patients in intensive care to reduce stress and anxiety and improve long-term prognoses. Sepsis patients present particular difficulties as they are at increased risk of a wide range of complications, such as multiple organ failure, neurological dysfunction, septic shock, ARDS, abdominal compartment syndrome, vasoplegic syndrome, and myocardial dysfunction. The development of any one of these complications can cause the patient's rapid deterioration, and each has distinct implications in terms of appropriate and safe forms of sedation. In this way, the present article reviews the sedative and analgesic drugs commonly used in the ICU and, placing special emphasis on their strategic administration in sepsis patients, develops a set of proposals for sedoanalgesia aimed at improving outcomes for this group of patients. These proposals represent a move away from simplistic approaches like avoiding benzodiazepines to more "objective-guided sedation" that accounts for a patient's principal pathology, as well as any comorbidities, and takes full advantage of the therapeutic arsenal currently available to achieve personalised, patient-centred treatment goals.
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Affiliation(s)
- José Miguel Marcos-Vidal
- Department of Anesthesiology and Critical Care, Universitary Hospital of Leon, 24071 Leon, Spain; (R.G.); (M.M.); (E.H.); (C.G.)
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Maravilla-Herrera P, Merino M, Alfonso Zamora S, Balea Filgueiras J, Carrascosa Carrillo JM, Delgado Sánchez O, Dolz Sinisterra F, García-Ruiz A, Herranz Pinto P, Manfredi A, Martínez Olmos J, Morales de los Ríos Luna P, Puig L, Ros S, Hidalgo-Vega Á. The social value of a PASI 90 or PASI 100 response in patients with moderate-to-severe plaque psoriasis in Spain. Front Public Health 2023; 11:1000776. [PMID: 36778548 PMCID: PMC9909187 DOI: 10.3389/fpubh.2023.1000776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 01/09/2023] [Indexed: 01/27/2023] Open
Abstract
Introduction Psoriasis is a chronic disease involving the skin, which significantly impacts the quality of life. Disease severity and treatment efficacy (i.e., response) are assessed through the Psoriasis Area and Severity Index (PASI). A PASI 75 response, i.e., an improvement of at least 75% with respect to the baseline PASI score, has traditionally been used as a therapeutic benchmark in clinical trials. Therapeutic advances have made PASI 90 or PASI 100 responses possible in most patients treated with some biologics. A greater response may generate social value beyond clinical outcomes that would benefit both patients and society. Methods A 1-year economic model was applied to estimate the impact of having a PASI 75, PASI 90, or PASI 100 response in four areas of analysis (quality of life, activities of daily living, work productivity, and out-of-pocket expenditures) and the social value of having a PASI 90 or PASI 100 response in comparison with a PASI 75 response. A mixed-methods approach based on the scientific literature, a focus group with patient, and an advisory committee with psoriasis stakeholders was used. The model included three different scenarios: having a PASI 90 vs a PASI 75 response; a PASI 100 vs a PASI 90 response; and a PASI 100 vs a PASI 75 response. A sensitivity analysis was included. Results The annual economic impact per patient with moderate-to-severe plaque psoriasis having a PASI 75 response was estimated at Ł 6,139, mainly related to labour productivity losses and quality of life reductions. Having a PASI 90 or a PASI 100 response would reduce this impact to €3,956 or €1,353, respectively. Accordingly, the social value of having a PASI 90 instead of a PASI 75 response was estimated at €2,183, and €4,786 with a PASI 100 response. Discussion A PASI 90 or PASI 100 response would have a lower economic impact and a greater social value than a PASI 75 response for patients with moderate-to-severe plaque psoriasis.
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Affiliation(s)
| | - María Merino
- Department of Health Outcomes Research, Weber, Madrid, Spain,*Correspondence: María Merino ✉
| | - Santiago Alfonso Zamora
- Department of Management, Psoriasis and Psoriatic Arthritis Patient and Family Association (Acción Psoriasis), Barcelona, Spain
| | | | | | - Olga Delgado Sánchez
- Department of Management, Spanish Society of Hospital Pharmacy (SEFH), Madrid, Spain,Department of Pharmacy, Son Espases University Hospital, Illes Balears, Spain
| | | | - Antonio García-Ruiz
- Health Economics and Rational Use of Medicines, Department of Pharmacology and Clinical Therapeutics, Biomedical Research Institute of Malaga (IBIMA), University of Malaga, Malaga, Spain
| | | | - Antonio Manfredi
- Department of Management, Psoriasis and Psoriatic Arthritis Patient and Family Association (Acción Psoriasis), Barcelona, Spain
| | | | | | - Lluís Puig
- Department of Dermatology, Santa Creu i Sant Pau Hospital, Barcelona, Spain,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sandra Ros
- Psychologist, Departments of Dermatology and Rheumatology, and Cardiac Transplant Unit, Santa Creu i Sant Pau Hospital, Barcelona, Spain
| | - Álvaro Hidalgo-Vega
- Department of Economic Analysis and Finances, University of Castilla-La Mancha, Toledo, Spain,Fundación Weber, Madrid, Spain
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Yubero A, Barquín A, Estévez P, Pajares B, Sánchez L, Reche P, Alarcón J, Calzas J, Gaba L, Fuentes J, Santaballa A, Salvador C, Manso L, Herrero A, Taus Á, Márquez R, Madani J, Merino M, Marquina G, Casado V, Constenla M, Gutiérrez M, Dosil A, González-Martín A. Rucaparib in recurrent ovarian cancer: real-world experience from the rucaparib early access programme in Spain – A GEICO study. BMC Cancer 2022; 22:1150. [DOI: 10.1186/s12885-022-10191-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 10/17/2022] [Indexed: 11/09/2022] Open
Abstract
Abstract
Background:
Rucaparib is a poly(ADP-ribose) polymerase inhibitor approved in Europe as maintenance therapy for recurrent platinum-sensitive (Pt-S) ovarian cancer (OC). The Rucaparib Access Programme (RAP) was designed to provide early access to rucaparib for the above-mentioned indication, as well as for patients with BRCA-mutated Pt-S or platinum-resistant (Pt-R) OC and no therapeutic alternatives.
Methods:
In this observational, retrospective study we analysed the efficacy and safety of rucaparib within the RAP in Spain. Hospitals associated with the Spanish Ovarian Cancer Research Group (GEICO) recruited patients with high-grade epithelial ovarian, fallopian tube, or primary peritoneal cancer treated with rucaparib 600 mg twice daily as maintenance or treatment (Pt-S/Pt-R) in the RAP. Baseline characteristics, efficacy, and safety data were collected.
Results:
Between July 2020 and February 2021, 51 patients treated in 22 hospitals in the RAP were included in the study. Eighteen patients with a median of 3 (range, 1–6) prior treatment lines received rucaparib as maintenance; median progression-free survival (PFS) for this group was 9.1 months (95% confidence interval [CI], 4.2–11.6 months). Among 33 patients (median 5 [range, 1–9] prior treatment lines) who received rucaparib as treatment, 7 and 26 patients had Pt-S and Pt-R disease, respectively. Median PFS was 10.6 months (95% CI, 2.5 months-not reached) in the Pt-S group and 2.2 months (95% CI, 1.1–3.2 months) in the Pt-R group. Grade ≥ 3 treatment-emergent adverse events were reported in 39% of all patients, the most common being anaemia (12% and 15% in the maintenance and treatment groups, respectively). At data cut-off, 5 patients remained on treatment.
Conclusion
Efficacy results in these heavily pre-treated patients were similar to those from previous trials. The safety profile of rucaparib in real life was predictable and manageable.
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Merino M, Ivanova Y, Maravilla-Herrera P, Barragán B, Sierra J, Peñuelas-Saiz Á, Hidalgo-Vega Á. Optimising the management of patients with multiple myeloma in Spain: A measurement of the social return on investment. Eur J Cancer Care (Engl) 2022; 31:e13706. [PMID: 36177961 DOI: 10.1111/ecc.13706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 09/05/2022] [Accepted: 09/07/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to reach a consensus on a set of proposals to optimise the disease management of Multiple myeloma (MM) within the Spanish National Health System (SNHS) and to apply the Social Return on Investment (SROI) method to estimate their social impact. METHODS A Multidisciplinary Working Team (MWT) including MM main stakeholders was organised. A survey was administered to gather information from patients regarding the impact of MM on different life domains. A forecast-type SROI analysis, with a 1-year timeframe, was applied. RESULTS Fifteen proposals were selected, to optimise MM management, including actions for early diagnosis, psychological support, improvement of information for patients and quick access to palliative care, among others. The implementation of these proposals would benefit patients, their informal caregivers and the SNHS. The investment required would amount to 10.32 million euros with a social return of 43.31 million euros: 4.2 euros for each euro invested. According to the sensitivity analysis, this ratio could range from 3.38 to 5.20 euros from the worst to the best-case scenario. CONCLUSIONS The current management of MM could be optimised by implementing a set of proposals that would most likely result in an overall positive social return.
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Affiliation(s)
| | | | | | - Begoña Barragán
- AEAL, Asociación Española de Afectados por Linfoma, Mieloma y Leucemia, Madrid, Spain
| | - Jordi Sierra
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Ángeles Peñuelas-Saiz
- Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Álvaro Hidalgo-Vega
- Fundación Weber, Madrid, Spain.,Universidad de Castilla-La Mancha, Toledo, Spain
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7
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Merino M, Martín Lorenzo T, Maravilla-Herrera P, Ancochea J, Gómez Sáenz JT, Hass N, Molina J, Peces-Barba G, Trapero-Bertran M, Trigueros Carrero JA, Hidalgo-Vega Á. A Social Return on Investment Analysis of Improving the Management of Chronic Obstructive Pulmonary Disease Within the Spanish National Healthcare System. Int J Chron Obstruct Pulmon Dis 2022; 17:1431-1442. [PMID: 35761956 PMCID: PMC9233487 DOI: 10.2147/copd.s361700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/02/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To define a set of proposals that would improve the current management of chronic obstructive pulmonary disease (COPD) within the Spanish National Healthcare System (SNHS) from a comprehensive multidisciplinary perspective and to assess the impact of its implementation from clinical, healthcare, economic, and social perspectives. Patients and Methods A group of 20 stakeholders related to COPD (healthcare professionals, patients, and informal caregivers, among others) participated in an online Delphi process to agree on a set of 15 proposals that would improve the current management of COPD within the SNHS in four areas: diagnosis, risk stratification, management of exacerbations, and management of stable COPD. A one-year forecast-type social return on investment (SROI) analysis was used to estimate the impact that implementing the set of proposals would have in relation to the investment required. A sensitivity analysis was used to test the strength of the model when varying assumption-based data-points. Results The hypothetical implementation of the complete set of 15 proposals would require a €668 million investment and would generate a €2079 million social impact concerning savings for the SNHS and quality of life improvements for patients and their informal caregivers, among others. Accordingly, for every euro invested in the set of proposals, a social return of €3.11 would be generated (€2.71 in the worst-case scenario and €3.62 in the best-case scenario) of both tangible (32.56%) and intangible nature (67.44%). Conclusion Altogether, implementing this set of 15 proposals would generate a positive social impact, threefold the required investment. The results may inform decisions relative to healthcare policy and practice regarding COPD management within the SNHS, further contributing to reduce the large burden of COPD.
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Affiliation(s)
| | | | | | - Julio Ancochea
- Pulmonology Service, La Princesa University Hospital - IIS-Princesa, Madrid, Spain
- Faculty of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- Respiratory Diseases Networking Biomedical Research Centre - CIBERES, Carlos III Institute of Health - ISCIII, Madrid, Spain
| | | | - Nicole Hass
- Chronic Obstructive Pulmonary Disease Patient and Family Association - APEPOC, Pontevedra, Spain
| | - Jesús Molina
- Francia Health Centre, Fuenlabrada, Madrid, Spain
| | - Germán Peces-Barba
- Pulmonology Service, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Marta Trapero-Bertran
- Basic Sciences Department, University Institute for Patient Care, Universitat Internacional de Catalunya, Barcelona, Spain
| | | | - Álvaro Hidalgo-Vega
- Department of Economic Analysis and Finances, Universidad de Castilla-La Mancha, Toledo, Spain
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Urrechaga E, Valladares C, Martinez A, Merino M, Muguerza G. T143 The effect of thyroid status on HbA1c. Clin Chim Acta 2022. [DOI: 10.1016/j.cca.2022.04.622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Urrechaga E, Martinez A, Merino M, Muguerza G, Perez I. T220 Sigma metrics for evaluating the performance of complete blood counts. Clin Chim Acta 2022. [DOI: 10.1016/j.cca.2022.04.708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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10
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Urrechaga E, Perez I, Martinez A, Merino M, Muguerza G. T218 Reticulocyte hemoglobin (CHR) by Mindray BC 6800 plus for the assessment of iron deficient erythropoiesis in rheumatologic disorders. Clin Chim Acta 2022. [DOI: 10.1016/j.cca.2022.04.706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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11
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Soto I, Mateo J, García-Diego DA, Gil B, Ruiz-Beato E, Ivanova Y, Martín Lorenzo T, Maravilla-Herrera P, Hidalgo-Vega Á, Merino M. The impact of improving haemophilia A management within the Spanish National Healthcare System: a social return on investment analysis. BMC Health Serv Res 2022; 22:115. [PMID: 35081958 PMCID: PMC8793183 DOI: 10.1186/s12913-021-07447-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 12/22/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Haemophilia A (HA) has been associated with poor health-related quality of life and a large economic burden, accentuated by severity, arthropathy, and inhibitors. To meet global standards of care, the management of HA should align with the principles of care outlined by the World Federation of Haemophilia. The aims of the present study were to establish a set of proposals to improve HA management within the Spanish National Health System (SNHS) and to estimate the impact its hypothetical implementation would generate from a clinical, healthcare, economic, and social perspective. METHODS A multidisciplinary group of experts agreed on a set of 15 proposals to improve HA management within the SNHS. Thereafter, a forecast-type Social Return on Investment analysis was carried out to estimate the impact of implementing this set of proposals within the SNHS over a one-year timeframe, in relation to the required investment. RESULTS This study estimated that the implementation of the complete set of 15 proposals would require a total investment of 2.34 M€ and have a total impact of 14.60 M€. Accordingly, every euro invested in the complete set of 15 proposals would yield a social return of €6.23 (€3.37 in the worst-case scenario and €9.69 in the best-case scenario) of both tangible and intangible nature in similar proportions (45.71 and 54.29%, respectively). CONCLUSIONS These results can be used to inform policy and practice such that interventions that may potentially improve current public health challenges associated with the management of HA may be implemented.
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Affiliation(s)
| | - José Mateo
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | | | - Yoana Ivanova
- Weber, Calle Moreto, 17, 5 Dcha, 28014 Madrid, Spain
| | | | | | | | - María Merino
- Weber, Calle Moreto, 17, 5 Dcha, 28014 Madrid, Spain
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Córdoba KM, Serrano-Mendioroz I, Jericó D, Merino M, Jiang L, Sampedro A, Alegre M, Corrales F, Garrido MJ, Martini PGV, Lanciego JL, Prieto J, Berraondo P, Fontanellas A. Recombinant porphobilinogen deaminase targeted to the liver corrects enzymopenia in a mouse model of acute intermittent porphyria. Sci Transl Med 2022; 14:eabc0700. [PMID: 35020410 DOI: 10.1126/scitranslmed.abc0700] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Karol M Córdoba
- Hepatology Program, Center for Applied Medical Research (CIMA), University of Navarra, 31008 Pamplona, Spain.,Navarra Institute for Health Research (IDISNA), 31008 Pamplona, Spain
| | - Irantzu Serrano-Mendioroz
- Hepatology Program, Center for Applied Medical Research (CIMA), University of Navarra, 31008 Pamplona, Spain.,Navarra Institute for Health Research (IDISNA), 31008 Pamplona, Spain
| | - Daniel Jericó
- Hepatology Program, Center for Applied Medical Research (CIMA), University of Navarra, 31008 Pamplona, Spain.,Navarra Institute for Health Research (IDISNA), 31008 Pamplona, Spain
| | - María Merino
- Department of Pharmacy and Pharmaceutical Technology, School of Pharmacy, University of Navarra, 31008 Pamplona, Spain
| | - Lei Jiang
- Moderna Inc., Cambridge, MA 02139, USA
| | - Ana Sampedro
- Hepatology Program, Center for Applied Medical Research (CIMA), University of Navarra, 31008 Pamplona, Spain.,Navarra Institute for Health Research (IDISNA), 31008 Pamplona, Spain
| | - Manuel Alegre
- Neurophysiology Laboratory, Neuroscience Area, CIMA and Clínica Universitaria, University of Navarra, 31008 Pamplona, Spain
| | - Fernando Corrales
- Proteomics Unit, Centro Nacional de Biotecnología (CSIC), 28049 Madrid, Spain
| | - María J Garrido
- Department of Pharmacy and Pharmaceutical Technology, School of Pharmacy, University of Navarra, 31008 Pamplona, Spain
| | | | - José Luis Lanciego
- Navarra Institute for Health Research (IDISNA), 31008 Pamplona, Spain.,Neurosciences Department, CIMA-University of Navarra, 31008 Pamplona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNed), Instituto de Salud Carlos III, 28031 Madrid, Spain
| | - Jesús Prieto
- Hepatology Program, Center for Applied Medical Research (CIMA), University of Navarra, 31008 Pamplona, Spain
| | - Pedro Berraondo
- Navarra Institute for Health Research (IDISNA), 31008 Pamplona, Spain.,Program of Immunology and Immunotherapy, Cima Universidad de Navarra, 31008 Pamplona, Spain.,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Antonio Fontanellas
- Hepatology Program, Center for Applied Medical Research (CIMA), University of Navarra, 31008 Pamplona, Spain.,Navarra Institute for Health Research (IDISNA), 31008 Pamplona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, 28029 Madrid, Spain
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Merino M, Ivanova Y, Martín Lorenzo T, Hidalgo-Vega Á. Improving rheumatoid arthritis management within the Spanish National Health System: a social return on investment study. Clin Exp Rheumatol 2022; 40:104-111. [PMID: 33635230 DOI: 10.55563/clinexprheumatol/mh38sy] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 01/25/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To define a set of proposals that would improve the current management of patients with rheumatoid arthritis (RA) within the Spanish National Health System (SNHS), and to estimate the impact of their implementation from a social perspective. METHODS A one-year forecast-type Social Return on Investment (SROI) analysis was performed on the basis of information collected from a scientific literature review, official data, and multiple stakeholders regarding RA. A sub-analysis was performed within the areas of diagnosis, early RA (<2 years from diagnosis), and established RA (≥2 years from diagnosis). RESULTS Stakeholders agreed on a set of 22 proposals, which included incorporating specialised nursing, addressing adherence issues, providing psychological support, or promoting the role of patient associations, among others. Their implementation would require an investment of 289 million euros and yield a social return of 913 million euros, i.e. a social return of 3.16 euros per euro invested (2.92 euros in the worst-case scenario and 3.40 euros in the best-case scenario). The greatest social return relative to investment and the greatest attributed to intangible aspects were observed within the area of early RA. CONCLUSIONS Evidence-based recommendations for the management of RA are aspirational. Nevertheless, the present study estimated that the implementation of the set of proposals would result in a positive impact relative to the investment needed to implement them. The results may guide management decisions to reduce the burden associated with RA, and help bridge the gap between evidence-based recommendations and routine clinical practice.
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Affiliation(s)
| | - Yoana Ivanova
- Pharmacoeconomics and Market Access, Weber, Madrid, Spain
| | | | - Álvaro Hidalgo-Vega
- University of Castilla-La Mancha, Economic Analysis and Finance Department, Toledo, Spain
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Ciruelos E, Salvador Bofill F, Perello Martorell A, Conejo EA, González-Farré X, Palacios-Ozores P, Merino M, Villagrasa P, Navarro EV, Pascual T, Prat A, Pernas Simon S. 73TiP SOLTI1710 PROMETEO II: Palbociclib in combination with letrozole in hormone receptor-positive (HR+)/HER2-negative residual disease after standard neoadjuvant chemotherapy (NAC). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.03.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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15
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Merino M, Lozano T, Casares N, Lana H, Troconiz IF, Ten Hagen TLM, Kochan G, Berraondo P, Zalba S, Garrido MJ. Dual activity of PD-L1 targeted Doxorubicin immunoliposomes promoted an enhanced efficacy of the antitumor immune response in melanoma murine model. J Nanobiotechnology 2021; 19:102. [PMID: 33849551 PMCID: PMC8042980 DOI: 10.1186/s12951-021-00846-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/27/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The immunomodulation of the antitumor response driven by immunocheckpoint inhibitors (ICIs) such as PD-L1 (Programmed Death Ligand-1) monoclonal antibody (α-PD-L1) have shown relevant clinical outcomes in a subset of patients. This fact has led to the search for rational combinations with other therapeutic agents such as Doxorubicin (Dox), which cytotoxicity involves an immune activation that may enhance ICI response. Therefore, this study aims to evaluate the combination of chemotherapy and ICI by developing Dox Immunoliposomes functionalized with monovalent-variable fragments (Fab') of α-PD-L1. RESULTS Immunoliposomes were assayed in vitro and in vivo in a B16 OVA melanoma murine cell line over-expressing PD-L1. Here, immune system activation in tumor, spleen and lymph nodes, together with the antitumor efficacy were evaluated. Results showed that immunoliposomes bound specifically to PD-L1+ cells, yielding higher cell interaction and Dox internalization, and decreasing up to 30-fold the IC50, compared to conventional liposomes. This mechanism supported a higher in vivo response. Indeed, immunoliposomes promoted full tumor regression in 20% of mice and increased in 1 month the survival rate. This formulation was the only treatment able to induce significant (p < 0.01) increase of activated tumor specific cytotoxic T lymphocytes at the tumor site. CONCLUSION PD-L1 targeted liposomes encapsulating Dox have proved to be a rational combination able to enhance the modulation of the immune system by blocking PD-L1 and selectively internalizing Dox, thus successfully providing a dual activity offered by both, chemo and immune therapeutic strategies.
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Affiliation(s)
- María Merino
- Department of Pharmaceutical Technology and Chemistry, School of Pharmacy, University of Navarra, 31008, Pamplona, Navarra, Spain
| | - Teresa Lozano
- Program of Immunology and Immunotherapy, CIMA-Universidad de Navarra, Pamplona, Spain.,Navarra Institute for Health Research (IdisNA), Pamplona, Spain
| | - Noelia Casares
- Program of Immunology and Immunotherapy, CIMA-Universidad de Navarra, Pamplona, Spain.,Navarra Institute for Health Research (IdisNA), Pamplona, Spain
| | - Hugo Lana
- Department of Pharmaceutical Technology and Chemistry, School of Pharmacy, University of Navarra, 31008, Pamplona, Navarra, Spain
| | - Iñaki F Troconiz
- Department of Pharmaceutical Technology and Chemistry, School of Pharmacy, University of Navarra, 31008, Pamplona, Navarra, Spain.,Navarra Institute for Health Research (IdisNA), Pamplona, Spain
| | - Timo L M Ten Hagen
- Laboratory of Experimental Oncology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Grazyna Kochan
- Navarra Institute for Health Research (IdisNA), Pamplona, Spain.,Department of Oncology, Navarrabiomed-Biomedical Research Centre, Pamplona, Spain
| | - Pedro Berraondo
- Program of Immunology and Immunotherapy, CIMA-Universidad de Navarra, Pamplona, Spain.,Navarra Institute for Health Research (IdisNA), Pamplona, Spain
| | - Sara Zalba
- Department of Pharmaceutical Technology and Chemistry, School of Pharmacy, University of Navarra, 31008, Pamplona, Navarra, Spain. .,Navarra Institute for Health Research (IdisNA), Pamplona, Spain.
| | - María J Garrido
- Department of Pharmaceutical Technology and Chemistry, School of Pharmacy, University of Navarra, 31008, Pamplona, Navarra, Spain. .,Navarra Institute for Health Research (IdisNA), Pamplona, Spain.
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Merino M, Braçe O, González-Domínguez A, Hidalgo-Vega Á, Garrido-Cumbrera M, Gratacós J. Social economic costs of ankylosing spondylitis in Spain. Clin Exp Rheumatol 2021. [DOI: 10.55563/clinexprheumatol/lycdc8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | - Olta Braçe
- Health & Territory Research (HTR), Universidad de Sevilla, Spain
| | | | - Álvaro Hidalgo-Vega
- Universidad de Castilla-La Mancha, Toledo, and Fundación Weber, Madrid, Spain
| | - Marco Garrido-Cumbrera
- Health & Territory Research (HTR), Universidad de Sevilla, and Spanish Federation of Spondyloarthritis Associations (CEADE), Fuenlabrada, Spain
| | - Jordi Gratacós
- Rheumatology Department, University Hospital Parc Taulí, 13PT Research Institute (UAB), Sabadell, Barcelona; Medicine Department (UAB), Barcelona, Spain
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Merino M, Colomé E, Esposito F, Beato C, Araújo A, de Miguel Y, Gemas V, Font C. PO-63 Empowering cancer patients for non-pharmacological primary prevention and early recognition of cancer-associated thrombosis (CAT): the EMPATIC-CP survey. Thromb Res 2021. [DOI: 10.1016/s0049-3848(21)00236-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Fernández LP, Merino M, Colmenarejo G, Moreno-Rubio J, Sánchez-Martínez R, Quijada-Freire A, Gómez de Cedrón M, Reglero G, Casado E, Sereno M, Ramírez de Molina A. Metabolic enzyme ACSL3 is a prognostic biomarker and correlates with anticancer effectiveness of statins in non-small cell lung cancer. Mol Oncol 2020; 14:3135-3152. [PMID: 33030783 PMCID: PMC7718959 DOI: 10.1002/1878-0261.12816] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 09/20/2020] [Indexed: 12/24/2022] Open
Abstract
Lung cancer is one of the most common cancers, still characterized by high mortality rates. As lipid metabolism contributes to cancer metabolic reprogramming, several lipid metabolism genes are considered prognostic biomarkers of cancer. Statins are a class of lipid-lowering compounds used in treatment of cardiovascular disease that are currently studied for their antitumor effects. However, their exact mechanism of action and specific conditions in which they should be administered remains unclear. Here, we found that simvastatin treatment effectively promoted antiproliferative effects and modulated lipid metabolism-related pathways in non-small cell lung cancer (NSCLC) cells and that the antiproliferative effects of statins were potentiated by overexpression of acyl-CoA synthetase long-chain family member 3 (ACSL3). Moreover, ACSL3 overexpression was associated with worse clinical outcome in patients with high-grade NSCLC. Finally, we found that patients with high expression levels of ACSL3 displayed a clinical benefit of statins treatment. Therefore, our study highlights ACSL3 as a prognostic biomarker for NSCLC, useful to select patients who would obtain a clinical benefit from statin administration.
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Affiliation(s)
| | - María Merino
- Medical Oncology Department, Infanta Sofía University Hospital, San Sebastián de los Reyes, Madrid, Spain
| | - Gonzalo Colmenarejo
- Biostatistics and Bioinformatics Unit, IMDEA Food Institute, CEI UAM+CSIC, Madrid, Spain
| | - Juan Moreno-Rubio
- Molecular Oncology Group, IMDEA Food Institute, CEI UAM + CSIC, Madrid, Spain
| | | | | | | | - Guillermo Reglero
- Molecular Oncology Group, IMDEA Food Institute, CEI UAM + CSIC, Madrid, Spain
| | - Enrique Casado
- Medical Oncology Department, Infanta Sofía University Hospital, San Sebastián de los Reyes, Madrid, Spain
| | - María Sereno
- Medical Oncology Department, Infanta Sofía University Hospital, San Sebastián de los Reyes, Madrid, Spain
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Merino M, Braçe O, González A, Hidalgo-Vega Á, Garrido-Cumbrera M, Gratacos-Masmitja J. THU0548 THE ECONOMIC BURDEN OF ANKYLOSING SPONDYLITIS IN SPAIN. RESULTS OF THE SPANISH ATLAS 2017. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Ankylosing Spondylitis (AS) is a disease associated with a high number of comorbidities, chronic pain, functional disability, and resource consumption.Objectives:This study aimed to estimate the burden of disease for patients diagnosed with AS in Spain.Methods:Data from 578 unselected patients with AS were collected in 2016 for the Spanish Atlas of Axial Spondyloarthritis via an online survey. The estimated costs were: Direct Health Care Costs (borne by the National Health System, NHS) and Direct Non-Health Care Costs (borne by patients) were estimated with the bottom-up method, multiplying the resource consumption by the unit price of each resource. Indirect Costs (labour productivity losses) were estimated using the human capital method. Costs were compared between levels of disease activity using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score (<4 or low inflammation versus ≥4 or high inflammation) and risk of mental distress using the 12-item General Health Questionnaire (GHQ-12) score (<3 or low risk versus ≥3 or high risk).Results:The average annual cost per patient with AS in 2015 amounted to €11,462.3 (± 13,745.5) per patient. Direct Health Care Cost meant an annual average of €6,999.8 (± 9,216.8) per patient, to which an annual average of €611.3 (± 1,276.5) per patient associated with Direct Non-Health Care Cost borne by patients must be added. Pharmacological treatment accounted for the largest percentage of the costs borne by the NHS (64.6%), while for patients most of the cost was attributed to rehabilitative therapies and/or physical activity (91%). The average annual Indirect Costs derived from labour productivity losses were €3,851.2 (± 8,484.0) per patient, mainly associated to absenteeism. All categories showed statistically significant differences (p<0.05) between BASDAI groups (<4 vs ≥4) except for the Direct Non-Healthcare Cost, showing a progressive rise in cost from low to high inflammation. Regarding the 12-item General Health Questionnaire (GHQ-12), all categories showed statistically significant differences between GHQ-12 (<3 vs ≥3), with higher costs associated with higher risk of poor mental health (Table 1).Table 1.Average annual costs per patient according to BASDAI and GHQ-12 groups (in Euros, 2015)NDirect Health CostsDirect Non-Health CostsIndirect CostsTotal CostBASDAI<4917,592.0*557.32,426.5*10,575.8*≥43769,706.9*768.05,104.8*15,579.7*Psychological distress (GHQ-12)<31468,146.8*493.6*3,927.2*12,567.6*≥32609,772.9*807.2*4,512.3*15,092.5*Total5786,999.8611.33,851.211,462.3* p <0.05Conclusion:Direct Health Care Costs, and those attributed to pharmacological treatment in particular, accounted for the largest component of the cost associated with AS. However, a significant proportion of the overall costs can be further attributed to labour productivity losses.Acknowledgments:Funded by Novartis Farmacéutica S.A.Disclosure of Interests:María Merino: None declared, Olta Braçe: None declared, Almudena González: None declared, Álvaro Hidalgo-Vega: None declared, Marco Garrido-Cumbrera: None declared, Jordi Gratacos-Masmitja Grant/research support from: a grant from Pfizzer to study implementation of multidisciplinary units to manage PSA in SPAIN, Consultant of: Pfizzer, MSD, ABBVIE, Janssen, Amgen, BMS, Novartis, Lilly, Speakers bureau: Pfizzer, MSD, ABBVIE, Janssen, Amgen, BMS, Novartis, Lilly
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Amalou A, Seifabadi R, Varble N, Li M, Turkbey B, Anderson V, Mehralivand S, Merino M, Choyke P, Pinto P, Xu S, Wood B. Abstract No. 604 Get the needle and ultrasound out of the rectum in prostate interventions. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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21
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Moral Torres E, Fernández Fernández Ó, Carrascal Rueda P, Ruiz-Beato E, Estella Pérez E, Manzanares Estrada R, Gómez-García T, Jiménez M, Hidalgo-Vega Á, Merino M. Social value of a set of proposals for the ideal approach of multiple sclerosis within the Spanish National Health System: a social return on investment study. BMC Health Serv Res 2020; 20:84. [PMID: 32019531 PMCID: PMC7001370 DOI: 10.1186/s12913-020-4946-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 01/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multiple Sclerosis (MS) is a chronic inflammatory, demyelinating and neurodegenerative disease that in many cases produces disability, having a high impact in patients' lives, reducing significantly their quality of life. The aim of this study was to agree on a set of proposals to improve the current management of MS within the Spanish National Health System (SNHS) and apply the Social Return on Investment (SROI) method to measure the potential social impact these proposals would create. METHODS A Multidisciplinary Working Team of nine experts, with representation from the main stakeholders regarding MS, was set up to agree on a set of proposals to improve the management of MS. A forecast SROI analysis was carried out, with a one-year timeframe. Data sources included an expert consultation, a narrative literature review and a survey to 532 MS patients. We estimated the required investment of a hypothetical implementation, as well as the potential social value that it could create. We calculated outcomes in monetary units and we measured intangible outcomes through financial proxies. RESULTS The proposed ideal approach revealed that there are still unmet needs related to MS that can be addressed within the SNHS. Investment would amount to 148 million € and social return to 272 million €, so each euro invested could yield almost €2 of social return. CONCLUSIONS This study could guide health interventions, resulting in money savings for the SNHS and increases in patients' quality of life.
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Affiliation(s)
- Ester Moral Torres
- Neurology Service, Moisès Broggi Hospital - General Hospital of l'Hospitalet, Barcelona, Spain
| | | | | | | | | | | | | | - Margarita Jiménez
- Pharmacoeconomics and Market Access Department, Weber, Madrid, Spain
| | - Álvaro Hidalgo-Vega
- Economy and Health Research Seminar, Universidad de Castilla-La Mancha, Toledo, Spain
| | - María Merino
- Health Outcomes Research Department, Weber, Calle Moreto, 17, 5 Dcha, 28014, Madrid, Madrid, Spain.
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Merino M, Jiménez M, Manito N, Casariego E, Ivanova Y, González‐Domínguez A, San Saturnino M, Hidalgo‐Vega Á, Blanch C. The social return on investment of a new approach to heart failure in the Spanish National Health System. ESC Heart Fail 2020; 7:130-137. [PMID: 31916416 PMCID: PMC7083495 DOI: 10.1002/ehf2.12535] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 09/12/2019] [Accepted: 09/17/2019] [Indexed: 11/11/2022] Open
Abstract
AIMS We aim to agree on a set of proposals to improve the current management of heart failure (HF) within the Spanish National Health System (SNHS) and apply the social return on investment (SROI) method to measure the social impact that these proposals would generate. METHODS AND RESULTS A multidisciplinary working team of 16 experts was set up, with representation from the main stakeholders regarding HF: medical specialists (cardiologists, internal medicine physicians, general practitioners, and geriatric physicians), nursing professionals, health management professionals, patients, and informal caregivers. This team established a set of proposals to improve the management of HF according to the main areas of HF care: emergency and hospitalization, primary care, cardiology, and internal medicine. A forecast-type SROI method, with a 1-year time frame, was applied to measure the social impact resulting from the implementation of these proposals. The required investment and social return were estimated and summarized into a ratio indicating how much social return could be generated for each euro invested. Intangible returns were included and quantified through financial proxies. The approach to improve the management of HF consisted of 28 proposals, including the implementation of a case management nurse network, standardization of operational protocols, psychological support, availability of echocardiography machines at emergency departments, stationary units and primary care, early specialist visits after hospital discharge, and cardiac rehabilitation units, among others. These proposals would benefit not only patients and their informal caregivers but also the SNHS. Regarding patients, proposals would increase their autonomy in everyday activities, decrease anxiety, increase psychological and physical well-being, improve pharmacological adherence and self-care, enhance understanding of the disease, delay disease progression, expedite medical assessment, and prevent the decrease in work productivity associated with HF management. Regarding informal caregivers, proposals would increase their quality of life; improve their social, economic, and emotional well-being; and reduce their care burden. The SNHS would benefit from shorter stays of HF patients at intensive care units and reduction of hospitalizations and admissions to emergency departments. The investment needed to implement these proposals would amount to €548m and yield a social return of €1932m, that is, €3.52 for each euro invested. CONCLUSIONS The current management of HF could be improved by a set of proposals that resulted in an overall positive social return, varying between areas of analysis. This may guide the allocation of healthcare resources and improve the quality of life of patients with HF.
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Affiliation(s)
- María Merino
- Department of Health Outcomes ResearchInstituto Max WeberMadridSpain
| | - Margarita Jiménez
- Department of Pharmacoeconomics and Market AccessInstituto Max WeberMadridSpain
| | - Nicolás Manito
- Department of Heart Failure and TransplantHospital Universitario de Bellvitge, Hospitalet de LlobregatBarcelonaSpain
| | - Emilio Casariego
- Department of Internal MedicineComplejo Hospitalario de LugoLugoSpain
| | - Yoana Ivanova
- Department of Pharmacoeconomics and Market AccessInstituto Max WeberMadridSpain
| | | | | | - Álvaro Hidalgo‐Vega
- Economy and Health Research SeminarUniversidad de Castilla‐La ManchaToledoSpain
| | - Carles Blanch
- Early Access & Health EconomicsNovartisBarcelonaSpain
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Carretero G, Moreno D, González-Domínguez A, Trigos D, Ledesma A, Sarquella E, Merino M, Blanch C. Multidisciplinary approach to psoriasis in the Spanish National Health System: A social return on investment study. Glob Reg Health Technol Assess 2020; 7:50-56. [PMID: 36627964 PMCID: PMC9677591 DOI: 10.33393/grhta.2020.2146] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 06/22/2020] [Indexed: 01/13/2023] Open
Abstract
Introduction Psoriasis is a chronic disease in which patients feel stigmatization, social rejection, and suffer from low self-esteem. There are still unmet needs that make it necessary to define a new multidisciplinary approach to provide benefits not only to patients and their families but also to the Spanish National Health System (SNHS) and society. The aim was to define a new approach to better address the unmet needs of patients with psoriasis within the SNHS and to measure its impact from a social perspective, that is, in clinical, health care, economic, and social terms. Methods Multidisciplinary experts identified, agreed on, and selected several health care interventions that were feasible for implementation in the SNHS. This process was carried out in four different areas: diagnosis, mild psoriasis, moderate psoriasis, and severe psoriasis. To estimate investment and social return, the social return on investment (SROI) method was used. Results The new approach to psoriasis management in the SNHS comprised 18 proposals. The investment needed for the implementation of this new approach would amount to €222.77 million and its return to €1,123.11 million. This would yield a SROI ratio of €5.04 for every euro invested. Conclusion The new approach to psoriasis management would yield a positive social return. The results will allow optimal strategic planning adapted to each assistance situation, to achieve a comprehensive and multidisciplinary approach.
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Affiliation(s)
| | - David Moreno
- Department of Dermatology, Virgen Macarena Hospital, Seville - Spain
| | | | - David Trigos
- Acción Psoriasis, Psoriasis Patients and Relatives Association, Barcelona - Spain
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Merino M, Villoro R, Hidalgo-Vega Á, Carmona C. Health-related quality of life of patients diagnosed with COPD in Extremadura, Spain: results from an observational study. Health Qual Life Outcomes 2019; 17:189. [PMID: 31888646 PMCID: PMC6937847 DOI: 10.1186/s12955-019-1244-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 11/13/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND COPD is a high prevalence chronic disease that involves large reductions of health-related quality of life (HRQL) of patients. This study aims to describe the HRQL of patients with COPD in Extremadura (Spain). METHODS This is a cross-sectional observational study carried out using a representative sample of patients diagnosed with COPD in Extremadura. The inclusion criteria were patients of legal age, diagnosed with COPD at least 12 months prior to the visit, residing in Extremadura, with electronic medical records available for the 12 months prior to the visit and providing informed consent. The intervention aimed to elicit HRQL indicators obtained from two validated questionnaires: EuroQol - 5 Dimensions - 5 Levels (EQ-5D-5L), and St. George's Respiratory Questionnaire-COPD (SGRQ-C). The main outcome measures were general HRQL (utility and visual analogue scale) and specific quality of life of COPD patients (total score and three component scores: Symptoms, Activity, and Impacts). Stepwise multiple regression analysis was applied to evaluate the association of EQ-5D-5L and SGRQ-C with respect to clinical and sociodemographic characteristics of the patients. RESULTS We recruited 386 patients (mean age 71.8 ± 10.3 years, 76.2% males). In the EQ-5D-5L, participants reported greater problems with respect to mobility (56.5%) and pain/discomfort (48.2%). The mean utility was 0.72 ± 0.31, and the SGRQ-C total score was 40.9 ± 25.0. The results of both questionnaires were associated with number of exacerbations in the last 12 months, level of COPD severity, gender, and education level of the patient (p < 0.05). CONCLUSIONS The results for both utility and total SGRQ-C score indicate that having suffered exacerbations in the last year, presenting a higher level of severity, being a woman, and having a low education level are related to worse HRQL in patients with COPD.
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Affiliation(s)
- María Merino
- Fundación Weber, Calle Moreto 17, 5 D, 28014, Madrid, Spain
| | - Renata Villoro
- Fundación Weber, Calle Moreto 17, 5 D, 28014, Madrid, Spain
| | - Álvaro Hidalgo-Vega
- Fundación Weber, Calle Moreto 17, 5 D, 28014, Madrid, Spain
- Universidad de Castilla-La Mancha, Cobertizo de San Pedro Mártir s/n, 45071 Toledo, Spain
| | - Concepción Carmona
- Servicio Extremeño de Salud, Avenida de las Américas 2, 06800 Mérida, Badajoz, Spain
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Merino M, Fernández L, Moyano MS, De Molina AR, Rubio JM, Colmenarejo G, Raposo CG, Gómez ML, Martínez SF, Zamora CA, Tévar FZ, Gordo AJ, Sáez EC. P1.03-33 Analysis of Lipid Metabolism Genes in Advanced Small Cell Lung Cancer. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Urrechaga E, Merino M, De La Hera P, Javier AF. Markers of hypochromia in the study of erythropoiesis and iron availability in patients with Inflammatory Bowell Disease. Clin Chim Acta 2019. [DOI: 10.1016/j.cca.2019.03.907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Hidalgo-Vega Á, Martell N, Orozco-Beltrán D, Galgo A, Muñiz O, Górriz JL, Ferrer-Vidal D, Sabaté N, Merino M. [Tools to improve efficiency in the clinical management of hypertensive patients]. Hipertens Riesgo Vasc 2019; 36:70-84. [PMID: 30037730 DOI: 10.1016/j.hipert.2018.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 06/13/2018] [Accepted: 06/14/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To create a tool to evaluate the efficiency of the clinical management of hypertensive patients in Primary Care. MATERIAL AND METHODS A web-based questionnaire was designed for Primary Care centres to self-evaluate the management of hypertension in five specific areas: information systems, diagnostic and analytical tests, organisational aspects, use of resources, and continuous training programmes for patients and healthcare professionals. A committee of experts previously defined these questions and their ideal responses or "control", based on the scientific literature or, if there were no published references, by consensus of the committee. A descriptive analysis was performed on the data, and an adherence score was created that ranged from 0 (no adherence) to 1 (total adherence). RESULTS A total of 35 Primary Care centres entered their data into the website for the clinical management of hypertensive patients. The highest adherence to the ideal algorithm was observed in the area "Diagnostic and analytical tests" (0.69±0.10), and the lowest in "Continuous training programmes for patients and professionals" (0.42±0.21). CONCLUSIONS The efficiency of clinical management in hypertensive patients can be analysed using the website tool created for this purpose. Its use allows an internal audit to detect the areas that need improvement, and also serves to make comparative evaluations in the different areas of management over time.
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Affiliation(s)
| | - N Martell
- Hospital Clínico San Carlos, Madrid, España
| | | | - A Galgo
- Centro de Salud Espronceda, Madrid, España
| | - O Muñiz
- Hospital Universitario Virgen del Rocío, Sevilla, España
| | - J L Górriz
- Hospital Clínico Universitario, Valencia, España
| | | | - N Sabaté
- Hospital Universitario Vall d'Hebron, Barcelona, España
| | - M Merino
- Weber, Economía y Salud, Majadahonda, España.
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Civantos S, Durán M, Flández B, Merino M, Navea C, Guijarro G, Martell N, Monereo S. Factores predictores de diabetes mellitus posparto en pacientes con diabetes gestacional. ENDOCRINOL DIAB NUTR 2019; 66:83-89. [DOI: 10.1016/j.endinu.2018.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 08/17/2018] [Accepted: 08/23/2018] [Indexed: 01/23/2023]
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Merino M, Contreras A, Casares N, Troconiz IF, Ten Hagen TL, Berraondo P, Zalba S, Garrido MJ. A new immune-nanoplatform for promoting adaptive antitumor immune response. Nanomedicine 2019; 17:13-25. [PMID: 30654186 DOI: 10.1016/j.nano.2018.12.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 12/21/2018] [Accepted: 12/28/2018] [Indexed: 01/02/2023]
Abstract
Immunoliposomes (ILs), obtained with monoclonal antibodies (mAbs) decorating the liposome surface, are used for cancer treatment. These mAbs provide the recognition of molecules upregulated in cancer cells, like Programmed Death-Ligand 1 (PD-L1), an immune-checkpoint involved in tumor resistance, forming a complex that blocks this molecule and thereby, induces antitumor immune response. This mechanism introduces a new concept for ILs. ILs coupled to anti-PD-L1 or its Fab' fragment have been developed and in vitro/in vivo characterized. Factors such as coupling methods, PEG density and ligand size were optimized. In vitro data showed that Fab'-ILs displayed the highest PD-L1 cell interaction, correlating with a higher in vivo tumor accumulation and an increase of effector cytotoxic CD8+ T cells, providing tumor shrinkage and total regression in 20% of mice. Therefore, a novel immune-nanoplatform able to modulate the immune system has been developed, allowing the encapsulation of several agents for combinatorial therapies.
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Affiliation(s)
- María Merino
- Department of Pharmacy and Pharmaceutical Technology, School of Pharmacy, University of Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdisNA)
| | - Ana Contreras
- Department of Pharmacy and Pharmaceutical Technology, School of Pharmacy, University of Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdisNA)
| | - Noelia Casares
- Program of Immunology and Immunotherapy, CIMA, Pamplona, Spain; Navarra Institute for Health Research (IdisNA)
| | - Iñaki F Troconiz
- Department of Pharmacy and Pharmaceutical Technology, School of Pharmacy, University of Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdisNA)
| | - Timo Lm Ten Hagen
- Laboratory of Experimental Oncology, Erasmus MC, Rotterdam, The Netherlands
| | - Pedro Berraondo
- Program of Immunology and Immunotherapy, CIMA, Pamplona, Spain; Navarra Institute for Health Research (IdisNA)
| | - Sara Zalba
- Department of Pharmacy and Pharmaceutical Technology, School of Pharmacy, University of Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdisNA)
| | - María J Garrido
- Department of Pharmacy and Pharmaceutical Technology, School of Pharmacy, University of Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdisNA).
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Sánchez-Barroso L, Apellaniz-Ruiz M, Gutiérrez-Gutiérrez G, Santos M, Roldán-Romero JM, Curras M, Remacha L, Calsina B, Calvo I, Sereno M, Merino M, García-Donas J, Castelo B, Guerra E, Letón R, Montero-Conde C, Cascón A, Inglada-Pérez L, Robledo M, Rodríguez-Antona C. Concomitant Medications and Risk of Chemotherapy-Induced Peripheral Neuropathy. Oncologist 2018; 24:e784-e792. [PMID: 30470691 DOI: 10.1634/theoncologist.2018-0418] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 10/16/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Peripheral neuropathy is the dose-limiting toxicity of many oncology drugs, including paclitaxel. There is large interindividual variability in the neuropathy, and several risk factors have been proposed; however, many have not been replicated. Here we present a comprehensive study aimed at identifying treatment and physiopathology-related paclitaxel-induced neuropathy risk factors in a large cohort of well-characterized patients. PATIENTS AND METHODS Analyses included 503 patients with breast or ovarian cancer who received paclitaxel treatment. Paclitaxel dose modifications caused by the neuropathy were extracted from medical records and patients self-reported neuropathy symptoms were collected. Multivariate logistic regression analyses were performed to identify concomitant medications and comorbidities associated with paclitaxel-induced neuropathy. RESULTS Older patients had higher neuropathy: for each increase of 1 year of age, the risk of dose modifications and grade 3 neuropathy increased 4% and 5%, respectively. Cardiovascular drugs increased the risk of paclitaxel dose reductions (odds ratio [OR], 2.51; p = .006), with a stronger association for beta-adrenergic antagonists. The total number of concomitant medications also showed an association with dose modifications (OR, 1.25; p = .012 for each concomitant drug increase). A dose modification predictive model that included the new identified factors gave an area under the curve of 0.74 (p = 1.07 × 10-10). Preexisting nerve compression syndromes seemed to increase neuropathy risk. CONCLUSION Baseline characteristics of the patients, including age and concomitant medications, could be used to identify individuals at high risk of neuropathy, personalizing chemotherapy treatment and reducing the risk of severe neuropathy. IMPLICATIONS FOR PRACTICE Peripheral neuropathy is a common adverse effect of many cancer drugs, including chemotherapeutics, targeted therapies, and immune checkpoint inhibitors. About 40% of survivors of cancer have functional deficits caused by this toxicity, some of them irreversible. Currently, there are no effective treatments to prevent or treat this neuropathy. This study, performed in a large cohort of well-characterized patients homogenously treated with paclitaxel, identified concomitant medications, comorbidities, and demographic factors associated with peripheral neuropathy. These factors could serve to identify patients at high risk of severe neuropathy for whom alternative non-neurotoxic alternatives may be considered.
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Affiliation(s)
- Lara Sánchez-Barroso
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
- Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Maria Apellaniz-Ruiz
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | | | - María Santos
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Juan M Roldán-Romero
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Maria Curras
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Laura Remacha
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Bruna Calsina
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Isabel Calvo
- Medical Oncology Department, Hospital Montepríncipe, Madrid, Spain
- Medical Oncology Department, Centro Integral Oncológico Clara Campal, Madrid, Spain
| | - María Sereno
- Medical Oncology Department, Hospital Universitario Infanta Sofía, Madrid, Spain
| | - María Merino
- Medical Oncology Department, Hospital Universitario Infanta Sofía, Madrid, Spain
| | - Jesús García-Donas
- Genitourinary Tumors Programme, Centro Integral Oncológico Clara Campal, Madrid, Spain
| | - Beatriz Castelo
- Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Eva Guerra
- Medical Oncology Department, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - Rocio Letón
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Cristina Montero-Conde
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Alberto Cascón
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
- ISCIII Center for Biomedical Research on Rare Diseases (CIBERER), Madrid, Spain
| | - Lucía Inglada-Pérez
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
- ISCIII Center for Biomedical Research on Rare Diseases (CIBERER), Madrid, Spain
| | - Mercedes Robledo
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
- ISCIII Center for Biomedical Research on Rare Diseases (CIBERER), Madrid, Spain
| | - Cristina Rodríguez-Antona
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
- ISCIII Center for Biomedical Research on Rare Diseases (CIBERER), Madrid, Spain
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Pérez de Llano L, García-Rivero JL, Urrutia I, Martínez-Moragón E, Ramos J, Cebollero P, Carballada F, Blanco-Aparicio M, Vennera MDC, Merino M, Torralba-García Y, Plaza V. A Simple Score for Future Risk Prediction in Patients with Controlled Asthma Who Undergo a Guidelines-Based Step-Down Strategy. J Allergy Clin Immunol Pract 2018; 7:1214-1221.e3. [PMID: 30368006 DOI: 10.1016/j.jaip.2018.10.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 10/13/2018] [Accepted: 10/15/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND The minimum controlling dose of treatment must be established in patients with asthma, but the outcome of step-down is unpredictable. OBJECTIVE To identify factors associated with risk of control loss when stepping down asthma treatment and to develop a score to predict this risk. METHODS A prospective, multicenter study including adults with well-controlled asthma was performed. Treatment was stepped up or stepped down over a 12-month period to maintain asthma control. We determined associations between clinical and functional variables and step-down failure. Finally, we derived a score to predict loss of control in 1 cohort and validated it in an independent cohort. RESULTS The derivation cohort consisted of 228 patients; 218 completed at least 1 step-down episode and a total of 495 step-down episodes were evaluated. A medical-record documented postbronchodilator spirometry result of <70% forced expiratory volume in 1 second (FEV1)/forced vital capacity (odds ratio [OR] = 2.08; 95% confidence interval [CI]: 1.26-3.43), current FEV1 < 80% (OR = 1.80; 95% CI: 1.03-3.14), ≥1 severe exacerbation in the previous 12 months (OR = 2.43; 95% CI: 1.48-4.01), and Asthma Control Test score < 25 (OR = 2.30; 95% CI: 1.35-3.92) were independently associated with failure. The score showed an area under the curve of 0.690 (95% CI: 0.633-0.747; P < .05) in the derivation cohort and 0.76 (95% CI: 0.643-0.882; P < .001) in a validation cohort of 114 patients. A score <4.5 implies a low risk of failure (<20%), whereas a score >8 implies a high risk (>40%). CONCLUSION This score can facilitate the prediction of step-down failure before medication taper in patients with well-controlled asthma.
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Affiliation(s)
| | | | - Isabel Urrutia
- Pneumology Service, Hospital de Galdakao, Bizkaia, Spain
| | | | - Jacinto Ramos
- Pneumology Service, Complejo Asistencial de Salamanca, Salamanca, València, Spain
| | - Pilar Cebollero
- Pneumology Service, Complejo Hospitalario de Navarra, Navarra, Spain
| | | | - Marina Blanco-Aparicio
- Pneumology Service, Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Spain
| | - María Del Carmen Vennera
- Servei de Pneumologia i Allèrgia Respiratòria, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigaciones Biomédicas en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - María Merino
- Health Outcomes Research Department, Weber, Economía y Salud, Madrid, Spain
| | - Yolanda Torralba-García
- Servei de Pneumologia i Allèrgia Respiratòria, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigaciones Biomédicas en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Vicente Plaza
- Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomédica Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Department of Medicine, Barcelona, Spain
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Abstract
Purpose COPD has been associated with a high number of comorbidities and a relatively high level of health care resource utilization. This study aimed to estimate the social economic impact of COPD in the autonomous community of Extremadura (Spain) in 2015. Patients and methods This is a retrospective observational study carried out using a representative sample of patients diagnosed with COPD in Extremadura. Sociodemographic data, data on health care resource utilization, formal and informal care received by the patients, and loss of labor productivity in the last 12 months were collected through an electronic data collection platform. Direct health care costs were estimated using the bottom-up approach, costs of informal care were assessed using the substitution method, and labor productivity losses were calculated using the human capital method. Results A sample of 386 patients was obtained (mean age: 71.8±10.3 years, males: 76.2%). The results show an average annual cost per patient of 3,077 euros. Direct health care costs represented 43.8% (1,645 euros), direct non-health care costs amounted to 38.3% (1,440 euros), and labor productivity losses represented 17.9% (672 euros) of the average annual cost. The total annual cost of patients with COPD in Extremadura reached 36.2 million euros in 2015. Conclusion COPD poses a significant burden for the health care system and the society of Extremadura. The implementation of preventive and control measures could result in a substantial reduction in the economic impact.
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Affiliation(s)
| | | | - Álvaro Hidalgo-Vega
- Weber Foundation, Majadahonda, Madrid, Spain,
- Department of Economic Analysis and Finances, University of Castilla-La Mancha, Toledo, Spain
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Lip GYH, Al-Saady N, Hjortshoj SP, Goudev A, Huber K, Cohen AA, Jin J, Merino M, Winters SM, Goette A. P1923Edoxaban vs warfarin in vitamin K antagonist experienced and naive patients from the edoxaban versus warfarin in subjects undergoing cardioversion of atrial fibrillation (ENSURE-AF) randomized trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- G Y H Lip
- University of Birmingham, Birmingham, United Kingdom
| | - N Al-Saady
- Covance Inc., Maidenshead, United Kingdom
| | | | - A Goudev
- Queen Giovanna University Hospital, Sofia, Bulgaria
| | - K Huber
- Wilhelminen Hospital, Vienna, Austria
| | - A.-A Cohen
- University Pierre & Marie Curie Paris VI, Paris, France
| | - J Jin
- Daichii Sankyo Pharma Development, Basking Ridge, United States of America
| | - M Merino
- Daichii Sankyo Pharma Development, Basking Ridge, United States of America
| | - S M Winters
- Daiichi Sankyo, Inc, Global Medical Affairs, Basking Ridge, United States of America
| | - A Goette
- St. Vincenz-Hospital, Paderborn, Germany
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Vlagea A, Falagan S, Gutiérrez-Gutiérrez G, Moreno-Rubio J, Merino M, Zambrana F, Casado E, Sereno M. Antinuclear antibodies and cancer: A literature review. Crit Rev Oncol Hematol 2018; 127:42-49. [DOI: 10.1016/j.critrevonc.2018.05.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 03/26/2018] [Accepted: 05/07/2018] [Indexed: 12/22/2022] Open
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Merino M, Zalba S, Garrido MJ. Immunoliposomes in clinical oncology: State of the art and future perspectives. J Control Release 2018; 275:162-176. [DOI: 10.1016/j.jconrel.2018.02.015] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 02/09/2018] [Accepted: 02/10/2018] [Indexed: 02/02/2023]
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Cerezuela P, Salgado M, Gallardo E, Muñoz-Langa J, Castellón V, Barbosa M, Beato C, Martínez de Castro E, Martínez V, García-Escobar I, Doménech P, Guijarro R, Hervás D, Merino M, de Miguel Y, Colomé E, Trujillo-Santos J. Characterization of thrombosis risk in patients with cancer. Thromb Res 2018. [DOI: 10.1016/j.thromres.2018.02.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Lip GYH, Merino JL, Banach M, Al-Saady N, Jin J, Merino M, Winters SM, Merkely B, Goette A. P1181Clinical factors related to successful or unsuccessful cardioversion in the edoxaban versus warfarin in subjects undergoing cardioversion of atrial fibrillation (ENSURE-AF) randomized trial. Europace 2018. [DOI: 10.1093/europace/euy015.665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- GYH Lip
- University of Birmingham, Birmingham, United Kingdom
| | - J L Merino
- University Hospital La Paz, Madrid, Spain
| | - M Banach
- Medical University of Lodz, Lodz, Poland
| | | | - J Jin
- Daiichi Sankyo Pharma Development, Basking Ridge, United States of America
| | - M Merino
- Daiichi Sankyo Pharma Development, Basking Ridge, United States of America
| | - S M Winters
- Daiichi Sankyo, Inc, Global Medical Affairs, Basking Ridge, United States of America
| | - B Merkely
- Semmelweis University, Budapest, Hungary
| | - A Goette
- St Vincenz-Hosp, Paderborn, Germany
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Contreras-Sandoval AM, Merino M, Vasquez M, Trocóniz IF, Berraondo P, Garrido MJ. Correlation between anti-PD-L1 tumor concentrations and tumor-specific and nonspecific biomarkers in a melanoma mouse model. Oncotarget 2018; 7:76891-76901. [PMID: 27764774 PMCID: PMC5363557 DOI: 10.18632/oncotarget.12727] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 10/11/2016] [Indexed: 01/15/2023] Open
Abstract
Blockade of PD-L1 with specific monoclonal antibodies (anti-PD-L1) represents a therapeutic strategy to increase the capability of the immune system to modulate the tumor immune-resistance. The relationship between anti-PD-L1 tumor exposition and anti-tumor effect represents a challenge that has been addressed in this work through the identification of certain biomarkers implicated in the antibody's mechanism of action, using a syngeneic melanoma mouse model. The development of an in-vitro/in-vivo platform has allowed us to investigate the PD-L1 behavior after its blockage with anti-PD-L1 at cellular level and in animals. In-vitro studies showed that the complex PD-L1/anti-PD-L1 was retained mainly at the cell surface. The antibody concentration and time exposure affected directly the recycling or ligand turnover. In-vivo studies showed that anti-PD-L1 was therapeutically active at all stage of the disease, with a rapid onset, a low but durable efficacy and non-relevant toxic effect. This efficacy measured as tumor shrinkage correlated with tumor-specific infiltrating lymphocytes (TILs), which increased as antibody tumor concentrations increased. Both, TILS and antibody concentrations followed similar kinetic patterns, justifying the observed anti-PD-L1 rapid onset. Interestingly, peripheral lymphocytes (PBLs) behave as infiltrating lymphocytes, suggesting that these PBLs might be considered as a possible biomarker for antibody activity.
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Affiliation(s)
- Ana M Contreras-Sandoval
- School of Pharmacy, Department of Pharmacy and Pharmaceutical Technology, University of Navarra, 31008 Pamplona, Spain
| | - María Merino
- School of Pharmacy, Department of Pharmacy and Pharmaceutical Technology, University of Navarra, 31008 Pamplona, Spain
| | - Marcos Vasquez
- Program of Immunology and Immunotherapy, Center for Applied Medical Research (CIMA), Navarra Institute for Health Research (IdiSNA), Pamplona, Navarra, 31008, Spain
| | - Iñaki F Trocóniz
- School of Pharmacy, Department of Pharmacy and Pharmaceutical Technology, University of Navarra, 31008 Pamplona, Spain
| | - Pedro Berraondo
- Program of Immunology and Immunotherapy, Center for Applied Medical Research (CIMA), Navarra Institute for Health Research (IdiSNA), Pamplona, Navarra, 31008, Spain
| | - María J Garrido
- School of Pharmacy, Department of Pharmacy and Pharmaceutical Technology, University of Navarra, 31008 Pamplona, Spain
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Sereno M, Merino M, Aguayo C, Hernández S, Gutiérrez-Gutiérrez G, Tévar FZ, López-Gómez M, Raposo CG, Casado-Sáenz E. A Major Response to Trabectedin in Metastatic Malignant Fibrous Histiocytoma of the Vertebra: A Case Report and Review of the Literature. Tumori 2018; 99:e43-8. [DOI: 10.1177/030089161309900227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Malignant fibrous histiocytoma is an aggressive tumor, the most common soft-tissue sarcoma of adult age. It is usually located in the extremities and retroperitoneum, and very rarely there is skeletal involvement. Surgery is the preferred treatment in early disease; in advanced disease, chemotherapy is the main therapeutic strategy. We present a 25-year-old female patient diagnosed with a vertebral mass in T5 with a severely compromised spinal cord. She underwent surgical decompression and the pathological findings were consistent with malignant fibrous histiocytoma. After several surgical treatments she had pulmonary progression and was therefore started on chemotherapy. She had a very poor response to most of the administered regimens until she initiated trabectedin 1 mg/m2 every three weeks. She showed a significant improvement with a major response of the lung metastases. This report indicates that trabectedin is an active drug in advanced, previously treated metastatic malignant fibrous histiocytoma.
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Affiliation(s)
- María Sereno
- Oncology Department, Infanta Sofía University Hospital, Madrid
| | - María Merino
- Oncology Department, Infanta Sofía University Hospital, Madrid
| | | | - Susana Hernández
- Radiology Department, Infanta Sofía University Hospital, Madrid, Spain
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Calio B, Sidana A, Sugano D, Gaur S, Jain A, Maruf M, Xu S, Yan P, Kruecker J, Merino M, Choyke P, Turkbey B, Wood B, Pinto P. Changes in prostate cancer detection rate of MRI-TRUS fusion vs systematic biopsy over time: evidence of a learning curve. Prostate Cancer Prostatic Dis 2017; 20:436-441. [PMID: 28762373 DOI: 10.1038/pcan.2017.34] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 06/04/2017] [Accepted: 06/10/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND To determine the effect of urologist and radiologist learning curves and changes in MRI-TRUS fusion platform during 9 years of NCI's experience with multiparametric magnetic resonance imaging (mpMRI)/TRUS fusion biopsy. METHODS A prospectively maintained database of patients undergoing mpMRI followed by fusion biopsy (Fbx) and systematic biopsy (Sbx) from 2007 to 2016 was reviewed. The patients were stratified based on the timing of first biopsy. Cohort 1 (7/2007-12/2010) accounted for learning curve. Cohort 2 (1/2011-5/2013) and cohort 3 (5/2013-4/2016) included patients biopsied prior to and after debut of a new software platform, respectively. Clinically significant (CS) disease was defined as Gleason 7 (3+4) or higher. McNemar's test compared cancer detection rates (CDRs) of Sbx and Fbx between time periods. RESULTS 1528 patients were included in the study with 230, 537 and 761 patients included in three respective cohorts. Median age (interquartile range) was 61.0 (±9.0), 62.0 (±7.3), and 64.0 (±11.0) years in three cohorts, respectively (P<0.001). Fbx and Sbx had comparable CS CDR in cohort 1 (24.8 vs 22.2%, P=0.377). Fbx detected significantly more CS disease compared to Sbx in the following two periods (cohort 2: 31.5 vs 25.0%, P=0.001; cohort 3: 36.4 vs 30.3%, P<0.001) and detected significantly less low risk disease in the same period (cohort 2: 14.5 vs 19.6%, P<0.001; cohort 3: 12.6 vs 16.7%, P<0.001). Even after multivariate adjustment with age, PSA, race, clinical stage and MRI suspicion score, Fbx CS cancer detection increased in successive cohorts (cohort 2: OR 2.23, P=0.043; cohort 3: OR 2.92, P=0.007). CONCLUSIONS In the past 9 years, there has been significant improvement in the accuracy of Fbx. Our results show that after an early learning period, Fbx detected higher rates of CS cancer and lower rates of clinically insignificant cancer than Sbx. Software advances allowed for even greater detection of CS disease.
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Affiliation(s)
- B Calio
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - A Sidana
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - D Sugano
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - S Gaur
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - A Jain
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - M Maruf
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - S Xu
- Center for Interventional Oncology, National Cancer Institute and Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - P Yan
- Center for Interventional Oncology, National Cancer Institute and Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - J Kruecker
- Center for Interventional Oncology, National Cancer Institute and Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - M Merino
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - P Choyke
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - B Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - B Wood
- Center for Interventional Oncology, National Cancer Institute and Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - P Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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López-Bastida J, López-Siguero JP, Oliva-Moreno J, Perez-Nieves M, Villoro R, Dilla T, Merino M, Jiang D, Aranda-Reneo I, Reviriego J, Vázquez LA. Social economic costs of type 1 diabetes mellitus in pediatric patients in Spain: CHRYSTAL observational study. Diabetes Res Clin Pract 2017; 127:59-69. [PMID: 28319803 DOI: 10.1016/j.diabres.2017.02.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 01/12/2017] [Accepted: 02/25/2017] [Indexed: 12/01/2022]
Abstract
AIMS To estimate the social-economic costs of Type 1 Diabetes Mellitus (T1DM) in patients aged 0-17years in Spain from a social perspective. METHODS We conducted a cross-sectional observational study in 2014 of 275 T1DM pediatric outpatients distributed across 12 public health centers in Spain. Data on demographic and clinical characteristics, healthcare utilization and informal care were collected from medical records and questionnaires completed by clinicians and patients' caregivers. RESULTS A valid sample of 249 individuals was analyzed. The average annual cost for a T1DM patient was €27,274. Direct healthcare costs were €4070 and direct non-healthcare cost were €23,204. Informal (familial) care represented 83% of total cost, followed by medical material (8%), outpatient and primary care visits (3.1%) and insulin (2.1%). Direct healthcare cost per patient statistically differed by glycated haemoglobin (HbA1c) level [mean cost €4704 in HbA1c ≥7.5% (≥58mmol/mol) group vs. €3616 in HbA1c<7.5% (<58mmol/mol) group)]; and by the presence or absence of complications and comorbidities (mean cost €5713 in group with complications or comorbidities vs. €3636 in group without complications or comorbidities). CONCLUSIONS T1DM amongst pediatric patients incurs in considerable societal costs. Informal care represents the largest cost category.
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Affiliation(s)
- Julio López-Bastida
- University of Castilla-La Mancha, Avda. Real Fábrica de Seda, s/n, 45600 Talavera de la Reina, Toledo, Spain.
| | - Juan Pedro López-Siguero
- Pediatric Endocrinology Department, Regional University Hospital, Avda Arroyo de los Ángeles s/n, 29011 Málaga, Spain
| | - Juan Oliva-Moreno
- Department of Economics and Finance, University of Castilla-La Mancha, Cobertizo de San Pedro Mártir s/n, 45071 Toledo, Spain
| | | | - Renata Villoro
- Instituto Max Weber, Calle Norias 123, 28221 Majadahonda (Madrid), Spain
| | - Tatiana Dilla
- Eli Lilly and Company, Avda. de la Industria 30, 28108 Alcobendas (Madrid), Spain
| | - María Merino
- Instituto Max Weber, Calle Norias 123, 28221 Majadahonda (Madrid), Spain
| | - Dingfeng Jiang
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, USA
| | - Isaac Aranda-Reneo
- Department of Economics and Finance, University of Castilla-La Mancha, Avda. Real Fábrica de Seda, s/n, 45600 Talavera de la Reina, Toledo, Spain
| | - Jesús Reviriego
- Eli Lilly and Company, Avda. de la Industria 30, 28108 Alcobendas (Madrid), Spain
| | - Luis Alberto Vázquez
- Department of Endocrinology, Marqués de Valdecilla University Hospital, Avda Valdecilla, 39008 Santander, Spain
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Rumbo-Feal S, Pérez A, Ramelot TA, Álvarez-Fraga L, Vallejo JA, Beceiro A, Ohneck EJ, Arivett BA, Merino M, Fiester SE, Kennedy MA, Actis LA, Bou G, Poza M. Contribution of the A. baumannii A1S_0114 Gene to the Interaction with Eukaryotic Cells and Virulence. Front Cell Infect Microbiol 2017; 7:108. [PMID: 28421168 PMCID: PMC5376624 DOI: 10.3389/fcimb.2017.00108] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 03/17/2017] [Indexed: 11/29/2022] Open
Abstract
Genetic and functional studies showed that some components of the Acinetobacter baumannii ATCC 17978 A1S_0112-A1S_0119 gene cluster are critical for biofilm biogenesis and surface motility. Recently, our group has shown that the A1S_0114 gene was involved in biofilm formation, a process related with pathogenesis. Confirming our previous results, microscopy images revealed that the ATCC 17978 Δ0114 derivative lacking this gene was unable to form a mature biofilm structure. Therefore, other bacterial phenotypes were analyzed to determine the role of this gene in the pathogenicity of A. baumannii ATCC 17978. The interaction of the ATCC 17978 parental strain and the Δ0114 mutant with A549 human alveolar epithelial cells was quantified revealing that the A1S_0114 gene was necessary for proper attachment to A549 cells. This dependency correlates with the negative effect of the A1S_0114 deletion on the expression of genes coding for surface proteins and pili-assembly systems, which are known to play a role in adhesion. Three different experimental animal models, including vertebrate and invertebrate hosts, confirmed the role of the A1S_0114 gene in virulence. All of the experimental infection assays indicated that the virulence of the ATCC 17978 was significantly reduced when this gene was inactivated. Finally, we discovered that the A1S_0114 gene was involved in the production of a small lipopeptide-like compound herein referred to as acinetin 505 (Ac-505). Ac-505 was isolated from ATCC 17978 spent media and its chemical structure was interpreted by mass spectrometry. Overall, our observations provide novel information on the role of the A1S_0114 gene in A. baumannii's pathobiology and lay the foundation for future work to determine the mechanisms by which Ac-505, or possibly an Ac-505 precursor, could execute critical functions as a secondary metabolite.
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Affiliation(s)
- Soraya Rumbo-Feal
- Departamento de Microbiología, Instituto de Investigación Biomédica, Complejo Hospitalario Universitario (CHUAC), Universidad de A Coruña (UDC)A Coruña, Spain
| | - Astrid Pérez
- Departamento de Microbiología, Instituto de Investigación Biomédica, Complejo Hospitalario Universitario (CHUAC), Universidad de A Coruña (UDC)A Coruña, Spain.,Departamento de Microbiología y Parasitología, Universidad de Santiago de CompostelaSantiago de Compostela, Spain.,Department of Microbiology, Miami UniversityOxford, OH, USA
| | - Theresa A Ramelot
- Department of Chemistry and Biochemistry, Miami UniversityOxford, OH, USA
| | - Laura Álvarez-Fraga
- Departamento de Microbiología, Instituto de Investigación Biomédica, Complejo Hospitalario Universitario (CHUAC), Universidad de A Coruña (UDC)A Coruña, Spain
| | - Juan A Vallejo
- Departamento de Microbiología, Instituto de Investigación Biomédica, Complejo Hospitalario Universitario (CHUAC), Universidad de A Coruña (UDC)A Coruña, Spain
| | - Alejandro Beceiro
- Departamento de Microbiología, Instituto de Investigación Biomédica, Complejo Hospitalario Universitario (CHUAC), Universidad de A Coruña (UDC)A Coruña, Spain
| | - Emily J Ohneck
- Department of Microbiology, Miami UniversityOxford, OH, USA
| | | | - María Merino
- Departamento de Microbiología, Instituto de Investigación Biomédica, Complejo Hospitalario Universitario (CHUAC), Universidad de A Coruña (UDC)A Coruña, Spain
| | | | - Michael A Kennedy
- Department of Chemistry and Biochemistry, Miami UniversityOxford, OH, USA
| | - Luis A Actis
- Department of Microbiology, Miami UniversityOxford, OH, USA
| | - Germán Bou
- Departamento de Microbiología, Instituto de Investigación Biomédica, Complejo Hospitalario Universitario (CHUAC), Universidad de A Coruña (UDC)A Coruña, Spain
| | - Margarita Poza
- Departamento de Microbiología, Instituto de Investigación Biomédica, Complejo Hospitalario Universitario (CHUAC), Universidad de A Coruña (UDC)A Coruña, Spain
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Jerez A, Merino M, Buño I, Chen-Liang TH, Iniesta P, Garcia A, Teruel R, Amigo M, Alamo J, Suarez J, Ortuño F, Vicente V. Donor Cell MDS with Rare Complex Karyotype After Mismatch Alobmt for Ph+ALL. Leuk Res 2017. [DOI: 10.1016/s0145-2126(17)30409-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gaur S, Mehralivand S, Bednarova S, Calio B, Sugano D, Mertan F, Merino M, Choyke P, Wood B, Pinto P, Turkbey B. Comparison of PIRADSv2 and in-house system in detection of prostate cancer for subsequent MR/US fusion biopsy. J Vasc Interv Radiol 2017. [DOI: 10.1016/j.jvir.2016.12.760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Sereno M, Gutiérrez-Gutiérrez G, Rubio JM, Apellániz-Ruiz M, Sánchez-Barroso L, Casado E, Falagan S, López-Gómez M, Merino M, Gómez-Raposo C, Rodriguez-Salas N, Tébar FZ, Rodríguez-Antona C. Genetic polymorphisms of SCN9A are associated with oxaliplatin-induced neuropathy. BMC Cancer 2017; 17:63. [PMID: 28103821 PMCID: PMC5248487 DOI: 10.1186/s12885-016-3031-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 12/13/2016] [Indexed: 12/02/2022] Open
Abstract
Background Oxaliplatin is a chemotherapy agent active against digestive tumors. Peripheral neuropathy is one of the most important dose-limiting toxicity of this drug. It occurs in around 60–80% of the patients, and 15% of them develop severe neuropathy. The pathophysiology of oxaliplatin neurotoxicity remains unclear. SCN9A is a gene codifying for a subtype sodium channel (type IX, subunit α) and mutations in this gene are involved in neuropathic perception. In this study we investigated whether SCN9A genetic variants were associated with risk of neurotoxicity in patients diagnosed of cancer on treatment with oxaliplatin. Methods Blood samples from 94 patients diagnosed of digestive cancer that had received oxaliplatin in adjuvant or metastatic setting were obtained from three hospitals in Madrid. These patients were classified into two groups: “cases” developed oxaliplatin-induced grade 3–4 neuropathy (n = 48), and “controls” (n = 46) had no neuropathy or grade 1. The neuropathy was evaluated by an expert neurologist and included a clinical examination and classification according to validated neurological scales: National Cancer Institute Common Toxicity Criteria (NCI-CTC), Oxaliplatin-Specific Neurotoxicity Scale (OSNS) and Total Neuropathy score (TNS). Genotyping was performed for 3 SCN9A missense polymorphisms: rs6746030 (R1150W), rs74401238 (R1110Q) and rs41268673 (P610T), and associations between genotypes and neuropathy were evaluated. Results We found that SCN9A rs6746030 was associated with protection for severe neuropathy (OR = 0.39, 95% CI = 0.16–0.96; p = 0.041). Multivariate analysis adjusting for diabetes provided similar results (p = 0.036). No significant differences in neuropathy risk were detected for rs74401238 and rs41268673. Conclusion SCN9A rs6746030 was associated with protection for severe oxaliplatin-induced peripheral neuropathy. The validation of this exploratory study is ongoing in an independent series.
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Affiliation(s)
- María Sereno
- Medical Oncology Department, Infanta Sofía University Hospital, SS de los Reyes, Madrid, Spain.
| | | | - Juan Moreno Rubio
- Medical Oncology Department, Infanta Sofía University Hospital, SS de los Reyes, Madrid, Spain
| | - María Apellániz-Ruiz
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Lara Sánchez-Barroso
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Enrique Casado
- Medical Oncology Department, Infanta Sofía University Hospital, SS de los Reyes, Madrid, Spain
| | - Sandra Falagan
- Medical Oncology Department, Infanta Sofía University Hospital, SS de los Reyes, Madrid, Spain
| | - Miriam López-Gómez
- Medical Oncology Department, Infanta Sofía University Hospital, SS de los Reyes, Madrid, Spain
| | - María Merino
- Medical Oncology Department, Infanta Sofía University Hospital, SS de los Reyes, Madrid, Spain
| | - César Gómez-Raposo
- Medical Oncology Department, Infanta Sofía University Hospital, SS de los Reyes, Madrid, Spain
| | - Nuria Rodriguez-Salas
- Medical Oncologist, Medical Oncology Department, La Paz University Hospital, Madrid, Spain
| | | | - Cristina Rodríguez-Antona
- Hereditary Endocrine Cancer Group, Human Cancer Genetics Programme, Spanish National Cancer Center (CNIO), Madrid, Spain.,ISCIII Center for Biomedical Research on Rare Diseases (CIBERER), Madrid, Spain
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Pérez A, Merino M, Rumbo-Feal S, Álvarez-Fraga L, Vallejo JA, Beceiro A, Ohneck EJ, Mateos J, Fernández-Puente P, Actis LA, Poza M, Bou G. The FhaB/FhaC two-partner secretion system is involved in adhesion of Acinetobacter baumannii AbH12O-A2 strain. Virulence 2016; 8:959-974. [PMID: 27858524 DOI: 10.1080/21505594.2016.1262313] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Acinetobacter baumannii is a hospital-acquired pathogen that shows an extraordinary capacity to stay in the hospital environment. Adherence of the bacteria to eukaryotic cells or to abiotic surfaces is the first step for establishing an infection. The A. baumannii strain AbH12O-A2 showed an exceptional ability to adhere to A549 epithelial cells. The AbFhaB/FhaC 2-partner secretion (TPS) system involved in adhesion was discovered after the screening of the recently determined A. baumannii AbH12O-A2 strain genome (CP009534.1). The AbFhaB is a large exoprotein which transport to the bacterial surface is mediated by the AbFhaC protein. In the present study, the role of this TPS system in the AbH12O-A2 adherence phenotype was investigated. The functional inactivation of this 2-partner secretion system was addressed by analyzing the outer membrane vesicles (OMV) proteomic profile from the wild-type strain and its derivative mutant AbH12O-A2ΔfhaC demonstrating that AbFhaB is no longer detected in the absence of AbFhaC. Scanning electron microscopy (SEM) and adhesion experiments demonstrated that inactivation of the AbFhaB/FhaC system significantly decreases bacterial attachment to A549 alveolar epithelial cells. Moreover, it has been demonstrated that this 2-partner secretion system is involved in fibronectin-mediated adherence of the A. baumannii AbH12O-A2 isolate. Finally, we report that the AbFhaB/FhaC system is involved in virulence when tested using invertebrate and vertebrate hosts. These data suggest the potential role that this AbFhaB/FhaC secretion system could play in the pathobiology of A. baumannii.
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Affiliation(s)
- A Pérez
- a Departamento de Microbiología , Instituto de Investigación Biomédica (INIBIC), Complejo Hospitalario Universitario (CHUAC), Universidad da Coruña (UDC) , A Coruña , Spain.,b Departamento de Microbiología y Parasitología , Universidad de Santiago de Compostela (USC) , Santiago de Compostela , Spain.,c Department of Microbiology , Miami University , Oxford , OH , USA
| | - M Merino
- a Departamento de Microbiología , Instituto de Investigación Biomédica (INIBIC), Complejo Hospitalario Universitario (CHUAC), Universidad da Coruña (UDC) , A Coruña , Spain
| | - S Rumbo-Feal
- a Departamento de Microbiología , Instituto de Investigación Biomédica (INIBIC), Complejo Hospitalario Universitario (CHUAC), Universidad da Coruña (UDC) , A Coruña , Spain
| | - L Álvarez-Fraga
- a Departamento de Microbiología , Instituto de Investigación Biomédica (INIBIC), Complejo Hospitalario Universitario (CHUAC), Universidad da Coruña (UDC) , A Coruña , Spain
| | - J A Vallejo
- a Departamento de Microbiología , Instituto de Investigación Biomédica (INIBIC), Complejo Hospitalario Universitario (CHUAC), Universidad da Coruña (UDC) , A Coruña , Spain
| | - A Beceiro
- a Departamento de Microbiología , Instituto de Investigación Biomédica (INIBIC), Complejo Hospitalario Universitario (CHUAC), Universidad da Coruña (UDC) , A Coruña , Spain
| | - E J Ohneck
- c Department of Microbiology , Miami University , Oxford , OH , USA
| | - J Mateos
- d Grupo de Proteómica-ProteoRed/Plataforma PBR2-ISCIII, Servicio de Reumatología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario de A Coruña (CHUAC), Universidade da Coruña (UDC) , A Coruña , Spain.,e Marine Research Institute, Consejo Superior de Investigaciones Científicas (CSIC) , Vigo , Spain
| | - P Fernández-Puente
- d Grupo de Proteómica-ProteoRed/Plataforma PBR2-ISCIII, Servicio de Reumatología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario de A Coruña (CHUAC), Universidade da Coruña (UDC) , A Coruña , Spain
| | - L A Actis
- c Department of Microbiology , Miami University , Oxford , OH , USA
| | - M Poza
- a Departamento de Microbiología , Instituto de Investigación Biomédica (INIBIC), Complejo Hospitalario Universitario (CHUAC), Universidad da Coruña (UDC) , A Coruña , Spain
| | - G Bou
- a Departamento de Microbiología , Instituto de Investigación Biomédica (INIBIC), Complejo Hospitalario Universitario (CHUAC), Universidad da Coruña (UDC) , A Coruña , Spain
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Villoro R, Merino M, Hidalgo-Vega A. Quality of life and use of health care resources among patients with chronic depression. Patient Relat Outcome Meas 2016; 7:145-155. [PMID: 27713651 PMCID: PMC5045235 DOI: 10.2147/prom.s101595] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE This study estimates the health-related quality of life and the health care resource utilization of patients diagnosed with chronic depression (CD) in Spain. PATIENTS AND METHODS We used the Spanish National Health Survey 2011-2012, a cross-sectional survey representative at the national level, that selects people aged between 18 and 64 years (n=14,691). We estimated utility indices through the EuroQol five-dimensional descriptive system questionnaire included in the survey. We calculated percentage use of health care resources (medical visits, hospitalizations, emergency services, and drug consumption) and average number of resources used when available. A systematic comparison was made between people diagnosed with CD and other chronic conditions (OCCs). The chi-square test, Mann-Whitney U-test, and Kruskal-Wallis test were used to determine the statistical significance of differences between comparison groups. Multivariate analyses (Poisson regression, logistic regression, and linear regression) were also carried out to assess the relationship between quality of life and consumption of health care resources. RESULTS Approximately, 6.1% of the subjects aged between 18 and 64 years were diagnosed with CD (average age 48.3±11 years, 71.7% females). After controlling for age, sex, and total number of comorbidities, a diagnosis of CD reduced utility scores by 0.09 (P<0.05) vs OCCs, and increased the average number of hospitalizations by 15%, the average number of days at hospital by 51%, and the average number of visits to emergency services by 15% (P<0.05). CD also increased the average number of visits to secondary care by 14% and visits to general practitioners by 4%. People with CD had a higher probability of consuming drugs than people with OCCs (odds ratio [OR]: 1.24, P<0.05), but only 38.6% took antidepressants. CONCLUSION People with CD had significantly lower health-related quality of life than people with OCCs. CD was associated with increased hospital length of stay and involved a higher consumption of emergency services and drugs than OCCs.
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Affiliation(s)
- Renata Villoro
- Department of Health Economics, Instituto Max Weber, Madrid
| | - María Merino
- Department of Health Economics, Instituto Max Weber, Madrid
| | - Alvaro Hidalgo-Vega
- Department of Economics and Finance, University of Castilla-La Mancha, Toledo, Spain
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Català R, Villoro R, Merino M, Sangenís S, Colomés L, Hernández Flix S, Pérez de Llano LA. Cost-effectiveness of Continuous Positive Airway Pressure Treatment in Moderate-Severe Obstructive Sleep Apnea Syndrome. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.arbr.2016.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Apellániz-Ruiz M, Tejero H, Inglada-Pérez L, Sánchez-Barroso L, Gutiérrez-Gutiérrez G, Calvo I, Castelo B, Redondo A, García-Donás J, Romero-Laorden N, Sereno M, Merino M, Currás-Freixes M, Montero-Conde C, Mancikova V, Åvall-Lundqvist E, Green H, Al-Shahrour F, Cascón A, Robledo M, Rodríguez-Antona C. Targeted Sequencing Reveals Low-Frequency Variants in EPHA Genes as Markers of Paclitaxel-Induced Peripheral Neuropathy. Clin Cancer Res 2016; 23:1227-1235. [PMID: 27582484 DOI: 10.1158/1078-0432.ccr-16-0694] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 07/29/2016] [Accepted: 08/16/2016] [Indexed: 11/16/2022]
Abstract
Purpose: Neuropathy is the dose-limiting toxicity of paclitaxel and a major cause for decreased quality of life. Genetic factors have been shown to contribute to paclitaxel neuropathy susceptibility; however, the major causes for interindividual differences remain unexplained. In this study, we identified genetic markers associated with paclitaxel-induced neuropathy through massive sequencing of candidate genes.Experimental Design: We sequenced the coding region of 4 EPHA genes, 5 genes involved in paclitaxel pharmacokinetics, and 30 Charcot-Marie-Tooth genes, in 228 cancer patients with no/low neuropathy or high-grade neuropathy during paclitaxel treatment. An independent validation series included 202 paclitaxel-treated patients. Variation-/gene-based analyses were used to compare variant frequencies among neuropathy groups, and Cox regression models were used to analyze neuropathy along treatment.Results: Gene-based analysis identified EPHA6 as the gene most significantly associated with paclitaxel-induced neuropathy. Low-frequency nonsynonymous variants in EPHA6 were present exclusively in patients with high neuropathy, and all affected the ligand-binding domain of the protein. Accumulated dose analysis in the discovery series showed a significantly higher neuropathy risk for EPHA5/6/8 low-frequency nonsynonymous variant carriers [HR, 14.60; 95% confidence interval (CI), 2.33-91.62; P = 0.0042], and an independent cohort confirmed an increased neuropathy risk (HR, 2.07; 95% CI, 1.14-3.77; P = 0.017). Combining the series gave an estimated 2.5-fold higher risk of neuropathy (95% CI, 1.46-4.31; P = 9.1 × 10-4).Conclusions: This first study sequencing EPHA genes revealed that low-frequency variants in EPHA6, EPHA5, and EPHA8 contribute to the susceptibility to paclitaxel-induced neuropathy. Furthermore, EPHA's neuronal injury repair function suggests that these genes might constitute important neuropathy markers for many neurotoxic drugs. Clin Cancer Res; 23(5); 1227-35. ©2016 AACR.
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Affiliation(s)
- María Apellániz-Ruiz
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Héctor Tejero
- Translational Bioinformatics Unit, Spanish National Cancer Research Centre, Madrid, Spain
| | - Lucía Inglada-Pérez
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain.,ISCIII Center for Biomedical Research on Rare Diseases (CIBERER), Madrid, Spain
| | - Lara Sánchez-Barroso
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | | | - Isabel Calvo
- Medical Oncology Department, Hospital Montepríncipe, Madrid, Spain.,Medical Oncology Department, Centro Integral Oncológico Clara Campal, Madrid, Spain
| | - Beatriz Castelo
- Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Andrés Redondo
- Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Jesús García-Donás
- Gynecological and Genitourinary Tumors Programme, Centro Integral Oncológico Clara Campal, Madrid, Spain
| | - Nuria Romero-Laorden
- Gynecological and Genitourinary Tumors Programme, Centro Integral Oncológico Clara Campal, Madrid, Spain
| | - María Sereno
- Medical Oncology Department, Hospital Universitario Infanta Sofía, Madrid, Spain
| | - María Merino
- Medical Oncology Department, Hospital Universitario Infanta Sofía, Madrid, Spain
| | - María Currás-Freixes
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Cristina Montero-Conde
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Veronika Mancikova
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Elisabeth Åvall-Lundqvist
- Department of Oncology and Department of Clinical and Experimental Medicine, Linköpings Universitet, Linköping, Sweden
| | - Henrik Green
- Clinical Pharmacology, Division of Drug Research, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköpings Universitet, Linköping, Sweden.,Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden
| | - Fátima Al-Shahrour
- Translational Bioinformatics Unit, Spanish National Cancer Research Centre, Madrid, Spain
| | - Alberto Cascón
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain.,ISCIII Center for Biomedical Research on Rare Diseases (CIBERER), Madrid, Spain
| | - Mercedes Robledo
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain.,ISCIII Center for Biomedical Research on Rare Diseases (CIBERER), Madrid, Spain
| | - Cristina Rodríguez-Antona
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain. .,ISCIII Center for Biomedical Research on Rare Diseases (CIBERER), Madrid, Spain
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Villoro R, Merino M, Hidalgo-Vega A, Jiménez M, Martínez L, Aracil J. Women with urinary incontinence in Spain: Health-related quality of life and the use of healthcare resources. Maturitas 2016; 94:52-57. [PMID: 27823745 DOI: 10.1016/j.maturitas.2016.08.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 07/03/2016] [Accepted: 08/18/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To describe Health-Related Quality of Life (HRQOL) and healthcare resource utilization in women aged 60 and over in Spain. DESIGN Descriptive analysis of primary data from the Spanish National Health Survey, 2012. MAIN OUTCOME MEASURES Utility indices were obtained through the EQ5D5L questionnaire included in the survey, and utilization rates of consultations, hospitalizations, emergency services, and medication intake. HRQOL and utilization rates were systematically compared between women diagnosed with UI, women diagnosed with other chronic conditions (OCC) and healthy women of the same age. RESULTS Utility indices were 0.47 in UI women versus 0.78 and 0.96 in women diagnosed with OCC and healthy women, respectively. Each year 351,675 Quality Adjusted Life Years are lost in Spain due to UI in the population of women aged 60 and over. Resource utilization of these women was significantly higher than that of other women. CONCLUSIONS UI has a larger impact on both HRQOL and healthcare consumption in women who are aged 60 and over, than OCC. Appropriate treatment of UI might entail an important gain in terms of HRQOL and a significant reduction in healthcare consumption in Spain.
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Affiliation(s)
- Renata Villoro
- Instituto Max Weber, Calle Las Norias, 123, Majadahonda, 28221 Madrid, Spain.
| | - María Merino
- Instituto Max Weber, Calle Las Norias, 123, Majadahonda, 28221 Madrid, Spain
| | - Alvaro Hidalgo-Vega
- Department of Economics, Universidad de Castilla-La Mancha, Facultad de Ciencias Jurídicas y Sociales de Toledo, Cobertizo de San Pedro Mártir s/n., Toledo, 45071, Spain
| | - Margarita Jiménez
- Instituto Max Weber, Calle Las Norias, 123, Majadahonda, 28221 Madrid, Spain
| | - Lucía Martínez
- Instituto Max Weber, Calle Las Norias, 123, Majadahonda, 28221 Madrid, Spain
| | - Javier Aracil
- Allergan, International Market Access Area, 1st floor Marlow International Parkway, Marlow, Bucks SL7 1YL, United Kingdom
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