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Cebrian A, Escobar C, Aranda U, Palacios B, Capel M, Sicras A, Sicras A, Hormigo A, Manito N, Botana M, Alcázar R. Including KDIGO cardiovascular risk stratification into SCORE scale could improve the accuracy to better stratify cardiovascular risk. Nefrologia 2024; 44:292-294. [PMID: 36494287 DOI: 10.1016/j.nefroe.2021.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 11/26/2021] [Indexed: 06/17/2023] Open
Affiliation(s)
- Ana Cebrian
- Primary Care Center Cartagena Casco, Cartagena, Murcia, Spain
| | | | | | | | | | - Antoni Sicras
- Health Economics and Outcomes Research, Atrys Health, Barcelona, Spain
| | - Aram Sicras
- Health Economics and Outcomes Research, Atrys Health, Barcelona, Spain
| | | | - Nicolás Manito
- Hospital de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
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López-Azor JC, Delgado JF, Vélez J, Rodríguez R, Solís J, Del Oro M, Ortega C, Salguero-Bodes R, Palacios B, Vicent L, Moreno G, Rosillo N, Varela L, Capel M, Arribas F, Bernal JL, Bueno H. Differences in clinical outcomes, health care resource utilization and costs in heart failure patients according to left ventricular ejection fraction. Rev Esp Cardiol (Engl Ed) 2023; 76:862-871. [PMID: 37331588 DOI: 10.1016/j.rec.2023.06.003] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/15/2023] [Indexed: 06/20/2023]
Abstract
INTRODUCTION AND OBJECTIVES The impact of left ventricular ejection fraction (LVEF) on health care resource utilization (HCRU) and cost in heart failure (HF) patients is not well known. We aimed to compare outcomes, HCRUs and costs according to LVEF groups. METHODS Retrospective, observational study of all patients with an emergency department (ED) visit or admission to a tertiary hospital in Spain 2018 with a primary HF diagnosis. We excluded patients with newly diagnosed heart failure. One-year clinical outcomes, costs and HCRUs were compared according to LVEF (reduced [HFrEF], mildly reduced [HFmrEF], and preserved [HFpEF]). RESULTS Among 1287 patients with a primary diagnosis of HF in the ED, 365 (28.4%) were discharged to home (ED group), and 919 (71.4%) were hospitalized (hospital group [HG]). In total, 190 patients (14.7%) had HFrEF, 146 (11.4%) HFmrEF, and 951 (73.9%) HFpEF. The mean age was 80.1±10.7 years; 57.1% were female. The median [interquartile range] of costs per patient/y was €1889 [259-6269] in the ED group and €5008 [2747-9589] in the HG (P <.001). Hospitalization rates were higher in patients with HFrEF in the ED group. The median costs of HFrEF per patient/y were higher in patients in both groups: €4763 [2076-17 155] vs €3900 [590-8013] for HFmrEF vs €3812 [259-5486] for HFpEF in the ED group, and €6321 [3335-796] vs €6170 [3189-10484] vs €4636 [2609-8977], respectively, in the hospital group (all P <.001). This difference was driven by the more frequent admission to intensive care units, and greater use of diagnostic and therapeutic tests among HFrEF patients. CONCLUSIONS In HF, LVEF significantly impacts costs and HCRU. Costs were higher in patients with HFrEF, especially those requiring hospitalization, than in those with HFpEF.
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Affiliation(s)
- Juan Carlos López-Azor
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Facultad de Medicina, Universidad Europea, Madrid, Spain
| | - Juan Francisco Delgado
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Jorge Vélez
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Departamento de control de gestión, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Rocío Rodríguez
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Departamento de control de gestión, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Jorge Solís
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Manuel Del Oro
- Departamento de control de gestión, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Carmen Ortega
- Departamento de control de gestión, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Rafael Salguero-Bodes
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | | | - Lourdes Vicent
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Guillermo Moreno
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Nicolás Rosillo
- Departamento de Medicina Preventiva, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | | | | | - Fernando Arribas
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - José L Bernal
- Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Héctor Bueno
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Facultad de Medicina, Universidad Complutense, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.
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López-Azor JC, Delgado JF, Vélez J, Rodríguez R, Solís J, Oro MD, Ortega C, Salguero-Bodes R, Palacios B, Vicent L, Moreno G, Rosillo N, Varela L, Capel M, Arribas F, Bernal JL, Bueno H. Impacto de la fracción de eyección del ventrículo izquierdo en el consumo de recursos, los costes y el pronóstico en pacientes con insuficiencia cardiaca. Rev Esp Cardiol 2023. [DOI: 10.1016/j.recesp.2023.03.013] [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: 03/30/2023]
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Escobar C, Varela L, Palacios B, Capel M, Sicras-Mainar A, Sicras-Navarro A, Hormigo A, Alcázar R, Manito N, Botana M. Características clínicas, manejo y riesgo de complicaciones a un año en pacientes con insuficiencia cardíaca con y sin diabetes tipo 2 en España. Rev Clin Esp 2022. [DOI: 10.1016/j.rce.2021.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Bueno H, Goñi C, Salguero-Bodes R, Palacios B, Vicent L, Moreno G, Rosillo N, Varela L, Capel M, Delgado J, Arribas F, del Oro M, Ortega C, Bernal JL. Primary vs. Secondary Heart Failure Diagnosis: Differences in Clinical Outcomes, Healthcare Resource Utilization and Cost. Front Cardiovasc Med 2022; 9:818525. [PMID: 35369321 PMCID: PMC8967997 DOI: 10.3389/fcvm.2022.818525] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 02/14/2022] [Indexed: 11/17/2022] Open
Abstract
Background There is scarce information on patients with secondary heart failure diagnosis (sHF). We aimed to compare the characteristics, burden, and outcomes of sHF with those with primary HF diagnosis (pHF). Methods Retrospective, observational study on patients ≥18 years with emergency department (ED) visits during 2018 with pHF and sHF in ED or hospital (ICD-10-CM) diagnostic codes. Baseline characteristics, 30-day and 1-year mortality, readmission and re-ED visit rates, and costs were compared between sHF and pHF. Results Out of the 797 patients discharged home from the ED, 45.5% had sHF, and these presented lower 1-year hospitalization, re-ED visit rates, and costs. In contrast, out of the 2,286 hospitalized patients, 55% had sHF and 45% pHF. Hospitalized sHF patients had significantly (p < 0.01) greater comorbidity, lower use of recommended HF therapies, longer length of stay (10.8 ± 10.1 vs. 9.7 ± 7.9 days), and higher in-hospital and 1-year mortality (32 vs. 25.8%) with no significant differences in readmission rates and lower 1-year re-ED visit rate. Hospitalized sHF patients had higher total costs (€12,262,422 vs. €9,144,952, p < 0.001), mean cost per patient-year (€9,755 ± 13,395 vs. €8,887 ± 12,059), and average daily cost per patient. Conclusion Hospitalized sHF patients have a worse initial prognosis, greater use of healthcare resources, and higher costs.
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Affiliation(s)
- Héctor Bueno
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
- Spanish National Centre for Cardiovascular Research, Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- *Correspondence: Héctor Bueno,
| | - Clara Goñi
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
- Department of Management Control, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Rafael Salguero-Bodes
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | | | - Lourdes Vicent
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Guillermo Moreno
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, Spain
| | - Nicolás Rosillo
- Department of Preventive Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | - Juan Delgado
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Fernando Arribas
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Manuel del Oro
- Department of Management Control, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Carmen Ortega
- Department of Management Control, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Jose L. Bernal
- Department of Management Control, Hospital Universitario 12 de Octubre, Madrid, Spain
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Alcázar R, Escobar C, Palacios B, Aranda U, Varela L, Capel M, Sicras A, Sicras A, Hormigo A, Manito N, Botana M. Risk of outcomes in a Spanish population with chronic kidney disease. Clin Kidney J 2022; 15:1415-1424. [PMID: 35756747 PMCID: PMC9217652 DOI: 10.1093/ckj/sfac066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Indexed: 11/14/2022] Open
Abstract
Objectives To assess mortality and cardiovascular and renal outcomes among patients with chronic kidney disease (CKD) (primary objective), with a particular focus on heart failure (HF) risk following diagnosis of CKD (secondary objective) in Spain. Methods We conducted an observational study comprising cross-sectional and longitudinal retrospective analyses using secondary data from electronic health records. For the primary objective, adults with prevalent CKD [estimated glomerular filtration rate (eGFR) <60 or ≥60 mL/min/1.73 m2 with a urine albumin:creatinine ratio (UACR) ≥30 mg/g at the index date (1 January 2017)] were included. For the secondary objective, adults with incident CKD in 2017 were enrolled. Results In the prevalent population, 46 786 patients with CKD without HF [75.8 ± 14.4 years, eGFR 51.4 ± 10.1 mL/min/1.73 m2; 75.1% on renin–angiotensin system inhibitors (RASis)] and 8391 with CKD and HF (79.4 ± 10.9 years, eGFR 46.4 ± 9.8 mL/min/1.73 m2) were included. In the prevalent population, the risk of all-cause death {hazard ratio [HR] 1.107 [95% confidence interval (CI) 1.064–1.153]}, HF hospitalization [HR 1.439 (95% CI 1.387–1.493)] and UACR progression [HR 1.323 (95% CI 1.182–1.481)] was greater in those patients with CKD and HF versus CKD only. For the incident population, 1594 patients with CKD without HF and 727 with CKD and HF were included. Within 24 months from the CKD diagnosis (with/without HF at baseline), 6.5% of patients developed their first HF hospitalization. Although 60.7% were taking RASis, only 3.4% were at maximal doses and among diabetics, 1.3% were taking sodium-glucose cotransporter-2 inhibitors. Conclusions The presence of HF among CKD patients markedly increases the risk of outcomes. CKD patients have a high risk of HF, which could be partially related to insufficient treatment.
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Affiliation(s)
| | | | | | | | | | | | - Antoni Sicras
- Health Economics and Outcomes Research, Atrys Health, Barcelona, Spain
| | - Aram Sicras
- Health Economics and Outcomes Research, Atrys Health, Barcelona, Spain
| | | | - Nicolás Manito
- Hospital de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
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Escobar C, Morales C, Capel M, Simón S, Pérez-Alcántara F, Pomares E. Cost-effectiveness analysis of dapagliflozin for the treatment of type 2 diabetes mellitus in Spain: results of the DECLARE-TIMI 58 study. BMC Health Serv Res 2022; 22:217. [PMID: 35177053 PMCID: PMC8851809 DOI: 10.1186/s12913-022-07567-5] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 01/31/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objective of this study was to carry out a cost-effectiveness analysis of dapagliflozin, as an add-on therapy to standard of care (SoC), for the treatment of type 2 diabetes mellitus (T2DM) in Spain, based on the results of the DECLARE-TIMI 58 trial. METHODS A discrete event simulation model (Cardiff T2DM) based on the data observed in the DECLARE-TIMI 58 trial was adapted to the Spanish setting to estimate the costs and health outcomes of treatment with dapagliflozin in patients with T2DM who had or were at risk of atherosclerotic cardiovascular disease. Macrovascular events (hospitalization for heart failure, myocardial infarction, stroke, and unstable angina), end-stage renal disease and cardiovascular and non-cardiovascular mortality were modeled according to the survival equations of the DECLARE-TIMI 58 study. Microvascular events (blindness and ulcers) were estimated based on the risk equations of the UK Prospective Diabetes Study. The analysis was conducted from the Spanish National Health System perspective and the time horizon was 30 years. The results were evaluated in terms of cost per quality-adjusted life year (QALY) gained. Only direct health costs were included, and a 3% discount rate was applied to costs and health outcomes. Univariate and probabilistic sensitivity analyses (PSA) were made to assess the robustness of the results. RESULTS In the main analysis, dapagliflozin was a dominant therapeutic option compared with placebo, with greater effectiveness (0.08 QALYs) and lower associated total costs per patient (€ -2,921). The univariate sensitivity analysis and the PSA confirmed the robustness of the results. The PSA showed the probability that dapagliflozin was a dominant alternative compared with placebo was 84.2% and that it was cost-effective of 92.1%, under a willingness-to-pay of € 20,000/QALY gained. CONCLUSIONS The analysis of data from the DECLARE-TIMI 58 trial shows that dapagliflozin would be a cost-effective option in Spain for the treatment of adult patients with T2DM, as an add-on therapy to SoC, compared with placebo.
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Affiliation(s)
| | | | | | - Susana Simón
- HEOR & Market Access, AstraZeneca, Madrid, Spain
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Cebrian A, Escobar C, Aranda U, Palacios B, Capel M, Sicras A, Sicras A, Hormigo A, Manito N, Botana M, Alcázar R. The 2021 European Society of Cardiology cardiovascular disease prevention guidelines: Adding albuminuria to the SCORE scale increases the prevalence of very high/high cardiovascular risk among patients with chronic kidney disease. Clin Kidney J 2022; 15:1204-1208. [PMID: 35664262 PMCID: PMC9155243 DOI: 10.1093/ckj/sfac019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
- Ana Cebrian
- Primary care center Cartagena Casco, Cartagena, Murcia, Spain
| | | | | | | | | | - Antoni Sicras
- Health Economics and Outcomes Research, Atrys Health, Barcelona, Spain
| | - Aram Sicras
- Health Economics and Outcomes Research, Atrys Health, Barcelona, Spain
| | | | - Nicolás Manito
- Hospital de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
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Cebrian A, Escobar C, Aranda U, Palacios B, Capel M, Sicras A, Sicras A, Hormigo A, Manito N, Botana M, Alcázar R. Including KDIGO cardiovascular risk stratification into SCORE scale could improve the accuracy to better stratify cardiovascular risk. Nefrologia 2021. [DOI: 10.1016/j.nefro.2021.11.010] [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: 11/16/2022] Open
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Valero A, Molina J, Nuevo J, Simon S, Capel M, Sicras-Mainar A, Sicras-Navarro A, Plaza V. Economic consequences of the overuse of short-acting beta-adrenergic agonists (SABA) in the treatment of asthma in Spain. J Investig Allergol Clin Immunol 2021; 33:109-118. [PMID: 34825651 DOI: 10.18176/jiaci.0767] [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] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND To determine the relationship between short-acting beta-adrenergic agonist (SABA) overuse and healthcare resource use and costs in asthma patients in routine clinical practice. MATERIAL AND METHODS A longitudinal retrospective study in Spanish primary and specialized care using the BIG-PAC® Medical Records Database was conducted. Asthma patients ≥12 years of age who attended ≥ 2 consultations during 2017 and had 1-year follow-up data available were included. Main outcomes were demographics, comorbidities, medication, clinical and healthcare resource use and costs. The relationship between SABA overuseand healthcare costs, and between asthma severity and healthcare costs was determined. RESULTS This SABA use IN Asthma (SABINA) study included 39,555 patients, mean (standard deviation, SD) age 49.8 (20.7) years; 64.2% were female. Charlson comorbidity index was 0.7 (1.0). SABA overuse (≥ 3 canisters/year) was 28.7% (95% CI: 27.7-29.7), with an overall mean number of 3.3 (3.6) canisters/year. Overall, 5.1% of patients were prescribed ≥12 canisters/year. SABA overuse was correlated with healthcare costs (ρ = 0.621; p < 0.001).The adjusted mean annual cost/patient, according to the Global Initiative for Asthma (GINA 2019) classification of asthma severity, was €2,231, €2,345, €2,735, €3,473, and €4,243,for GINA steps 1-5, respectively (p < 0.001). Regardless of asthma severity, SABA overuse yielded a significant increase in healthcare costs per patient and year (€5,702 vs. €1,917, p < 0.001) compared with recommended use (< 2 canisters/year). CONCLUSIONS SABA overuse yields greater costs for the Spanish National Health System. Costs increased according to asthma severity.
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Affiliation(s)
- A Valero
- Sección de Alergología, Servicio de Neumología y Alergia, Hospital Clínic de Barcelona, Spain, Universitat de Barcelona, IDIBAPS, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - J Molina
- CS Francia, Dirección Asistencial Oeste, Fuenlabrada, Madrid, Spain
| | - J Nuevo
- Department of Medical Evidence and Health Economics, AstraZeneca, Madrid, Spain
| | - S Simon
- Department of Medical Evidence and Health Economics, AstraZeneca, Madrid, Spain
| | - M Capel
- Department of Medical Evidence and Health Economics, AstraZeneca, Madrid, Spain
| | - A Sicras-Mainar
- Health Economics and Outcomes Research, Real Life Data, Badalona, Barcelona, Spain
| | - A Sicras-Navarro
- Health Economics and Outcomes Research, Real Life Data, Badalona, Barcelona, Spain
| | - V Plaza
- Servei de Pneumologia i Al•lèrgia, Hospital de la Santa Creu i Sant Pau, Institut d´Investigació Biomèdica Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
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Escobar C, Aranda U, Palacios B, Capel M, Sicras A, Sicras A, Hormigo A, Alcázar R, Manito N, Botana M. Epidemiology, clinical profile, management, and two-year risk complications among patients with chronic kidney disease in Spain. Nefrologia 2021; 41:670-688. [PMID: 36165157 DOI: 10.1016/j.nefroe.2022.01.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 01/14/2021] [Accepted: 03/20/2021] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVES To describe the epidemiology, clinical profile, treatments, and to determine cardiovascular and renal outcomes after two years of follow-up in a contemporary chronic kidneay disease (CKD) population in Spain. This was also analyzed among the DAPA-CKD-like population (patients who met most inclusion criteria of DAPA-CKD trial). METHODS Observational, retrospective, population-based study using BIG-PAC database. The CKD population was defined as patients ≥18 years, with at least one diagnostic code of CKD prior to the index date (January 1st, 2018). CKD was defined as estimated glomerular filtration rate (eGFR) <60mL/min/1.73m2 (CKD-EPI), or albuminuria >30mg/g. RESULTS We identified 56,435 CKD patients after exclusions (76.4 years, 52.2% men, urine albumin-to-creatinine ratio 390.8mg/g, eGFR 49.7mL/min/1.73m2). CKD prevalence was 4.91% and incidence 2.10 per 1000 patient-years. Regarding treatments, 69.2% were taking renin-angiotensin system inhibitors (only 4.2% at maximal doses) and 3.5% of diabetic patients SGLT-2 inhibitors. During the two years of follow-up, rates of heart failure, all-cause death, myocardial infarction, stroke, and CKD were 17.9, 12.1, 7.2, 6.3, and 5.9 events per 100 patient-years, respectively. During this period, 44% of patients were hospitalized, and 6.8% died during hospitalization. Cardiovascular outcomes were more common in the DAPA-CKD-like population. CONCLUSIONS In Spain, CKD population is older and comorbidities, including diabetes and heart failure, are common. Cardiovascular and renal outcomes are frequent. There is room for improvement in CKD management, particularly through the use of drugs with proven cardiovascular and renal benefit.
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Affiliation(s)
| | | | | | | | - Antoni Sicras
- Health Economics and Outcomes Research, Atrys Health, Barcelona, Spain
| | - Aram Sicras
- Health Economics and Outcomes Research, Atrys Health, Barcelona, Spain
| | | | | | - Nicolás Manito
- Hospital de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
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Escobar C, Varela L, Palacios B, Capel M, Sicras-Mainar A, Sicras-Navarro A, Hormigo A, Alcázar R, Manito N, Botana M. Clinical characteristics, management, and one-year risk of complications among patients with heart failure with and without type 2 diabetes in Spain. Rev Clin Esp 2021; 222:195-204. [PMID: 34511336 DOI: 10.1016/j.rceng.2021.04.005] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 04/09/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This work aims to describe the clinical characteristics and therapeutic management and to determine cardiovascular outcomes after one year of follow-up in a contemporaneous population with heart failure (HF) with and without type 2 diabetes in Spain. These factors were also analyzed in the DAPA-HF-like population (patients who met most inclusion criteria of the DAPA-HF trial) and in patients treated with SGLT2 inhibitors at baseline. METHODS This work is an observational, retrospective, population-based study using the BIG-PAC database. The index date was January 1, 2019. People aged ≥ 18 years who received care for HF in 2019 were selected. Events that occurred in 2019 were analyzed. RESULTS We identified 21,851 patients with HF (age 78.0 ± 11.3 years, 53.0% men, 50.9% with HF with reduced left ventricular ejection fraction, 44.5% in NYHA functional class II). HF prevalence was 1.88% and incidence was 2.83 per 1,000 person-years. Regarding HF treatments, 66.1% were taking renin-angiotensin system inhibitors, 69.4% beta blockers, 31.2% aldosterone antagonists, and 7.5% sacubitril/valsartan. During the year of follow-up, 29.8% had HF decompensation which led to hospitalization (mean time to first event of 120.9 ± 72.5 days), 12.3% died, and 8.1% died during hospitalization. Events were more common among patients with type 2 diabetes. Hospitalizations for HF were more common in the DAPA-HF-like population. CONCLUSIONS In Spain, the population with HF is elderly and has many comorbidities. Approximately half of patients have HF with reduced left ventricular ejection fraction. There is room for improvement in HF management, particularly through the use of drugs that reduce both HF hospitalization and mortality, in order to reduce the burden of HF.
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Affiliation(s)
- C Escobar
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain.
| | - L Varela
- Departamento médico, AstraZeneca Spain
| | | | - M Capel
- Departamento médico, AstraZeneca Spain
| | - A Sicras-Mainar
- Investigación sobre economía y resultados de la salud, Atrys Health, Barcelona, Spain
| | - A Sicras-Navarro
- Investigación sobre economía y resultados de la salud, Atrys Health, Barcelona, Spain
| | - A Hormigo
- Centro de Salud de Atención Primaria Puerta Blanca, Málaga, Spain
| | - R Alcázar
- Servicio de Nefrología, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - N Manito
- Unidad de Insuficiencia Cardíaca Avanzada y Trasplante Cardíaco, Hospital de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - M Botana
- Servicio de Endocrinología, Hospital Universitario Lucus Augusti, Lugo, Spain
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Escobar C, Aranda U, Palacios B, Capel M, Sicras A, Sicras A, Hormigo A, Alcázar R, Manito N, Botana M. Epidemiology, clinical profile, management, and two-year risk complications among patients with chronic kidney disease in Spain. Nefrologia 2021; 41:S0211-6995(21)00101-6. [PMID: 34148667 DOI: 10.1016/j.nefro.2021.03.006] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/07/2021] [Accepted: 03/20/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To describe the epidemiology, clinical profile, treatments, and to determine cardiovascular and renal outcomes after two years of follow-up in a contemporary chronic kidneay disease (CKD) population in Spain. This was also analyzed among the DAPA-CKD-like population (patients who met most inclusion criteria of DAPA-CKD trial). METHODS Observational, retrospective, population-based study using BIG-PAC database. The CKD population was defined as patients ≥18 years, with at least one diagnostic code of CKD prior to the index date (January 1st, 2018). CKD was defined as estimated glomerular filtration rate (eGFR) <60mL/min/1.73m2 (CKD-EPI), or albuminuria >30mg/g. RESULTS We identified 56,435 CKD patients after exclusions (76.4 years, 52.2% men, urine albumin-to-creatinine ratio 390.8mg/g, eGFR 49.7mL/min/1.73m2). CKD prevalence was 4.91% and incidence 2.10 per 1000 patient-years. Regarding treatments, 69.2% were taking renin-angiotensin system inhibitors (only 4.2% at maximal doses) and 3.5% of diabetic patients SGLT-2 inhibitors. During the two years of follow-up, rates of heart failure, all-cause death, myocardial infarction, stroke, and CKD were 17.9, 12.1, 7.2, 6.3, and 5.9 events per 100 patient-years, respectively. During this period, 44% of patients were hospitalized, and 6.8% died during hospitalization. Cardiovascular outcomes were more common in the DAPA-CKD-like population. CONCLUSIONS In Spain, CKD population is older and comorbidities, including diabetes and heart failure, are common. Cardiovascular and renal outcomes are frequent. There is room for improvement in CKD management, particularly through the use of drugs with proven cardiovascular and renal benefit.
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Affiliation(s)
- Carlos Escobar
- Cardiology department, University hospital La Paz, Madrid, Spain.
| | - Unai Aranda
- Medical Department, AstraZeneca Farmaceutica, Madrid, Spain
| | | | - Margarita Capel
- Pricing & Health Economics and Outcomes Research, AstraZeneca Farmaceutica, Madrid, Spain
| | - Antoni Sicras
- Health Economics and Outcomes Research, Atrys Health, Barcelona, Spain
| | - Aram Sicras
- Health Economics and Outcomes Research, Atrys Health, Barcelona, Spain
| | | | - Roberto Alcázar
- Nephrology department, University hospital Infanta Leonor, Madrid, Spain
| | - Nicolás Manito
- Department of Heart Failure and Transplant, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Manuel Botana
- Endocrine department, University Hospital Lucus Augusti, Lugo, Spain
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Escobar C, Palacios B, Aranda U, Capel M, Sicras A, Sicras A, Hormigo A, Alcázar R, Manito N, Botana M. Costs and healthcare utilisation of patients with chronic kidney disease in Spain. BMC Health Serv Res 2021; 21:536. [PMID: 34074269 PMCID: PMC8167969 DOI: 10.1186/s12913-021-06566-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 03/08/2021] [Accepted: 05/20/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Data about the impact of chronic kidney disease (CKD) on health care costs in Spain are scarce This study was aimed to evaluate cumulative costs and healthcare utilisation in CKD in Spain. METHODS Observational, retrospective, population-based study, which included adults who received care for CKD between 2015 and 2019. Healthcare and medication costs were summarized on a yearly basis starting from the index date (1st January 2015), and then cumulatively until 2019. RESULTS We identified 44,214 patients with CKD (year 2015: age 76.4 ± 14.3 years, 49.0% women, albumin-to-creatinine ratio 362.9 ± 176.8 mg/g, estimated glomerular filtration rate 48.7 ± 13.2 mL/min/1.73 m2). During the 2015-2019 period, cumulative CKD associated costs reached 14,728.4 Euros, being cardiovascular disease hospitalizations, particularly due to heart failure and CKD, responsible for 77.1% of costs. Total medication cost accounted for 6.6% of the total cost. There was a progressive decrease in cardiovascular disease hospital costs per year (from 2741.1 Euros in 2015 to 1.971.7 Euros in 2019). This also occurred with cardiovascular and diabetic medication costs, as well as with the proportion of hospitalizations and mortality. Costs and healthcare resources use were higher in the DAPA-CKD like population, but also decreased over time. CONCLUSIONS Between 2015 and 2019, costs of patients with CKD in Spain were high, with cardiovascular hospitalizations as the key determinant. Medication costs were responsible for only a small proportion of total CKD costs. Improving CKD management, particularly with the use of cardiovascular and renal protective medications may be helpful to reduce CKD burden.
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Affiliation(s)
| | | | - Unai Aranda
- AstraZeneca Farmacéutica Spain, SA, Barcelona, Spain
| | | | - Antoni Sicras
- Health Economics and Outcomes Research, Atrys Health, Barcelona, Spain
| | - Aram Sicras
- Health Economics and Outcomes Research, Atrys Health, Barcelona, Spain
| | | | | | - Nicolás Manito
- Hospital de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
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Escobar C, Varela L, Palacios B, Capel M, Sicras A, Sicras A, Hormigo A, Alcázar R, Manito N, Botana M. Costs and healthcare utilisation of patients with heart failure in Spain. BMC Health Serv Res 2020; 20:964. [PMID: 33081776 PMCID: PMC7576860 DOI: 10.1186/s12913-020-05828-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [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: 07/29/2020] [Accepted: 10/15/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Increasing the knowledge about heart failure (HF) costs and their determinants is important to ascertain how HF management can be optimized, leading to a significant decrease of HF costs. This study evaluated the cumulative costs and healthcare utilisation in HF patients in Spain. METHODS Observational, retrospective, population-based study using BIG-PAC database, which included data from specialized and primary care of people ≥18 years, from seven autonomous communities in Spain, who received care for HF between 2015 and 2019. The healthcare and medication costs were summarized on a yearly basis starting from the index date (1st January 2015), and then cumulatively until 2019. RESULTS We identified 17,163 patients with HF (year 2015: mean age 77.3 ± 11.8 years, 53.5% men, 51.7% systolic HF, 43.6% on NYHA functional class II). During the 2015-2019 period, total HF associated costs reached 15,373 Euros per person, being cardiovascular disease hospitalizations the most important determinant (75.8%), particularly HF hospitalizations (51.0%). Total medication cost accounted for 7.0% of the total cost. During this period, there was a progressive decrease of cardiovascular disease hospital costs per year (from 2834 Euros in 2015 to 2146 Euros in 2019, P < 0.001), as well as cardiovascular and diabetic medication costs. CONCLUSIONS During the 2015-2019 period, costs of HF patients in Spain were substantial, being HF hospitalizations the most important determinant. Medication costs represented only a small proportion of total costs. Improving HF management, particularly through the use of drugs that reduce HF hospitalization may be helpful to reduce HF burden.
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Affiliation(s)
| | | | | | | | - Antoni Sicras
- Health Economics and Outcomes Research, Atrys Health, Barcelona, Spain
| | - Aram Sicras
- Health Economics and Outcomes Research, Atrys Health, Barcelona, Spain
| | | | | | - Nicolás Manito
- Hospital de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
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Capel M, Ciudin A, Mareque M, Rodríguez-Rincón RM, Simón S, Oyagüez I. Cost-Effectiveness Analysis of Exenatide versus GLP-1 Receptor Agonists in Patients with Type 2 Diabetes Mellitus. Pharmacoecon Open 2020; 4:277-286. [PMID: 31338828 PMCID: PMC7248155 DOI: 10.1007/s41669-019-0171-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The aim of this study was to assess the efficiency of exenatide 2 mg/week compared with other glucagon-like peptide-1 (GLP-1) receptor agonists (dulaglutide 1.5 mg/week, liraglutide 1.2 mg/day, liraglutide 1.8 mg/day and lixisenatide 20 μg/day) in adult patients with type 2 diabetes mellitus (T2DM) not adequately controlled on metformin alone from the perspective of the Spanish National Health System (NHS). METHODS Quality-adjusted life-years (QALYs) gained and total costs of each assessed drug combined with metformin (2 g/day) were estimated over a 40-year time horizon using the Cardiff Diabetes Model (based on UK Prospective Diabetes Study [UKPDS] 68 equations), which simulates disease progression considering the T2DM-related micro- and macrovascular complications, hypoglycaemia, nausea, body mass index (BMI) changes and treatment discontinuation due to adverse effects (AEs). Drug efficacy derived from an indirect comparison performed in a network meta-analysis. Patient characteristics were obtained from the literature. The baseline utility value (0.80) was derived from the PANORAMA study, applying utility decrements to micro- and macrovascular complications, hypoglycaemia episodes and changes in BMI. Treatment discontinuation due to AEs or poorly controlled diabetes (HbA1c > 7.5%) involved switching to second-line (basal insulin) or third-line (basal-bolus insulin) treatment. Total cost (€, 2018) included the costs of drug acquisition, hypoglycaemia, weight gain, micro- and macrovascular complications, nausea and treatment discontinuation due to AEs. An annual discount rate of 3% was applied to costs and outcomes. Deterministic and probabilistic sensitivity analyses (SA) were performed. RESULTS In base-case, exenatide 2 mg/week resulted in more QALYs (8.26) than dulaglutide 1.5 mg/week (8.19 QALYs), liraglutide 1.2 mg/day (8.10 QALYs), liraglutide 1.8 mg/day (8.20 QALYs) and lixisenatide 20 μg/day (8.13 QALYs). Total cost/patient was €20,423.27 (exenatide 2 mg/week), €22,611.94 (dulaglutide 1.5 mg/week), €21,065.97 (liraglutide 1.2 mg/day), €24,865.69 (liraglutide 1.8 mg/day) and €21,334.58 (lixisenatide 20 μg/day). Deterministic SA confirmed the robustness of the model. In the probabilistic SA, 95-99% of the 1000 Monte Carlo iterations performed were under a hypothetical willingness-to-pay threshold of €20,000/QALY gained. CONCLUSIONS Exenatide 2 mg/week would be a dominant strategy (more effective and less costly) versus the other GLP-1 receptor agonists assessed for the treatment of T2DM patients who are not adequately controlled on metformin alone.
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Affiliation(s)
| | | | - María Mareque
- Pharmacoeconomics and Outcomes Research Iberia (PORIB), Paseo Joaquín Rodrigo 4-I, Pozuelo de Alarcón, 28224, Madrid, Spain.
| | | | | | - Itziar Oyagüez
- Pharmacoeconomics and Outcomes Research Iberia (PORIB), Paseo Joaquín Rodrigo 4-I, Pozuelo de Alarcón, 28224, Madrid, Spain
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Sicras-Mainar A, Capel M, Navarro-Artieda R, Nuevo J, Orellana M, Resler G. Real-life retrospective observational study to determine the prevalence and economic burden of severe asthma in Spain. J Med Econ 2020; 23:492-500. [PMID: 31958257 DOI: 10.1080/13696998.2020.1719118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Indexed: 12/29/2022]
Abstract
Objective: We determined the percentage of patients with severe asthma and exacerbations and evaluated the costs of the disease based on blood eosinophil counts.Methods: A retrospective observational study based on the review of medical records in Spain was carried out. Patients ≥18 years of age requiring care during the years 2014-2015; diagnosed with asthma with at least 2 years of continuous records (at least one year prior to the index date defined as the first asthma medication prescription and at least one year after the index date) were included. Study groups: eosinophil counts <300 cells/μl and ≥300 cells/μl. Main variables: comorbidity, clinical parameters, exacerbations and annual asthma total costs.Results: A total of 268 severe asthmatic patients in Spain were included, representing 6.3% of the asthma population, with 58.6% having eosinophil count ≥300 cells/μl and 41.4% eosinophil count <300 cells/μl. The mean age was 56.1 years (63.4% women). Patients with eosinophilic inflammation (≥300 cells/μl) had lower FEV1 values (54.3% vs. 60.7%; p < .001), poorer treatment adherence (65.6% vs. 77.3%; p < .001), and a greater mean number of exacerbations (3.3 vs. 1.9; p < .001). Exacerbations were correlated to FEV1 (β=‒.606), eosinophils (β = .255), immunoglobulin E (β = .152), and age (β = .128), p < .001. The mean total asthma annual cost (ANCOVA) was 6222 vs. 4152 euros, respectively (p = .016). Health costs were associated with age (β = .323), FEV1 (β = .239), eosinophils (β = .177) and exacerbations (β = .158), p < .01.Limitations: Those inherent to retrospective studies; the possible inaccuracy of diagnostic coding referring to severe asthma and other comorbidities and the external validity of the results.Conclusions: Health costs of patients with severe asthma were high. Total annual asthma costs and resource use were greater in patients with ≥300 cells/μl. Age, eosinophilia, exacerbations and FEV1 were associated with greater resource utilization and costs for the health system.
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Affiliation(s)
| | - Margarita Capel
- Health Economics and Outcomes Research, AstraZeneca, Madrid, Spain
| | | | - Javier Nuevo
- Medical Evidence Observational Research, AstraZeneca, Madrid, Spain
| | | | - Gustavo Resler
- Medical and Regulatory Affairs, AstraZeneca, Madrid, Spain
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Zozaya N, Capel M, Simón S, Soto-González A. A systematic review of economic evaluations in non-insulin antidiabetic treatments for patients with type 2 diabetes mellitus. Global & Regional Health Technology Assessment 2019. [DOI: 10.1177/2284240319876574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The approval of new non-insulin treatments has broadened the therapeutic arsenal, but it has also increased the complexity of choice for the treatment of type 2 diabetes mellitus (DM2). The objective of this study was to systematically review the literature on economic evaluations associated with non-insulin antidiabetic drugs (NIADs) for DM2. We searched in Medline, IBECS, Doyma and SciELO databases for full economic evaluations of NIADs in adults with DM2 applied after the failure of the first line of pharmacological treatment, published between 2010 and 2017, focusing on studies that incorporated quality-adjusted life years (QALYs). The review included a total of 57 studies, in which 134 comparisons were made between NIADs. Under an acceptability threshold of 25,000 euros per QALY gained, iSLGT-2 were preferable to iDPP-4 and sulfonylureas in terms of incremental cost-utility. By contrast, there were no conclusive comparative results for the other two new NIAD groups (GLP-1 and iDPP-4). The heterogeneity of the studies’ methodologies and results hindered our ability to determine under what specific clinical assumptions some NIADs would be more cost-effective than others. Economic evaluations of healthcare should be used as part of the decision-making process, so multifactorial therapeutic management strategies should be established based on the patients’ clinical characteristics and preferences as principal criteria.
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Affiliation(s)
- Néboa Zozaya
- Department of Health Economics, Weber Economía y Salud, Madrid, Spain
- University of Las Palmas de Gran Canaria, Las Palmas, Spain
| | | | | | - Alfonso Soto-González
- Department of Endocrinology and Nutrition, Gerencia de Gestión Integrada de A Coruña, A Coruña, Spain
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Peña-Longobardo LM, Rodríguez-Sánchez B, Mata-Cases M, Rodríguez-Mañas L, Capel M, Oliva-Moreno J. Is quality of life different between diabetic and non-diabetic people? The importance of cardiovascular risks. PLoS One 2017; 12:e0189505. [PMID: 29240836 PMCID: PMC5730158 DOI: 10.1371/journal.pone.0189505] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 11/28/2017] [Indexed: 12/20/2022] Open
Abstract
Background To analyse and compare the impact of cardiovascular risk factors and disease on health-related quality of life (HRQoL) in people with and without diabetes living in the community. Methods We used data of 1,905 people with diabetes and 19,031 people without diabetes from the last Spanish National Health Survey (years 2011–2012). The HRQoL instrument used was the EuroQol 5D-5L, based on time trade-off scores. Matching methods were used to assess any differences in the HRQoL in people with and without diabetes with the same characteristics (age, gender, education level, and healthy lifestyle), according to cardiovascular risk factors and diseases. Disparities were also analysed for every dimension of HRQoL: mobility, daily activities, personal care, pain/discomfort, and anxiety/depression. Results There were no significant differences in time trade-off scores between people with and without diabetes when cardiovascular risk factors or established cardiovascular disease were not present. However, when cardiovascular risk factors were present, the HRQoL score was significantly lower in people with diabetes than in those without. This difference was indeed greater when cardiovascular diseases were present. More precisely, people with diabetes and any of the cardiovascular risk factors, who have not yet developed any cardiovascular disease, report lower HRQoL, 0.046 TTO score points over 1 (7.93 over 100 in the VAS score) compared to those without diabetes, and 0.14 TTO score points of difference (14.61 over 100 in the VAS score) if cardiovascular diseases were present. In fact, when the three risk factors were present in people with diabetes, HRQoL was significantly lower (0.10 TTO score points over 1 and 10.86 points over 100 in VAS score), obesity being the most influential risk factor. Conclusions The presence of established cardiovascular disease and/or cardiovascular risk factors, specially obesity, account for impaired quality of life in people with diabetes.
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Affiliation(s)
- L. M. Peña-Longobardo
- University of Castilla-La Mancha, Department of Economic Analysis and Finance, Toledo, Spain
- * E-mail:
| | - B. Rodríguez-Sánchez
- University of Groningen, Department of Economics, Econometrics and Finance, Groningen, The Netherlands
| | - M. Mata-Cases
- Primary Health Care Center La Mina, Gerència d’Àmbit d’Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | | | - M. Capel
- Astrazeneca, Health Economics and Outcomes Research, Madrid, Spain
| | - J. Oliva-Moreno
- University of Castilla-La Mancha, Department of Economic Analysis and Finance, Toledo, Spain
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Abstract
This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. It provides recommendations on the assessments and interventions for this group of patients receiving palliative and supportive care. Recommendations • Palliative and supportive care must be multidisciplinary. (G) • All core team members should have training in advanced communication skills. (G) • Palliative surgery should be considered in selected cases. (R) • Hypofractionated or short course radiotherapy should be considered for local pain control and for painful bony metastases. (R) • All palliative patients should have a functional endoscopic evaluation of swallowing (FEES) assessment of swallow to assess for risk of aspiration. (G) • Pain relief should be based on the World Health Organization pain ladder. (R) • Specialist pain management service involvement should be considered early for those with refractory pain. (G) • Constipation should be avoided by the judicious use of prophylactic laxatives and the correction of systemic causes such as dehydration, hypercalcaemia and hypothyroidism. (G) • Organic causes of confusion should be identified and corrected where appropriate, failing this, treatment with benzodiazepines or antipsychotics should be considered. (G) • Patients with symptoms suggestive of spinal metastases or metastatic cord compression must be managed in accordance with the National Institute for Health and Care Excellence guidance. (R) • Cardiopulmonary resuscitation is inappropriate in the palliative dying patient. (R) • 'Do not attempt cardiopulmonary resuscitation' orders should be completed and discussed with the patient and/or the family unless good reasons exist not to do so where appropriate. This is absolutely necessary when a patient's care is to be managed at home. (G).
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Affiliation(s)
- H Cocks
- ENT Department, City Hospitals Sunderland, Sunderland, UK
| | - K Ah-See
- Department of Otolaryngology – Head and Neck Surgery, Aberdeen Royal Infirmary, Aberdeen, UK
| | - M Capel
- George Thomas Hospice Care, Ty George Thomas, Park Road, Whitchurch, Cardiff, UK
| | - P Taylor
- St Benedict's Hospice, Sunderland, UK
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Gohary K, Leslie KE, Ford J, Capel M, LeBlanc SJ, Duffield TF. Effect of administration of recombinant bovine somatotropin on health and performance of lactating dairy cows diagnosed with hyperketonemia. J Dairy Sci 2015; 98:4392-400. [PMID: 25935251 DOI: 10.3168/jds.2014-8235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 04/14/2014] [Accepted: 03/25/2015] [Indexed: 11/19/2022]
Abstract
The effect of administering recombinant bovine somatotropin (rbST) to cows with hyperketonemia during the early postpartum period on health, metabolic parameters, milk production, and early reproductive performance was evaluated in a double-blinded clinical trial. Cows from 8 dairy herds in New York State were tested weekly between 3 and 16d in milk for elevated serum β-hydroxybutyrate. Cows were enrolled in the study when blood β-hydroxybutyrate was ≥1.3mmol/L for the first time. Enrolled cows were randomly assigned to a treatment (n=273) or placebo control (n=270) group. Treated cows were given 325mg of rbST subcutaneously on the day of enrollment and again 14d later. Control cows received the same regimen except the syringe contained only the carrier without somatotropin. After enrollment, blood samples were collected weekly for 4wk and submitted to the laboratory to be analyzed for selected metabolites. Risk ratios for clinical diseases subsequent to treatment were calculated using Poisson regression. Continuous data were analyzed using linear mixed models. Time to first insemination was assessed with survival analysis. In the 42d following the first administration of rbST, incidence risks of displaced abomasum, clinical ketosis, metritis, clinical mastitis, and lameness were not different between treatment groups. Cows treated with rbST had a slightly lower body condition score 28d after enrollment compared with control cows. In the 4wk following enrollment, serum nonesterified fatty acids and aspartate amino-transferase were slightly higher for treated than control cows, respectively. Serum glucose, calcium, haptoglobin, and β-hydroxybutyrate were similar between groups. Treatment had no effect on resolution of hyperketonemia in any of the 4wk after enrollment. Milk production in either of the 2-wk periods after each treatment was not different between treated and control cows. Furthermore, milk production was not different between groups from enrollment to 98d in milk (42.6±0.6 and 42.1±0.7kg/d for treatment and control groups, respectively). Treatment had no effect on time to first insemination (83 and 74d in milk for treatment and control groups, respectively; hazard ratio=0.72) or first insemination pregnancy risk (27 and 29% for treatment and control groups, respectively; risk ratio=0.92). Based on the current results, it is not recommended to use a low dose of rbST as therapy for cows with hyperketonemia.
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Affiliation(s)
- K Gohary
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, Ontario, N1G 2W1, Canada
| | - K E Leslie
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, Ontario, N1G 2W1, Canada
| | - J Ford
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, Ontario, N1G 2W1, Canada
| | - M Capel
- Perry Veterinary Clinic, Perry, NY 14530
| | - S J LeBlanc
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, Ontario, N1G 2W1, Canada
| | - T F Duffield
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, Ontario, N1G 2W1, Canada.
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Vila M, Viñas L, Aguilar I, Toro C, Pérez A, Capel M. PS-055 The incidence of drug allergies in hospitalised patients. Eur J Hosp Pharm 2015. [DOI: 10.1136/ejhpharm-2015-000639.380] [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] Open
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Capel M, Lopez-Sendon JL, Heras M, Carrera FJ, Brosa M. Cost Effectiveness Analysis Of Ticagrelor Versus Generic Clopidogrel In The Treatment Of Patients With Acute Coronary Syndrome In Spain. Value Health 2014; 17:A491. [PMID: 27201460 DOI: 10.1016/j.jval.2014.08.1452] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | | | - M Heras
- Clinic Hospital, Barcelona, Spain
| | | | - M Brosa
- Oblikue Consulting, Barcelona, Spain
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Sánchez-Covisa J, Franch J, Mauricio D, López-Martínez N, Chuang LH, Capel M. The Cost-Effectiveness Of Saxagliptin When Added To Metformin And Sulphonylurea In The Treatment Of Type 2 Diabetes Mellitus In Spain. Value Health 2014; 17:A350. [PMID: 27200676 DOI: 10.1016/j.jval.2014.08.726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | - J Franch
- EAP Raval Sud- Institut Català de la Salut - USR Barcelona ciutat - IDIAP Jordi Gol, Barcelona, Spain
| | - D Mauricio
- Germans Trias i Pujol University Hospital, Barcelona, Spain
| | | | - L H Chuang
- Pharmerit International, Rotterdam, The Netherlands
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Sánchez-Covisa J, Capel M, Baeten S, Verheggen BG. Comparative Cost-Effectiveness Analysis of Adding Twice-Daily Exenatide To Insulin Glargine Versus Adding Insulin Lispro To Treat Type 2 Diabetes In Spain. Value Health 2014; 17:A349-A350. [PMID: 27200673 DOI: 10.1016/j.jval.2014.08.723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | | | - S Baeten
- Pharmerit International, Rotterdam, The Netherlands
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Sánchez-Covisa J, Capel M, Schmidt R, Charokopou M, Verheggen BG. The Cost-Effectiveness of Dapagliflozin In Combination With Insulin for the Treatment of Type 2 Diabetes Mellitus (T2dm) In Spain. Value Health 2014; 17:A350. [PMID: 27200677 DOI: 10.1016/j.jval.2014.08.727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | | | - R Schmidt
- Pharmerit International, Rotterdam, The Netherlands
| | - M Charokopou
- Pharmerit International, Rotterdam, The Netherlands
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Cisneros C, Quiralte J, Capel M, Casado MÁ, Mellstrom C. Análisis coste-efectividad de budesonida/formoterol en el tratamiento de mantenimiento y a demanda (Symbicort SMART®) frente a salmeterol/fluticasona más terbutalina, en el tratamiento del asma persistente en España. ACTA ACUST UNITED AC 2013. [DOI: 10.1007/bf03321485] [Citation(s) in RCA: 3] [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: 11/28/2022]
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Chapinal N, LeBlanc S, Carson M, Leslie K, Godden S, Capel M, Santos J, Overton M, Duffield T. Herd-level association of serum metabolites in the transition period with disease, milk production, and early lactation reproductive performance. J Dairy Sci 2012; 95:5676-82. [DOI: 10.3168/jds.2011-5132] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 06/16/2012] [Indexed: 11/19/2022]
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Chapinal N, Carson M, LeBlanc S, Leslie K, Godden S, Capel M, Santos J, Overton M, Duffield T. The association of serum metabolites in the transition period with milk production and early-lactation reproductive performance. J Dairy Sci 2012; 95:1301-9. [DOI: 10.3168/jds.2011-4724] [Citation(s) in RCA: 140] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Accepted: 11/09/2011] [Indexed: 12/15/2022]
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Abstract
OBJECTIVE The objective of this study was to carry out a long-term cost-effectiveness analysis of rosuvastatin compared with generic atorvastatin in the treatment of patients at high cardiovascular (CV) risk (≥ 5% Systematic COronary Risk Evaluation [SCORE]) and patients with prior cardiovascular disease (CVD) in Spain. METHODS The efficacy data from the Statin Therapies for Elevated Lipid Levels compared Across doses to Rosuvastatin (STELLAR) study were used to simulate achievement of low-density lipoprotein cholesterol targets with different doses of rosuvastatin and generic atorvastatin for an initial period of 1 year. A Markov model was used to estimate the number of CV complications, quality-adjusted life years (QALYs), and healthcare costs (lipid-lowering treatment and CV events) for up to 20 years after initial treatment. The analysis was carried out from the perspective of the Spanish National Health System, with costs (in year 2010 euros) and effects being discounted at 3% per year. RESULTS Compared with generic atorvastatin, rosuvastatin was cost-effective (cost per QALY gained of less than €30,000) for the primary prevention of CV events in high-risk patients in most sub-groups analyzed. In patients with prior CVD, rosuvastatin was cost-effective in all sub-groups of men and most sub-groups of women. Key limitations of this study were the need to extrapolate data from a single trial to long-term modeled outcomes and the absence of other treatment options in the analysis. CONCLUSIONS For the treatment of dyslipidemic patients with high CV risk, rosuvastatin is more effective than generic atorvastatin in terms of survival and quality-of-life adjusted survival, with incremental cost-effectiveness ratios within the range generally used in Spain, in most sub-populations defined by various combinations of CV risk factors.
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Quirce S, Barcina C, Plaza V, Calvo E, Muñoz M, Ampudia R, Capel M. A comparison of budesonide/formoterol maintenance and reliever therapy versus conventional best practice in asthma management in Spain. J Asthma 2011; 48:839-47. [PMID: 21942354 DOI: 10.3109/02770903.2011.611954] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To study the effectiveness and safety in a real-life setting of budesonide/formoterol (Symbicort) Maintenance And Reliever Therapy® (Symbicort SMART®), a simplified management approach with one inhaler, compared with conventional best practice (CBP) with multiple inhalers in patients with persistent asthma. DESIGN Open-label randomized controlled parallel-group trial, 6-month treatment. PARTICIPANTS A total of 654 adult patients, with persistent asthma receiving treatment with inhaled corticosteroids (ICS), either alone or in conjunction with long-acting β(2)-agonist. MAIN OUTCOME MEASURES Time to first severe asthma exacerbation and number of severe asthma exacerbations. RESULTS No difference between groups was seen in time to first severe exacerbation (p = .2974). Exacerbation rates were low in both groups. A total of 22 patients in the Symbicort SMART group experienced a total of 24 severe asthma exacerbations, and 31 patients in the CBP group experienced a total of 34 severe asthma exacerbations (annual rate 0.16 vs. 0.22, p = .2869). The mean daily dose of ICS expressed in beclomethasone dipropionate equivalent was significantly lower in the Symbicort SMART group (including as-needed use) versus the CBP group (799 μg vs.1184 μg; p < .001). Mean scores in Asthma Control Questionnaire, five-question version, improved significantly in the SMART group compared with the CBP group (p = .0292). Symbicort SMART and CBP were equally well tolerated. The mean drug cost per patient per 6 months was lower for the patients in the SMART group compared with patients receiving CBP (€295.32 vs. €387.98, p < .0001). CONCLUSIONS A simplified regimen using budesonide/formoterol maintenance and reliever therapy (Symbicort SMART) was at least as effective at improving clinical control compared with CBP with a significantly lower ICS dose and lower drug costs.
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Affiliation(s)
- Santiago Quirce
- Department of Allergy, Hospital La Paz, IdiPAZ, Madrid, Spain.
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Chapinal N, Carson M, Duffield T, Capel M, Godden S, Overton M, Santos J, LeBlanc S. The association of serum metabolites with clinical disease during the transition period. J Dairy Sci 2011; 94:4897-903. [DOI: 10.3168/jds.2010-4075] [Citation(s) in RCA: 230] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Accepted: 06/02/2011] [Indexed: 11/19/2022]
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Capel M, Vout L, Gazi T. Outcome of referrals to a community specialist palliative care service, where do patients die? BMJ Support Palliat Care 2011. [DOI: 10.1136/bmjspcare-2011-000105.45] [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: 11/04/2022]
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Kourinov I, Ealick SE, Capel M, Banerjee S, Murphy F, Neau D, Perry K, Rajashankar K, Schuermann J, Sukumar N. NE-CAT crystallography beamlines for challenging structural biology research. Acta Crystallogr A 2011. [DOI: 10.1107/s0108767311087770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Kourinov I, Ealick E, Capel M, Lynch E, Murphy F, Rajashankar K, Sukumar N, Unik P, Withrow J. NorthEastern Collaborative Access Team (NE-CAT) beam lines at the Advanced Photon Source. Acta Crystallogr A 2008. [DOI: 10.1107/s0108767308094300] [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: 11/10/2022] Open
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37
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Teplitsky A, Feinberg H, Gilboa R, Lapidot A, Mechaly A, Stojanoff V, Capel M, Shoham Y, Shoham G. Crystallization and preliminary X-ray analysis of the thermostable alkaline-tolerant xylanase from Bacillus stearothermophilus T-6. Acta Crystallogr D Biol Crystallogr 2005; 53:608-11. [PMID: 15299894 DOI: 10.1107/s0907444997002734] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The extracellular thermostable xylanase (XT-6) produced by the thermophilic bacterium Bacillus stearothermophilus T-6 was shown to bleach pulp optimally at pH 9 and 338 K, and was successfully used in a large-scale biobleaching mill trial. The xylanase gene was cloned and sequenced. The mature enzyme consists of 379 amino acids with a calculated molecular weight of 43,808 and pI of 9.0. Crystallographic studies of XT-6 were initiated to study the mechanism of catalysis as well as to provide a structural basis for rational introduction of enhanced thermostability by site-specific mutagenesis. This report describes the crystallization and preliminary crystallographic characterization of the native XT-6 enzyme. The most suitable crystals were obtained by the vapor-diffusion method using ammonium sulfate and 2-methyl-2,4-pentanediol as an organic additive. The crystals belong to a primitive trigonal crystal system (space group P3(1) or P3(2)) with room-temperature cell dimensions of a = b = 114.9 and c = 122.6 A. At 103 K the volume of the unit cell decreased significantly with observed dimensions of a = b = 112.2 and c = 122.9 A. These crystals are mechanically strong and diffract X-rays to better than 2.2 A resolution. The crystals exhibit considerable radiation damage at room temperature even at relatively short exposures to X-rays. A full 2.3 A resolution diffraction data set (99.8% completeness) has recently been collected on flash-frozen crystals at 103 K using synchrotron radiation. Two derivatives of XT-6 were recently prepared. In the first derivative, a unique Cys residue replaced Glu265, the putative nucleophile in the active site. The second derivative was selenomethionyl xylanase which was produced biosynthetically. These derivatives have been crystallized and the resulting crystals were shown to be isomorphous to the native crystals and diffract X-rays to comparable resolutions.
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Affiliation(s)
- A Teplitsky
- Department of Inorganic Chemistry, Laboratory for Structural Chemistry and Biology, The Hebrew University of Jerusalem, Israel
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Dai P, Cebe P, Capel M, Alamo R, Mandelkern L. Small and wide-angle X-ray scattering study of metallocene isotactic poly(propylene). J Appl Crystallogr 2000. [DOI: 10.1107/s0021889899013321] [Citation(s) in RCA: 4] [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: 11/11/2022] Open
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Burley SK, Almo SC, Bonanno JB, Capel M, Chance MR, Gaasterland T, Lin D, Sali A, Studier FW, Swaminathan S. Structural genomics: beyond the human genome project. Nat Genet 1999; 23:151-7. [PMID: 10508510 DOI: 10.1038/13783] [Citation(s) in RCA: 275] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
With access to whole genome sequences for various organisms and imminent completion of the Human Genome Project, the entire process of discovery in molecular and cellular biology is poised to change. Massively parallel measurement strategies promise to revolutionize how we study and ultimately understand the complex biochemical circuitry responsible for controlling normal development, physiologic homeostasis and disease processes. This information explosion is also providing the foundation for an important new initiative in structural biology. We are about to embark on a program of high-throughput X-ray crystallography aimed at developing a comprehensive mechanistic understanding of normal and abnormal human and microbial physiology at the molecular level. We present the rationale for creation of a structural genomics initiative, recount the efforts of ongoing structural genomics pilot studies, and detail the lofty goals, technical challenges and pitfalls facing structural biologists.
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Affiliation(s)
- S K Burley
- Howard Hughes Medical Institute, 1230 York Avenue, New York, New York 10021, USA.
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Ban N, Nissen P, Hansen J, Capel M, Moore PB, Steitz TA. Placement of protein and RNA structures into a 5 A-resolution map of the 50S ribosomal subunit. Nature 1999; 400:841-7. [PMID: 10476961 DOI: 10.1038/23641] [Citation(s) in RCA: 310] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We have calculated at 5.0 A resolution an electron-density map of the large 50S ribosomal subunit from the bacterium Haloarcula marismortui by using phases derived from four heavy-atom derivatives, intercrystal density averaging and density-modification procedures. More than 300 base pairs of A-form RNA duplex have been fitted into this map, as have regions of non-A-form duplex, single-stranded segments and tetraloops. The long rods of RNA crisscrossing the subunit arise from the stacking of short, separate double helices, not all of which are A-form, and in many places proteins crosslink two or more of these rods. The polypeptide exit channel was marked by tungsten cluster compounds bound in one heavy-atom-derivatized crystal. We have determined the structure of the translation-factor-binding centre by fitting the crystal structures of the ribosomal proteins L6, L11 and L14, the sarcin-ricin loop RNA, and the RNA sequence that binds L11 into the electron density. We can position either elongation factor G or elongation factor Tu complexed with an aminoacylated transfer RNA and GTP onto the factor-binding centre in a manner that is consistent with results from biochemical and electron microscopy studies.
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Affiliation(s)
- N Ban
- Department of Molecular Biophysics & Biochemistry, Yale University, Howard Hughes Medical Institute, New Haven, Connecticut 06520-8114, USA
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Beckley-Kartey SA, Hotchkiss SA, Capel M. Comparative in vitro skin absorption and metabolism of coumarin (1,2-benzopyrone) in human, rat, and mouse. Toxicol Appl Pharmacol 1997; 145:34-42. [PMID: 9221821 DOI: 10.1006/taap.1997.8154] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The in vitro percutaneous absorption and skin metabolism of coumarin (1,2-benzopyrone) was studied in metabolically viable human, rat (F344), and mouse (CD1 and DBA/2) skin. Following application of [14C]coumarin (3.7 microg/cm2; 0.02% in ethanol) to unoccluded skin in flow-through diffusion cells of a skin absorption model (SAM), the absorption through the skin into the receptor fluid at 72 hr was rapid and extensive in all species, reaching (mean +/- SD) 50.4 + 9.1% of the applied dose in human, 51.3 +/- 7.3% in rat, and 44.9 +/- 13.5% in mouse. When the skin was occluded immediately after exposure, the extent of absorption at 72 hr was enhanced in all species. At 72 hr, substantial amounts of [14C]coumarin were found in unoccluded mouse skin (31.7 +/- 13.6%), with less in human (10.2 +/- 6.5%) and rat (12.7 +/- 5.0%) tissue. When occluded, the skin residues at 72 hr were 10.4 +/- 11.7% (mouse), 8.5 +/- 3.9% (human), and 11.9 +/- 7.5% (rat). The absorption of coumarin through rat skin into the receptor fluid over 72 hr was linearly related to the applied dose (r2 = 0.998 unoccluded skin; r2 = 0.999 occluded skin) over the dose range 3.7 to 378.7 microg/cm2. The nature and extent of cutaneous metabolism was studied following (i) topical application for 24 hr to human, rat, and mouse skin in the SAM system; (ii) incubation at 37 degrees C for up to 6 hr with human, rat, and mouse whole skin homogenates; and (iii) incubation at 37 degrees C for up to 24 hr with freshly isolated and cultured human epidermal keratinocytes. HPLC and GCMS analyses of skin extracts and receptor fluid confirmed that, in all three species, only the parent compound, coumarin, was present at all times from 10 min to 24 hr. These data indicate that topically applied coumarin is rapidly and extensively absorbed through human, rat, and mouse skin, and that the compound remains metabolically unchanged during absorption. These observations may have implications for the safe and effective use of coumarin in consumer products which come into contact with the skin and as a topical therapeutic agent.
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Affiliation(s)
- S A Beckley-Kartey
- Pharmacology and Toxicology, Imperial College School of Medicine at St. Mary's, London, United Kingdom
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Abstract
Previous studies showed that the equatorial diffraction spacing of the collagen molecules in mineralized tissues decreases when the tissue is dried and that the spacing in totally dried tissue is about the same (1.1 nm) whether mineralized or not. Here we report that spacing decreases were observed in both mineralized and unmineralized turkey leg tendon after soaking in various sodium chloride solutions up to 4.0 M concentration. The effect was seen by X-ray diffraction as well as by neutron diffraction. No effect was seen in turkey leg tendon soaked in 3.0 M ethylene glycol solution. The spacing in unmineralized tissue decreased from 1.459 +/- 0.011 nm in 0.15 M saline to 1.403 +/- 0.025 nm in 1.5 M saline, a change of 0.056 +/- 0.03 nm or 3.84%. In mineralized turkey leg tendon the corresponding spacings were 1.387 +/- 0.012 and 1.321 +/- 0.019 nm, a change of 0.046 +/- 0.02 nm or 3.4%. No significant dimensional change was noted in the thickness even though the equatorial diffraction spacing decreased by 3.4%. Electron microscopy showed the collagen fibrils within the mineralized turkey leg tendon to be surrounded by highly mineralized material. Presumably the composition of the extrafibrillar material is different from the intrafibrillar and therefore the extrafibrillar material is a different kind of composite. If it is assumed that the extrafibrillar material does not change dimensions significantly, then the collagen molecules in the fibrils can be mobile within the dimensionally stable cage-like structure.
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Affiliation(s)
- S Lees
- Forsyth Dental Center, 140 Fenway, Boston, Massachusetts 02115, USA
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Knott RB, Capel M, Hansen S, Handschumacher RE. A Small-Angle X-ray Scattering Study of the Binding of Cyclosporin A to Cyclophilin. J Appl Crystallogr 1995. [DOI: 10.1107/s0021889895003268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The small-angle X-ray scattering (SAXS) technique was used to investigate structural characteristics of the protein cyclophilin in solution and to attempt to detect major changes induced by the binding of the immunosuppressant drug cyclosporin A. Maximum-entropy methods were used to analyse the experimental SAXS data. The measured radius of gyration, Rg
, for cyclophilin is 16.3 (5) Å. This is equivalent to a compact sphere of radius 21.0 Å. There is qualitative agreement between the experimental SAXS profiles and the derived distance-distribution function, p(r), for cyclophilin, and similar profiles calculated from the crystallographic structure. The notable discrepancy is the difference of approximately 1.5 Å in the estimated radius of the equivalent sphere. On binding cyclosporin A, the main structure-related change in cyclophilin observed under these experimental conditions is an increased propensity to form oligomers. Meaningful estimates of Rg
for the monomeric complex are not possible because of the presence of a significant population of aggregates. In a second series of experiments, both native cyclophilin and the cyclophilin/cyclosporin A complex readily formed aggregates under the prevailing experimental conditions.
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Kotlarchyk M, Sheu EY, Capel M. Structural and dynamical transformations between neighboring dense microemulsion phases. Phys Rev A 1992; 46:928-939. [PMID: 9908193 DOI: 10.1103/physreva.46.928] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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James VJ, McConnell JF, Capel M. The d-spacing of collagen from mitral heart valves changes with ageing, but not with collagen type III content. Biochim Biophys Acta 1991; 1078:19-22. [PMID: 2049380 DOI: 10.1016/0167-4838(91)90086-f] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A low angle X-ray diffraction study of normal and myxomatous human heart valves has been carried out using a Synchrotron radiation source. This study has shown a slight progressive decrease in the d-spacing of the collagen with age. Despite suggestions reported in the literature, no significant relative change was observed in the d-spacing with the increase in the percentage of collagen type III from 24% in normal to 31% in myxomatous heart valves.
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Affiliation(s)
- V J James
- Department of Biophysics, Rex Vowels Low Angle Diffraction Laboratory, University of New South Wales, Kensington, Australia
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Abstract
We have developed analytical and preparative ion-exchange HPLC methods for the separation of bacterial ribosomal proteins. Proteins separated by the TSK SP-5-PW column were identified with reverse-phase HPLC and gel electrophoresis. The 21 proteins of the small ribosomal subunit were resolved into 18 peaks, and the 32 large ribosomal subunit proteins produced 25 distinct peaks. All peaks containing more than one protein were resolved using reverse-phase HPLC. Peak volumes were typically a few milliliters. Separation times were 90 min for analytical and 5 h for preparative columns. Preparative-scale sample loads ranged from 100 to 400 mg. Overall recovery efficiency for 30S and 50S subunit proteins was approximately 100%. 30S ribosomal subunit proteins purified by this method were shown to be fully capable of participating in vitro reassembly to form intact, active ribosomal subunits.
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Ramakrishnan V, Capel M, Kjeldgaard M, Engelman DM, Moore PB. Positions of proteins S14, S18 and S20 in the 30 S ribosomal subunit of Escherichia coli. J Mol Biol 1984; 174:265-84. [PMID: 6371250 DOI: 10.1016/0022-2836(84)90338-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
A map of the 30 S ribosomal subunit is presented giving the positions of 15 of its 21 proteins. The components located in the map are S1, S3, S4, S5, S6, S7, S8, S9, S10, S11, S12, S14, S15, S18 and S20.
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Bahr JT, Johal S, Capel M, Bourque DP. High specific activity ribulose 1,5-bisphosphate carboxylase-oxygenase from Nicotiana tabacum. Photosynth Res 1981; 2:235-242. [PMID: 24470242 DOI: 10.1007/bf00056260] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/1981] [Indexed: 06/03/2023]
Abstract
Ribulose 1,5-bisphosphate carboxylase (EC.4.1.1.39) has been obtained from Nicotiana tabacum leaf homogenates with specific activites from 0.5 to 0.8 µmol CO2 fixed (mg protein min)(-1). These activities are reconciled with much lower, previously reported activities. The results suggest that if the tobacco enzyme is assayed under optimum conditions there is little difference in the intrinsic specific activities of tobacco and spinach ribulose 1,5-bisphosphate carboxylase. Several factors affecting activity measurements were examined.
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Affiliation(s)
- J T Bahr
- Department of Biochemistry, University of Arizona, 85721, Tucson, AR, USA
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50
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Schindler DW, Kling H, Schmidt RV, Prokopowich J, Frost VE, Reid RA, Capel M. Eutrophication of Lake 227 by Addition of Phosphate and Nitrate: the Second, Third, and Fourth Years of Enrichment, 1970, 1971, and 1972. ACTA ACUST UNITED AC 1973. [DOI: 10.1139/f73-233] [Citation(s) in RCA: 109] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Lake 227, a small lake with extremely low concentrations of dissolved inorganic carbon, was fertilized with PO4 and NO3 for 4 years, beginning in 1969. The additions increased natural inputs of phosphorus and nitrogen about five times.Phytoplankton standing crop increased nearly two orders of magnitude, and the Cryptophyceae and Chrysophyceae present in natural lakes of the area were replaced by Chlorophyta and Cyanophyta. The standing crop of phytoplankton per square meter was near the maximum which could theoretically be maintained by surface light, in spite of the low carbon concentrations. Added phosphate and nitrate were rapidly removed by phytoplankton, so that concentrations in the lake remained low.Almost all of the added nutrient was retained by the lake, in spite of relatively fast water renewal times. An average of 80% of the phosphorus income of the lake was sedimented. There was no return of phosphorus from sediments in spite of anoxic conditions in the hypolimnion.Photosynthesizing plankton reduced dissolved inorganic carbon concentrations severely, causing a flux of atmospheric CO2 into the lake. From 69 to 95% of the inorganic + particulate carbon supplied to the lake was from the atmosphere. Results demonstrate that low carbon concentrations do not hinder eutrophication if phosphorus and nitrogen supplies are adequate.
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