1
|
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
| | | | | |
Collapse
|
2
|
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.
Collapse
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
| | | |
Collapse
|
3
|
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
| | | | | |
Collapse
|
4
|
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
|
5
|
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.
Collapse
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
| | | |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
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.
Collapse
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
| | | |
Collapse
|
8
|
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.
Collapse
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
| | | |
Collapse
|
9
|
Darbà J, Ramírez G, Sicras A, García-Bujalance L, Torvinen S, Sánchez-de la Rosa R. Identification of factors involved in medication compliance: incorrect inhaler technique of asthma treatment leads to poor compliance. Patient Prefer Adherence 2016; 10:135-45. [PMID: 26929605 PMCID: PMC4754100 DOI: 10.2147/ppa.s95303] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To identify the impact of delivery device of inhaled corticosteroids and long-acting β2-agonist (ICS/LABA) on asthma medication compliance, and investigate other factors associated with compliance. MATERIALS AND METHODS We conducted a retrospective and multicenter study based on a review of medical registries of asthmatic patients treated with ICS/LABA combinations (n=2,213) whose medical devices were either dry powder inhalers (DPIs, such as Accuhaler(®), Turbuhaler(®), and NEXThaler(®)) or pressurized metered-dose inhalers (pMDI). Medication compliance included persistence outcomes through 18 months and medication possession ratios. Data on potential confounders of treatment compliance such as asthma exacerbations, comorbidities, demographic characteristics, and health care resource utilization were also explored. RESULTS The probability of asthma medication compliance in case of DPIs was lower compared to pMDIs, which suggests that inhaler devices influence inhalation therapies. There were additional confounding factors that were considered as explanatory variables of compliance. A worse measure of airflow obstruction (forced expiration volume in 1 second), comorbidities and general practitioner (GP) consultations more than once per month decreased the probability of compliance. Within comorbidities, alcoholism was positively associated with compliance. Patients of 29-39, 40-50, and 51-61 age groups or suffering from more than two exacerbations during the study period were more likely to comply with their medication regime. The effects of DPIs toward compliance varied with the different DPIs. For instance, Accuhaler(®) had a greater negative effect on compliance compared to Turbuhaler(®) and Nexthaler(®) in cases of patients who suffered exacerbations. We found that GP consultations reduced the probability of medication compliance for patients treated with formoterol/budesonide combination. For retired patients, visiting the GP increased the probability of medication compliance. CONCLUSION We concluded that inhaler devices influence patients' compliance for long-term asthma medication. The impact of Accuhaler(®), Turbuhaler(®), and NEXThaler(®) on medication compliance was negative. We also identified some confounders of medication compliance such as patient's age, severity of asthma, comorbidities, and health care costs.
Collapse
Affiliation(s)
- Josep Darbà
- Department of Economics, Universitat de Barcelona, Barcelona, Spain
- Correspondence: Josep Darbà, Department of Economics, Universitat de Barcelona, Diagonal 690, 08034 Barcelona, Spain, Email
| | | | - Antoni Sicras
- Department of Planning, Badalona Serveis Assistencials S.A., Barcelona, Spain
| | | | - Saku Torvinen
- Market Access Department, Teva Pharmaceuticals Europe BV, Amsterdam, the Netherlands
| | | |
Collapse
|
10
|
Darbà J, Ramírez G, Sicras A, Francoli P, Torvinen S, Sánchez-de la Rosa R. The importance of inhaler devices: the choice of inhaler device may lead to suboptimal adherence in COPD patients. Int J Chron Obstruct Pulmon Dis 2015; 10:2335-45. [PMID: 26604733 PMCID: PMC4631413 DOI: 10.2147/copd.s90155] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective This study aims to identify factors associated with poor adherence to COPD treatment in patients receiving a fixed-dose combination (FDC) of inhaled corticosteroids and long-acting β2-agonist (ICS/LABA), focusing on the importance of inhaler devices. Methods We conducted a retrospective and multicenter study based on a review of medical registries between 2007 and 2012 of COPD patients (n=1,263) treated with ICS/LABA FDC, whose medical devices were either dry powder inhalers (DPIs) or pressurized metered-dose inhalers (pMDI). Medication adherence included persistence outcomes through 18 months and medication possession ratios. Data on exacerbations, comorbidities, demographic characteristics, and health care resource utilization were also included as confounders of adherence. Results The analyses revealed that COPD patients whose medication was delivered through a DPI were less likely to have medication adherence compared to patients with pMDI, after adjusting for confounding factors, especially active ingredients. Younger groups of patients were less likely to be adherent compared to the oldest group. Smoker men were less likely to be adherent compared to women and non-smokers. Comorbidities decreased the probability of treatment adherence. Those patients that visited their doctor once a month were more likely to adhere to their medication regimen; however, suboptimal adherence was more likely to occur among those patients who visited more than three times per month their doctor. We also found that worsening of COPD is negatively associated with adherence. Conclusion According to this study, inhaler devices influence patients’ adherence to long-term COPD medication. We also found that DPIs delivering ICS/LABA FDC had a negative impact on adherence. Patients’ clinic and socioeconomic characteristics were associated with adherence.
Collapse
Affiliation(s)
- Josep Darbà
- Department of Economics, Universitat de Barcelona, Spain
| | | | - Antoni Sicras
- Dirección de Planificación, Badalona Serveis Assistencials, SA, Barcelona, Spain
| | | | - Saku Torvinen
- Market Access Department, TEVA Pharmaceutical Europe BV, Amsterdam, the Netherlands
| | | |
Collapse
|
11
|
Sicras A, Rejas J, Navarro R, Planas A. Adding pregabalin or gabapentin for the management of community-treated patients with painful diabetic peripheral neuropathy: a comparative cost analysis. Clin Drug Investig 2014; 33:825-35. [PMID: 24085589 DOI: 10.1007/s40261-013-0131-8] [Citation(s) in RCA: 5] [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: 10/26/2022]
Abstract
BACKGROUND AND OBJECTIVE Painful diabetic peripheral neuropathy (pDPN) is a highly prevalent complication of diabetes mellitus, which is associated with substantial costs to society and national health systems. This economic impact varies depending on the therapeutic management provided to patients. The objective of this study was to compare healthcare resource utilization and costs among pDPN patients newly treated with pregabalin or gabapentin in routine medical practice. METHODS We performed a retrospective medical records study of pDPN patients newly treated with pregabalin or gabapentin as an add-on therapy who are covered by the Badalona Serveis Assistencials (BSA) health plan, a healthcare provider in Spain, from 2006 to 2009. Healthcare resource utilization and days off work were assessed. The societal perspective was used to estimate costs. RESULTS Three hundred and ninety-five records were eligible for analysis: 227 (57.5%) included pregabalin and 168 (42.5%) gabapentin. Mean (standard deviation) concomitant use of analgesics throughout the study was higher in the gabapentin cohort [3.9 (2.2) vs. 3.1 (2.1); p < 0.05], mainly due to greater use of non-narcotics (78.0 vs. 71.8%; p < 0.05) and opioids (32.7 vs. 28.6%; p < 0.05). Healthcare costs accounted for 59.2% of total costs, of which 71.9% occurred in primary care, with a mean cost per patient of €2,476 (year 2010 values). Adjusted mean (95% CI) total costs were significantly lower in pregabalin-treated patients [€2,003 (1,427-2,579)] than in gabapentin-treated patients [€3,127 (2,463-3,790)] (p = 0.013), mainly due to lower healthcare costs [€1,312 (1,192-1,432) vs. €1,675 (1,537-1,814); p < 0.001]. CONCLUSIONS Adding pregabalin to existing pDPN therapy resulted in lower total healthcare costs and lower resource utilization than resulted from adding gabapentin.
Collapse
Affiliation(s)
- Antoni Sicras
- Dirección de Planificación y Desarrollo Organizativo, Badalona Serveis Assistencials SA, Gaietà Soler, 6-8 entlo, 08911, Badalona, Barcelona, Spain,
| | | | | | | |
Collapse
|
12
|
Sicras A, Huerta A, Navarro R, Ibañez J. [Use of resources and associated costs of chronic obstructive pulmonary disease exacerbations: A population based retrospective study]. Semergen 2014; 40:189-97. [PMID: 24485969 DOI: 10.1016/j.semerg.2013.10.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [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: 09/23/2013] [Revised: 10/15/2013] [Accepted: 10/22/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Exacerbations are a clinical characteristic of chronic obstructive pulmonary disease (COPD). The objective of the study was to estimate the resource use and costs associated with COPD exacerbations PATIENTS AND METHODS Observational study performed by retrospective review of patient clinical charts of a Hospital and 6 associated Primary Care Centers. COPD patients >40years old who were followed-up during 2010-2011, and who fulfilled inclusion/exclusion criteria were included in the study. Healthcare resource use and costs associated to COPD exacerbations (moderate/severe) were estimated. Healthcare resource use, loss of productivity and costs associated to the follow-up of COPD patients (with/without exacerbations) were also estimated. STATISTICAL ANALYSIS regression model and ANCOVA, P<.05. RESULTS A total of 1,210patients were included in the study, of whom 51.2% experienced an exacerbation, and with an average of 4exacerbations/patient. Presence of exacerbations was associated with age, COPD severity, presence of comorbidities, and time from diagnosis. The average healthcare cost of an exacerbation was €481 (moderate: €375; severe: €863). Patients who experienced an exacerbation had a higher resource use and costs (P<.001). Thus, the follow-up cost of patients without exacerbations was €1,392 versus €3,175 for patients with exacerbations. CONCLUSION The presence of exacerbations in COPD patients was associated with an increase in resource use and associated costs.
Collapse
Affiliation(s)
- A Sicras
- Dirección de Planificación, Badalona Serveis Assistencials, Badalona, Barcelona, España
| | - A Huerta
- Departamento de Evaluación de Medicamentos, GlaxoSmithKline, Madrid, España.
| | - R Navarro
- Servicio de Documentación, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, España
| | - J Ibañez
- Dirección Médica, Badalona Serveis Assistencials, Badalona, Barcelona, España
| |
Collapse
|
13
|
Miravitlles M, Sicras A, Crespo C, Cuesta M, Brosa M, Galera J, Lahoz R, Lleonart M, Riera MI. Costs of chronic obstructive pulmonary disease in relation to compliance with guidelines: a study in the primary care setting. Ther Adv Respir Dis 2013; 7:139-50. [PMID: 23653458 DOI: 10.1177/1753465813484080] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [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: 11/16/2022] Open
Abstract
BACKGROUND The aim of this study was to analyse the economic impact of nonadherence to the Global Initiative for Obstructive Lung Disease (GOLD) guidelines in patients with chronic obstructive pulmonary disease (COPD). METHODS A retrospective analysis was carried out on a claim database. Patients aged at least 40 years with a diagnosis of COPD were eligible for this analysis. Demographics, medical data and use of resources were collected and direct and indirect costs were analysed (from January 2008 to June 2009). A probabilistic multivariate sensitivity analysis of avoided costs was carried out. All results are presented in annualized form and costs are expressed in Euros (2009). RESULTS A total of 1365 patients were included, 79.5% were men. The mean age (±standard deviation) was 71.4 (±10.3) years, the mean forced expiratory volume in 1 s (FEV1) was 65.3% and they had a COPD history of 5.5 (±2.9) years. Patients were divided into an adherent group and a nonadherent group depending on whether therapeutic recommendations according to severity defined in the GOLD guidelines (2007) were followed. Patients in both groups were also classified as having stage II (FEV1 < 80% and < 50%) or stage III disease (FEV1 < 50% and ≥ 30%). The total annual drug cost per patient in the nonadherent group was €771.5 while it was only €426.4 for the adherent group. The average direct cost per patient per year in the nonadherent stage II group was €1465 (±971) and it rose to €2942 (±1918) for patients in the nonadherent group with stage III disease. The potential saving from the implementation of the GOLD guidelines in stage II COPD amounted to €758 per patient per year (68% saving on drug cost). In contrast, the cost for patients with stage III disease was higher in the adherent group versus the nonadherent group (€2468). CONCLUSIONS The cost of COPD may vary according to compliance with the GOLD guidelines. The cost observed for patients with stage II disease is higher than expected in patients who adhere to treatment, but patients with stage III disease treated according to the GOLD guidelines had significantly higher treatment costs.
Collapse
Affiliation(s)
- Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d'Hebron, Pg. vall d'Hebron 119-129, 08035 Barcelona, Spain.
| | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Aguado A, Rodríguez D, Flor F, Sicras A, Ruiz A, Prados-Torres A. [Distribution of primary care expenditure according to sex and age group: a retrospective analysis]. Aten Primaria 2011; 44:145-52. [PMID: 21641689 DOI: 10.1016/j.aprim.2011.01.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Revised: 10/08/2010] [Accepted: 01/22/2011] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To study the primary care expenditure per person and the weight of different health resources within sex and age groups. DESIGN Cost analysis. Retrospective descriptive study. SETTING 14 urban primary care centers (assigned population: 313,000). PARTICIPANTS All patients who visited during 2008 (227,235). STUDY PERIOD January to December 2008. MAIN MEASUREMENTS Age, sex, visits, laboratory, radiology and complementary tests and referrals to specialists were obtained from patient electronic files. Pharmacy expenditure was obtained from invoices sent to the national health system by pharmacists. Fixed/semi-fixed costs were distributed among visits and a mean cost/visit was obtained. Costs were assigned for laboratory (mean application cost), for radiology and complementary tests (rate per type of test) and for referrals (adjusted rate). Descriptive analysis of data (median, interquartile range and coefficient of variance). RESULTS Median expenditure was 362 € (321 € for men and 396 € for women). For the up to 2 year-old group it was 410 €, for aged 15-44 203 € and 75 and above 1,255 €.). The up to 2 years old visits represented 81% of total cost while pharmacy was 8%, while for those aged 75 and above visits accounted for 21% of the total cost and pharmacy 63%. CONCLUSIONS Expenditure in primary care is higher in women, although the greatest differences were observed with age. In older than 74 years the median expenditure was six-fold higher than that for 3-44 years old group. In pediatrics the main source of expenditure was visits, representing 80% of the total in up to 2 years old. From 45 years old, pharmacy was the main source of expenditure and in those older than 74 it represented over 60% of the total.
Collapse
Affiliation(s)
- Alba Aguado
- Centre d'Atenció Integral Dos de Maig, Consorci Sanitari Integral, Barcelona, España.
| | | | | | | | | | | | | |
Collapse
|
15
|
Prados A, Bordonaba D, Sicras A, Estelrich J, Aza M, Bordonaba D, Calderón A, Corbacho MS, González F, Lallana MJ, López-Cabañas A, Magdalena J, Oliván B, Poblador B, Poncel A. Pharmacy cost outliers in primary care; multilevel approach based on ACG in the Spanish context. BMC Health Serv Res 2008. [PMCID: PMC3313304 DOI: 10.1186/1472-6963-8-s1-a18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
16
|
Sicras A, Rejas J, Navarro R, Serrat J, Blanca M. Metabolic syndrome in bipolar disorder: a cross-sectional assessment of a Health Management Organization database. Bipolar Disord 2008; 10:607-16. [PMID: 18657245 DOI: 10.1111/j.1399-5618.2008.00599.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To estimate the prevalence of metabolic syndrome (MS) in patients with bipolar disorder (BD) included in a Health Management Organization (HMO) database. METHODS A cross-sectional analysis of the administrative claim database of Badalona Serveis Assistencials (BSA) was performed. All patients of either sex over 16 years of age and receiving treatment for BD for more than three weeks were included in the study group. The reference group comprised the rest of patients in the BSA database without BD. MS was defined according to the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III modified criteria and required fulfillment of at least three of the following five components: body mass index (BMI) >or=28.8 kg/m(2), triglycerides >or=150 mg/dL, high-density lipoprotein (HDL) cholesterol <40 mg/dL (males)/<50 mg/dL (females), blood pressure >or=130/85 mmHg, and fasting glucose >or=110 mg/dL. Descriptive statistics, bivariate analysis, and logistic regression models were applied. RESULTS We identified 178 patients with BD out of 86,028 subjects (50.5% women; 45.5 +/- 17.8 years, mean +/- SD) included in the BSA database. MS prevalence was significantly higher in BD: 24.7% [95% confidence interval (CI): 18.6-31.7] versus 14.4% (CI: 14.2-14.7) with no statistically significant differences between genders; age-adjusted odds ratio (OR) = 1.65 (1.11-2.44, p = 0.013). All MS components were higher in the BD group, particularly BMI >28.8 kg/m(2) [33.1% (26.3-40.6) versus 17.9% (17.7-18.2), adjusted OR = 2.05 (1.46-2.87, p < 0.001)], high triglyceride levels [23.0% (17.1-29.9) versus 11.3% (11.1-11.5), adjusted OR = 2.09 (1.45-3.02, p < 0.001)], and low HDL cholesterol levels [54.5% (46.9-62.0) versus 29.4% (29.1-29.7), adjusted OR = 2.77 (2.02-3.80, p < 0.001)]. Furthermore, patients with BD showed a significantly higher frequency of obesity [41.4% (32.3-50.9) versus 27.1% (26.6-27.5); adjusted OR = 1.83 (1.24-2.68, p = 0.002)]. CONCLUSIONS Compared with the general population managed by the BSA, the prevalence of MS was significantly higher in patients with BD, mainly due to a higher prevalence of obesity, high triglyceride levels, and low HDL cholesterol levels. These findings strongly support the development of health policies addressing this problem in BD patients.
Collapse
Affiliation(s)
- Antoni Sicras
- Badalona Serveis Assistencials, Badalona, Barcelona, Spain.
| | | | | | | | | |
Collapse
|
17
|
Fernandez de Bobadilla J, Sicras A, Navarro R, Ezpeleta D, Alvarez C, Sanchez-Maestre C, Soto J. CARDIOVASCULAR RISK PROFILE, COSTS AND INCIDENCE OF EVENTS IN PATIENTS WITH STROKE IN A POPULATION ATTENDED IN PRIMARY CARE. ATHEROSCLEROSIS SUPP 2008. [DOI: 10.1016/s1567-5688(08)71002-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: 10/22/2022]
|
18
|
Aguado A, Guinó E, Mukherjee B, Sicras A, Serrat J, Acedo M, Ferro JJ, Moreno V. Variability in prescription drug expenditures explained by adjusted clinical groups (ACG) case-mix: a cross-sectional study of patient electronic records in primary care. BMC Health Serv Res 2008; 8:53. [PMID: 18318912 PMCID: PMC2292169 DOI: 10.1186/1472-6963-8-53] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [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: 09/28/2007] [Accepted: 03/04/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In view of rapidly increasing prescription costs, case-mix adjustment should be considered for effective control of costs. We have estimated the variability in pharmacy costs explained by ACG in centers using patient electronic records, profiled centers and physicians and analyzed the correlation between cost and quality of prescription. METHODS We analyzed 65,630 patient records attending five primary care centers in Spain during 2005. Variables explored were age, gender, registered diagnosed episodes of care during 2005, total cost of prescriptions, physician and center. One ACG was assigned to each patient with ACG case-mix software version 7.1. In a two-part model, logistic regression was used to explain the incurrence of drug expenditure at the first stage and a linear mixed model that considered the multilevel structure of data modeled the cost, conditional upon incurring any expense. Risk and efficiency indexes in pharmacy cost adjusted for ACG were obtained for centers and physicians. Spearman rank correlation between physician expenditure, adjusted for ACG, and a prescription quality index was also obtained. Pediatric and adult data were analyzed separately. RESULTS No prescription was recorded for 13% of adults and 39.6% of children. The proportion of variance of the incurrence of expenditure explained by ACGs was 0.29 in adults and 0.21 in children. For adults with prescriptions, the variance of cost explained by ACGs was 35.4%, by physician-center was 1.8% and age 10.5% (residual 52.3%). For children, ACGs explained 22.4% of cost and physician-center 10.9% (residual 66.7%). Center efficiency index for adults ranged 0.58 to 1.22 and for children 0.32 to 2.36. Spearman correlation between expenditure and prescription quality index was -0.36 in family physicians (p = 0.019, N = 41) and -0.52 in pediatricians (p = 0.08, N = 12). CONCLUSION In our setting, ACG is the variable studied that explains more variability in pharmacy cost in adults compared to physician and center. In children there is greater variability among physicians and centers not related to case-mix. In our sites, ACG is useful to profile physicians and centers using electronic records in real practical conditions. Physicians with lower pharmaceutical expenditure have higher scores for a prescription quality index.
Collapse
Affiliation(s)
- Alba Aguado
- Catalan Institute of Oncology, IDIBELL, L'Hospitalet, Barcelona, Spain.
| | | | | | | | | | | | | | | |
Collapse
|
19
|
Sicras A, Rejas J, Arco S, Flores E, Ortega G, Esparcia A, Suárez A, Gordillo MJ. Prevalence, resource utilization and costs of vascular dementia compared to Alzheimer's dementia in a population setting. Dement Geriatr Cogn Disord 2005; 19:305-15. [PMID: 15785031 DOI: 10.1159/000084556] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2004] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To determine the prevalence of dementia and to measure the monetary impact and health resources utilization of vascular dementia (VD) compared to Alzheimer's dementia (AD) in persons aged over 64 years in a population setting. METHODS Retrospective, cross-sectional study. In the initial phase, information was obtained on specific clinical characteristics from the subjects with an active diagnosis of dementia. The second phase consisted of a clinical evaluation and validation of the cases. Mini-Mental State Examination was used to assess cognitive impairment. Dementia and its subtypes were determined using established diagnostic criteria. Information was obtained on the use of health care resources (direct costs) and the number of hours devoted by the primary caregiver (indirect costs) for patients with a documented diagnosis of AD or VD within the last 6 months prior to the interview. A multiple logistic regression analysis was performed to correct the model. RESULTS A total of 6,004 subjects were analyzed, 258 with diagnosis of dementia (overall prevalence: 4.3%). An evaluation was made of 224 patients, and gross prevalence of AD and VD was 2.4 and 1.0%, respectively. Cost per patient per semester was EUR 8,086 for AD and EUR 11,039 for VD (p = 0.016). 85.5% of the cost was attributable to primary caregiver time in AD and 84.4% in VD. CONCLUSIONS The prevalence of AD and VD increases with age. No sociodemographic differences were seen between AD and VD. Costs associated with health care resource and primary caregiver utilization were high, being higher in VD than in AD.
Collapse
Affiliation(s)
- A Sicras
- Badalona Serveis Assistencials SL, Badalona, Barcelona, Spain
| | | | | | | | | | | | | | | |
Collapse
|
20
|
Sicras A, Rejas-Gutiérrez J. [Drug-cholinesterase-inhibitors persistence patterns in treated patients with dementia of Alzheimer type: retrospective comparative analysis of donepezil, rivastigmine and galantamine]. Rev Neurol 2004; 39:312-6. [PMID: 15340887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
INTRODUCTION AND OBJECTIVE Long term duration of treatment of the dementia of Alzheimer type, the most frequent type of dementia in our environment, is associated with delay in patient functional and cognitive impairment. The aim of the study was to determine retrospectively the persistence of treatment with donepezil, rivastigmine and galantamine in patients with dementia of the Alzheimer type in a population setting. PATIENTS AND METHODS Retrospective study performed in Primary Care Health Centres. The study included patients who were treated between January, 2000 and September, 2003. Kaplan-Meier survival analysis was applied to assess pattern of treatment persistence. RESULTS A total of 95 patients (78.8% female), with a mean age of 77.6 years (SD: 6.2) were included; 39 donepezil, 35 rivastigmine, and 21 galantamine, with a mean MMSE score of 10.3 +/- 7.8, 9.7 +/- 8.4 and 13.6 +/- 7.1, respectively (p = 0.256). Mean treatment duration was donepezil: 80.3 (SD: 7.7) weeks, rivastigmine: 52.4 (SD: 5.3) weeks and galantamine: 49.8 (SE: 4.0) weeks, p < or = 0.01. Median persistence of treatment was 129.3 weeks for donepezil, 59.1 for rivastigmine and 45.0 for galantamine, p < or = 0.001 in both cases. At week 52, 62% of donepezil-treated patients maintained the initial therapy, compared with 40% rivastigmine-treated and 33% galantamine-treated, p < 0.05. CONCLUSION This retrospective study found that patients with dementia of the Alzheimer type treated with donepezil showed more persistence of treatment compared which those who received rivastigmine or galantamine.
Collapse
Affiliation(s)
- A Sicras
- Departamento de Planificación, Badalona Serveis Assistencials, Badalona, Barcelona.
| | | |
Collapse
|
21
|
Sicras A, Peláez J, Martí J. Efecto de la prescripción farmacológica en residencias geriátricas según su entidad proveedora de referencia. Gaceta Sanitaria 2004; 18:220-4. [PMID: 15228921 DOI: 10.1016/s0213-9111(04)71836-1] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify the effect of the provider company (PC) of reference on drug prescriptions in nursing homes. METHODS We performed a descriptive study of all ambulatory prescriptions invoiced by the Catalan Health Service from 106 nursing homes in a health region in 2001. The PCs were grouped into private (n = 23; 1,158 residents) and public (n = 83; 3,163 residents). A system of evaluating quantitative, qualitative and relative use indicators was established according to therapeutic group or active principles. RESULTS Expenditure in the nursing homes was Euro 7.7 million, representing 6.3% of that generated by the PCs. The results obtained show differences in expenditure per resident, which amounted to Euro 1,601.56 +/- 317.20 in the private sector and Euro 1,843.49 +/- 516.56 in the public sector (p = 0.000). The percentage spent on drugs of high intrinsic value was 89.0 and 82.9% (p = 0.043), respectively. CONCLUSIONS Because of the study's limitations, the results should be generalized with caution. The volume of prescriptions in nursing homes was high. Moderate cost containment and a relative improvement in the quality of prescriptions in private PCs were observed.
Collapse
Affiliation(s)
- Antoni Sicras
- Unidad de Farmacia, Región Sanitaria del Barcelonés Norte y Maresme, Servei Català de la Salut, Badalona, Barcelona, Spain.
| | | | | |
Collapse
|
22
|
Affiliation(s)
- J Fusté
- Divisió d'Atenció Primària. Servei Català de la Salut. Barcelona. España.
| | | | | | | | | | | |
Collapse
|
23
|
Sicras A. [Nosocomial infection at a regional hospital]. Enferm Infecc Microbiol Clin 1989; 7:287-8. [PMID: 2490734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
|