Open Access
Health related quality of life of patients with generalized anxiety disorder
(2008) Cabasés Hita, Juan Manuel; Sánchez Iriso, Eduardo; Rovira i Forns, Joan; Economía; Ekonomia
Aims: To analyze the health-related quality of life of patients with Generalized Anxiety Disorder (GAD), with respect to the population at large and to a control group. The following goals are addressed: 1.- To determine what, if any, differences exist between the health status of patients diagnosed with GAD, the population in general and a group of control patients; 2.- To analyze the relation between the variables age, sex, and health status (as assessed by the patient’s GP) measured on the Hamilton anxiety scale, with the quality of life of the GAD patients and of the control group; 3.- To determine whether the variables age, sex, Hamilton scale values and index of quality of life influence the annual cost caused by the illness; 4.- To determine whether there are any differences in the evaluation of the same health status made by GAD patients and by the general population. This study forms part of a broader-ranging one (the ANCORA Study) set up to analyze Generalized Anxiety Disorder (GAD) and the costs and other burdens provoked by this illness in Spain. Material and Methods: Regression models were used to obtain the EQ-5D index of health state (EQindex) and to analyze the above-mentioned variables. The data on patients and on the costs of the illness are those registered in the ANCORA study. Results: The patients with GAD present a self-perceived level of health (EQ-5D) that is conspicuously below that corresponding to the general population, especially in three of the dimensions, namely usual activities, pain/discomfort and anxiety/depression. The mean value of the health index (EQindex) is ten points below that of the general population and that of the control group. Age was found to be negatively related to the health variables, as was a higher score on the Hamilton scale. For the group of patients with GAD, a worse perceived health state and a higher score on the Hamilton scale were associated with higher costs, although in the latter case the explicative power of the model is weak. Finally, the GAD patients assessed their health status more negatively than did the general population, with a visual analogue scale (VAS) result that was four points lower than that made by the general population.
Open Access
Reflexiones sobre la sanidad pública en España en el horizonte de 2020
(2013) Cabasés Hita, Juan Manuel; Economía; Ekonomia; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa: OTRI 2012005009
Este trabajo pretende desarrollar una visión para el Sistema Nacional de Salud (SNS) en la perspectiva del año 2020. Partiendo de una evaluación de la situación actual del sistema sanitario y a la luz de los principios que definen un buen sistema sanitario, describe un escenario factible para la sanidad en España basado en cambios estructurales que afectan a la financiación, la equidad en el acceso a la asistencia sanitaria, la coordinación sanitaria, la colaboración público-privada, la detección y corrección de holguras de ineficiencia en la oferta y la demanda sanitarias, el cambio en el modelo de cuidados orientado a la cronicidad, el nuevo papel de la Atención Primaria y de la Especializada, la motivación e incentivos de los profesionales sanitarios, el papel creciente de los ciudadanos, destinatarios de la asistencia sanitaria y responsables de su salud, y la determinación de prioridades mediante la evaluación económica sistemática de las decisiones en materia sanitaria
Open Access
Costs and effectiveness of a syringe distribution and needle exchange programme for HIV prevention in a regional setting
(2002) Cabasés Hita, Juan Manuel; Sánchez Iriso, Eduardo; Economía; Ekonomia
Objective: To estimate the costs and effectiveness of a HIV prevention intervention consisting of distribution of an anti-Aids kit and needle exchange, in operation since 1993 in Navarra, Spain. Methods: Total costs of the programme, namely production, storage and distribution as well as management, are estimated getting a cost figure per sterile syringe distributed. Effectiveness, defined as the number of averted HIV infections among IDUs due to their injecting behaviour, is estimated as a function of the level of coverage of the programme, using a mathematical model. Results: The estimated number of averted HIV infections ranged from 7.59 (in 1995) to 1.23 (in 2000). Yearly incremental cost-effectiveness ratios (ICER) ranged from 8.331 (in 1994) to 44.287 (in 2000) euro per HIV infection averted. With estimated health care costs of treatment of an HIV infection of 99.371 euro, the programme has been cost saving along the whole period considered. One way sensitivity analysis for 5 uncertain parameters was performed. These were the number of active IDUs in the region, number of annual injections among IDUs with non sterile syringes, percentage of lost and unused syringes of the total provided, probability of HIV infection due to injecting behaviour, and life expectancy of HIV+ persons. The results confirm our findings. We conclude the programme has been cost saving from the health care system perspective.
Open Access
Comparing the psychometric properties of the EQ-5D-5L between mental and somatic chronic patients populations
(2013) Cabasés Hita, Juan Manuel; Errea Rodríguez, María; Hernández Arenaz, Íñigo; Economía; Ekonomia
The validity and reliability of the EQ-5D-5L in comparison with the standard 3L has been tested through the analysis of psychometric properties making use of different samples of patients. However, it is likely that the condition of the illness may affect the power of the 5L version with respect to the 3L one. Here we report on parallel testing of EQ-5D-5L and 3L administered to a sample of chronic patients of both somatic and mental illness. The aim of this study is to check some psychometric properties in both subsamples. Methods: We check for the usual psychometric properties: feasibility, (in)consistency, ordinality (and transitivity), informativity, face validity and convergent validity. Also, we perform new analysis for checking transitivity and the Cronbach-? for convergent validity. Finally, we proposed a complementary way for looking at the property of informativity through three different indexes (effective, absolute and overall) based on the statistical discriminatory power. Data: We have a total of 1002 questionnaires finally collected. 444 (46.25%) chronic mental patients, 516 (53.75%) have somatic chronic illnesses; 42 observations of unknown origin of the illness have been dropped to perform this analysis. Results: The mean value reported in the VAS for the full sample is 60.93. Somatic patients report a mean of 64.42 points in this scale and mental patients report 56.83 points in the VAS. Analyzing the distribution of the responses to problems on each dimension we found, for all cases, a highly skewed distribution. Moreover, the distribution of responses changes significantly between subsamples, as expected. In all dimensions, it seems that somatic patients take more advantage of the extra levels introduced by the EQ-5D-5L. This group reduces to a greater extent the missing response rate, commit less (and of lower importance) inconsistencies, get a higher correlation of the 5L scale and the VAS within the 3L levels, complements better the dimensions to get an overall score (measured through the Cronbach’s alpha), reduces in a more significant way the “no problem” response and the Informativity gain is also superior (for both the Shannon Evenness Index and our Absolute Index). This higher performance of the EQ-5D-5L on somatic patients is endorsed by a higher preference of somatic patients toward the 5L version of the questionnaire than to the 3L one. Conclusion: Results show the suitability of the 5L version in both subsamples, but it is much more effective for somatic patients. These subsamples’ differences may be of concern when aggregating and comparing different data.
Open Access
La financiación sanitaria autonómica. Bases para una propuesta
(1998) Cabasés Hita, Juan Manuel; Economía; Ekonomia
Se analizan las novedades recientes en el debate sobre financiación territorial sanitaria: el nuevo modelo de financiación autonómica para el quinquenio 1997-2001, y la nueva RAWP, fórmula inglesa de reparto financiero sanitario y el acuerdo del Consejo de Polí’tica Fiscal y Financiera de 27 de Noviembre de 1997 estableciendo un mecanismo de financiación de la sanidad de la Seguridad Social para el cuatrienio 1998-2001. La discusión sobre financiación auton—çomica de la sanidad es un asunto donde el consenso deviene crucial, y éste ha de empezar por un acuerdo de principio ético. Consideramos que el principio es la igualdad de oportunidades. Nuestra propuesta consiste en profundizar en la corresponsabilidad fiscal incorporando la sanidad a la financiación autonómica general. En este nuevo marco, habrá que diseñar los mecanismos de garantí’a que permitan el logro de los objetivos de la Ley General de Sanidad. Quedan, así’, establecidas, las bases para una agenda de trabajo para elaborar el acuerdo del año 2001.
Open Access
Cost efectiveness analysis of therapeutic strategies for patients with chronic hepatitis C previously non responders to interferon
(2003) San Miguel Elcano, Ramón; Mar, Javier; Cabasés Hita, Juan Manuel; Guillén Grima, Francisco; Butí, María; Economía; Ekonomia
Background: The efficacy of combination therapy in previous non responders to interferon (IFN) monotherapy with chronic hepatitis C is lower than in naïve patients, and there has been no economic evaluation in this population. Aim: To develop a cost-effectiveness analysis of therapeutic regimens with IFN alpha and ribavirin in previous interferon non-responders. Methods: A Markov simulation model was used to project the clinical and economic outcomes of five different therapeutic strategies including a “no treatment” alternative using the health care system perspective. The effectiveness data for the different doses and durations was obtained from a previously performed meta-analysis. A sensitivity analysis was performed to test robustness of the model, analysing changes in different variables. Results: Applying a 3% discount rate, the standard patient on combination therapy for 12 months showed an increase of 0.80 years and 1.55 quality adjusted life years (QALYs), when comparing combination therapy for 12 months vs. “no treatment” strategy. This option led to an incremental cost-effectiveness ratio of 11,767 euros per year of life gained and 6,073 euros per QALY. Conclusions: Combination therapy with interferon plus ribavirin in previous interferon non-responders shows an incremental cost-effectiveness ratio within the range of some well accepted medical interventions in our health care system.
Open Access
Identity, incentives and motivational capital in public organizations
(2014) Berdud García-López, Mikel; Cabasés Hita, Juan Manuel; Nieto Vázquez, Jorge; Economía; Ekonomia
This paper explores optimality of contracts and incentives when the principal (public organization) can undertake investments to change agents’ (public workers) identity. In the model, workers within the organization can have different identities. We develop a principal-agent dynamical model with moral hazard, which captures the possibility of affecting this workers’ identity through contracts offered by the firm. In the model, identity is a motivation source which reduces agents’ disutility from effort. We use the term identity to refer to a situation in which the worker shares the organizational objectives and views herself as a part of the organization. Contrary, we use the term conflict to refer to a situation in which workers behave self-interested and frequently in the opposite way of the organisation. We assume that the principal can include investments to foster identity in contracts. Think for instance in developing a single culture that is shared by all the members of an organization. We discuss the conditions under which spending resources in changing workers’ identity and invest in this kind of motivational capital is optimal for organizations. Our results may help to inform public firms’ managers about the optimal design of incentive schemes and policies. For instance, we conclude that investing in motivational capital is the best option in the long run whereas pure monetary incentives works better in the short run.
Open Access
Societal perspective on the eliciting of health states preferences
(2000) Cabasés Hita, Juan Manuel; Ugalde, José M.; Gaminde, Idoia; Economía; Ekonomia
With the concept of 'societal perspective' in mind, a study using the PTO and 8 EQ-5D defined health states, (using two selection criteria: states self assessed by people in a real context -women with breast cancer-, and similar distance in the TTO-York tariff), with a sample of 51 individuals selected from the general population of Navarra (Spain), was carried out. The main objectives were: 1) To elicit some EQ-5D health states values using a societal technique (PTO); 2) to check people concern about severity of illness when valuing equal gains from different starting points in the scale; and 3) to asses the effect on values of limited potential health improvements. The results shown very high values for the health states selected (0.90 to 0.99), due to the effect of anchoring on immediate death. Severity does not seem to be considered by the majority of people interviewed, although some 25% of them showed preference for similar health gains in those individuals in worse initial health. The same can be said for the concern for the limited potential health improvement, where most people seem to show an utilitarian perception.
Open Access
Self perceived health status of schizophrenic patients in Spain: an analysis of geog raphical differences using bayesian approach
(2005) Cabasés Hita, Juan Manuel; Sánchez Iriso, Eduardo; Vázquez Polo, Francisco J.; Negrín, Miguel A.; Domínguez Irastorza, Emilio José; Economía; Ekonomia
Objectives. This paper explores the use of regression models for estimating health status of schizophrenic patients, from a Bayesian perspective. Our aims are: 1- To obtain a set of values of health states of the EQ-5D based on self-assessed health from a sample of schizophrenic patients. 2- To analyse the differences in the health status and in patients’ perceptions of their health status between four mental-health districts in Spain. Methods. We develop two linear models with dummy variables. The first model seeks to obtain an index of the health status of the patients using a VAS as a dependent variable and the different dimensions of EQ-5D as regressors. The second model allows to analyse the differences between the self-assessed health status in the different geographic areas and also the differences between the patients’ self-assessed health states, irrespective of their actual health state, in the different geographic areas. The analysis is done using Bayesian approach with Gibbs sampling (computer program WinBUGS 1.4). Data concerning self-assessed EQ-5D with VAS from four geographic areas of schizophrenic patients were obtained for the purposes of this analysis. Results. We obtained the health status index for this sample and analysed the differences for this index between the four geographic areas. Our study reveals variables that explain the differences in patients’ health status and differences in their health states assessment. We consider four possible scenarios.
Open Access
Contracting arrangements in the health strategy contex. A regional approach for Spain
(2000) Cabasés Hita, Juan Manuel; Gaminde, Idoia; Gabilondo, Luis; Economía; Ekonomia
Background. Several different proposals have been made recently to reform the organisation, financing and management of the health care system in Spain. The aim is to obtain improved efficiency, without prejudicing the equity level already achieved, by creating a more competitive framework. However, current health strategies seem not to be in accord with these proposals. This paper approaches the issue of matching these two main components of the health systems, health strategy and contracts, and emphasises the need to develop contracting arrangements within the general health policy framework. Design: Case studies, analysis of published and unpublished documents, and semi-structured interviews with key informants. Results and discussion. A review of regional health strategies and regional contracts developed in the 1990s is presented, followed by an analysis of the degree of incoherence between them. Then we discuss whether the programme contract can be an instrument guided by the health plan, commenting on its potential and limitations. Conclusion. The relationship between health strategy and health care management is practically non-existent in Spain. The need to insert the contract cycle within the broader framework of the planning cycle has led to proposals to adapt contracts and health plans to guarantee their coherence. This will require changes in the structure of both of these instruments and, probably, deeper structural modifications of the context within which both have been developed. To this aim, we make some recommendations for policy making.