Open Access
Economía de la salud: la medida del valor en la sanidad
(2020) Cabasés Hita, Juan Manuel; Economía; Ekonomia
La lección trata de economía de la salud, una disciplina cuyo objeto es la asignación de recursos escasos para mejorar la salud y el bienestar de los ciudadanos. Concretamente, se realizarán algunas reflexiones sobre la evaluación económica de tecnologías sanitarias centrándose en su aspecto más específico y complejo, la medida de la salud como variable de efectividad de las intervenciones sanitarias. El autor espera mostrar la relevancia que en esa medida ha de tener la voz del paciente, nuestra propia voz, que responde a esta pregunta crucial: ¿Cuánto estaríamos dispuestos a pagar por ganar un año en salud plena?
Open Access
Instrumentos económicos para la priorización de pacientes en lista de espera: los modelos de elección discreta
(2006) Cabasés Hita, Juan Manuel; Sánchez Iriso, Eduardo; San Miguel Inza, Fernando; Economía; Ekonomia
Objetivos. Analizar cuáles deben ser los criterios clínicos y sociales en base a los cuales deben ser priorizados los pacientes en listas de espera quirúrgicas programadas. Métodos Se estima un modelo de elección discreta (MED) utilizando una muestra representativa de la población general de Navarra. La muestra fue seleccionada mediante muestreo aleatorio simple por cuotas de edad y sexo, estratificada por áreas y municipios de residencia de la población mayor de 18 años. La información obtenida fue analizada mediante métodos bayesianos. Resultados. Los individuos ordenan a los pacientes según el tiempo de espera, la gravedad de la enfermedad y el coste de la intervención. Es decir, los pacientes que más tiempo llevan esperando, con enfermedades más graves y cuyos tratamientos son más costosos deberían ser intervenidos antes. Conclusiones. Los resultados indican que los tiempos de espera no deberían ser la única variable utilizada para la priorización de pacientes en las listas de espera. Un resultado interesante que deberá ser analizado en el futuro es la importancia otorgada al coste de la intervención. Los resultados reflejan también el potencial de los MED para crear mecanismos de priorización de pacientes en las listas de espera
Open Access
Valuation and modeling of EQ-5D-5L health states using a hybrid approach
(Wolters Kluwer Health, 2017) Ramos Goñi, Juan Manuel; Pinto Prades, José Luis; Oppe, Mark; Cabasés Hita, Juan Manuel; Serrano Aguilar, Pedro; Economía; Ekonomia
Background: The EQ-5D instrument is the most widely used preference-based health-related quality of life questionnaire in cost-effectiveness analysis of health care technologies. Recently, a version called EQ-5D-5L with 5 levels on each dimension was developed. This manuscript explores the performance of a hybrid approach for the modeling of EQ-5D-5L valuation data. Methods: Two elicitation techniques, the composite time trade-off, and discrete choice experiments, were applied to a sample of the Spanish population (n=1000) using a computer-based questionnaire. The sampling process consisted of 2 stages: stratified sampling of geographic area, followed by systematic sampling in each area. A hybrid regression model combining composite time trade-off and discrete choice data was used to estimate the potential value sets using main effects as starting point. The comparison between the models was performed using the criteria of logical consistency, goodness of fit, and parsimony. Results: Twenty-seven participants from the 1000 were removed following the exclusion criteria. The best-fitted model included 2 significant interaction terms but resulted in marginal improvements in model fit compared to the main effects model. We therefore selected the model results with main effects as a potential value set for this methodological study, based on the parsimony criteria. The results showed that the main effects hybrid model was consistent, with a range of utility values between 1 and −0.224. Conclusion: This paper shows the feasibility of using a hybrid approach to estimate a value set for EQ-5D-5L valuation data.
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.
Open Access
Attitudes towards blood and living organ donations
(2010) Cabasés Hita, Juan Manuel; Errea Rodríguez, María; Economía; Ekonomia
We model the decision of whether or not to become a blood/living organ donor. The expected utility for becoming a donor is a function of the degree of altruism, the consumption of goods, the costs of donation, the very pleasure of giving, and the recipient’s utility associated to donation. Empirically, we observe differences in the expected costs and benefits from donation between blood and non-blood donors, and between individuals with different willingness to donate living organs. Looking at benefits/costs of donation through reasons for donating/not donating, we conclude policies to encourage donation should focus on raising awareness and provide information.
Open Access
Tailoring integrated care services for high-risk patients with multiple chronic conditions: a risk stratification approach using cluster analysis
(BioMed Central, 2020) Bretos Azcona, Pablo Evaristo; Sánchez Iriso, Eduardo; Cabasés Hita, Juan Manuel; Economía; Ekonomia; Gobierno de Navarra / Nafarroako Gobernua
Background: The purpose of this study was to produce a risk stratification within a population of high-risk patients with multiple chronic conditions who are currently treated under a case management program and to explore the existence of different risk subgroups. Different care strategies were then suggested for healthcare reform according to the characteristics of each subgroup. Methods: All high-risk multimorbid patients from a case management program in the Navarra region of Spain were included in the study (n = 885). A 1-year mortality risk score was estimated for each patient by logistic regression. The population was then divided into subgroups according to the patients' estimated risk scores. We used cluster analysis to produce the stratification with Ward's linkage hierarchical algorithm. The characteristics of the resulting subgroups were analyzed, and post hoc pairwise tests were performed. Results: Three distinct risk strata were found, containing 45, 38 and 17% of patients. Age increased from cluster to cluster, and functional status, clinical severity, nursing needs and nutritional values deteriorated. Patients in cluster 1 had lower renal deterioration values, and patients in cluster 3 had higher rates of pressure skin ulcers, higher rates of cerebrovascular disease and dementia, and lower prevalence rates of chronic obstructive pulmonary disease. Conclusions: This study demonstrates the existence of distinct subgroups within a population of high-risk patients with multiple chronic conditions. Current case management integrated care programs use a uniform treatment strategy for patients who have diverse needs. Alternative treatment strategies should be considered to fit the needs of each patient subgroup.
Open Access
Actividad física y salud autopercibida en personas mayores de 50 años
(Universidad Autonoma de Madrid, 2017) Lera López, Fernando; Garrués Irisarri, Mirian; Ollo López, Andrea; Sánchez Iriso, Eduardo; Cabasés Hita, Juan Manuel; Sánchez-Santos, José Manuel; Economía; Ekonomia; Gestión de Empresas; Enpresen Kudeaketa
El propósito del estudio es analizar los posibles efectos de la actividad física sobre la salud autopercibida. Para ello, se encuestó a 765 personas entre 50-70 años durante 2012 en España. Se utilizó el cuestionario internacional de actividad física (IPAQ) para estimar el equivalente metabólico de la tarea (MET) total y en cuatro ámbitos: trabajo, ocio, hogar y desplazamientos. La salud auto-percibida se obtuvo de la escala visual analógica del EQ-5D-5L. Los resultados muestran que únicamente el gasto energético de actividad física en el tiempo de ocio incide positivamente en el nivel de salud percibido, el resto de ámbitos no tienen influencia significativa. Asimismo, la autopercepción de la salud es más negativa con mayor edad, menor nivel educativo y mayor frecuencia de uso de servicios sanitarios. En conclusión, la actividad física desarrollada en el tiempo libre podría plantearse como alternativa para mejorar la calidad de vida de los mayores.
Open Access
Impact of successful treatment with directacting antiviral agents on health-related quality of life in chronic hepatitis C patients
(Public Library of Science, 2018) Juanbeltz Zurbano, Regina; Martínez Baz, Iván; San Miguel Elcano, Ramón; Goñi Esarte, Silvia; Cabasés Hita, Juan Manuel; Castilla Catalán, Jesús; Estadística, Informática y Matemáticas; Estatistika, Informatika eta Matematika; Economía; Ekonomia
Background. Direct-acting antivirals (DAA) have demonstrated high efficacy to achieve sustained virological response (SVR) in chronic hepatitis C patients. We aim to assess the change in healthrelated quality of life (HRQoL) among patients successfully treated, and to identify predictors of this variation. Methods. In a prospective observational study, patients with chronic hepatitis C who started DAA therapy between May 2016 and April 2017 completed the EQ-5D-5L questionnaire at baseline and 12 weeks after the end of therapy before knowing the virological result. Analysis included all patients with SVR. Results. Median baseline EQ-5D-5L scores of the 206 enrolled patients were 0.857 utility and 70.0 visual analogue scale (VAS). Following SVR, a reduction occurred in the proportion of patients with mobility problems (35% vs 24%, p = 0.012), pain/discomfort (60% vs 42%, p<0.001) and anxiety/depression (57% vs 44%, p = 0.012), with an increase in utility (+0.053, p<0.001) and VAS (+10, p<0.001). Score improvements were also observed in cirrhotic (+0.048 utility, p = 0.027; +15 VAS, p<0.001) and HIV co-infected patients (+0.039 utility, p = 0.036; +5 VAS, p = 0.002). In multivariate analyses, middle age (45±64 years) and baseline anxiety/depression were associated to greater improvement in utility after SVR, and moderate-advanced liver fibrosis and cirrhosis to greater increase in VAS score. Low baseline values were associated to greater improvements in utility value and VAS score. Conclusions The cure of chronic hepatitis C infection with DAA has a short term positive impact on HRQoL with improvement in mobility, pain/discomfort, anxiety/depression, utility value and VAS score. Patients with poor baseline HRQoL were the most beneficed.
Open Access
Head-to-head comparison between the EQ-5D-5L and the EQ-5D-3L in general population health surveys
(BioMed Central, 2018) Martí Pastor, Marc; Pont, Angels; Ávila, Mónica; Garin, Olatz; Cabasés Hita, Juan Manuel; Economía; Ekonomia
Background: The EQ-5D has been frequently used in national health surveys. This study is a head-to-head comparison to assess how expanding the number of levels from three (EQ-5D-3L) to five in the new EQ-5D-5L version has improved its distribution, discriminatory power, and validity in the general population. Methods: A representative sample (N = 7554) from the Catalan Health Interview Survey 2011–2012, aged ≥18, answered both EQ-5D versions, and we evaluated the response redistribution and inconsistencies between them. To assess validity of this redistribution, we calculated the mean of the Visual Analogue Scale (VAS), which measures perceived health. The discriminatory power was examined with Shannon Indices, calculated for each dimension separately. Spanish preference value sets were applied to obtain utility indices, examining their distribution with statistics of central tendency and dispersion. We estimated the proportion of individuals reporting the best health state in EQ-5D-5L and EQ-5D-3L within groups of specific chronic conditions and their VAS mean. Results: A very small reduction in the percentage of individuals with the best health state was observed, from 61.8% in EQ-5D-3L to 60.8% in EQ-5D-5L. In contrast, a large proportion of individuals reporting extreme problems in the 3 L version moved to severe problems (level 4) in the 5 L version, particularly for pain/discomfort (75.5%) and anxiety/depression (66.4%). The average proportion of inconsistencies was 0.9%. The pattern of the perceived health VAS mean confirmed the hypothesis established a priori, supporting the validity of the observed redistribution. Shannon index showed that absolute informativity was higher in the 5 L version for all dimensions. The means (SD) of the Spanish EQ-5D-3L and EQ-5D-5L indices were 0.87 (0.25) and 0.89 (0.22). The proportion of individuals with the best health state within each specific chronic condition was very similar, regardless of the EQ-5D version (≤ 30% in half of the 28 chronic conditions). Conclusion: Although the proportion of individuals with the best possible health state is still very high, our findings support that the increase of levels provided by the EQ-5D-5L contributed to the validity and discriminatory power of this new version to measure health in general population, as in the national health surveys.
Open Access
An economic model of behaviour: attitudes towards altruistic blood and organ donations
(2009) Cabasés Hita, Juan Manuel; Errea Rodríguez, María; Economía; Ekonomia
The aim of this research is to model altruistic blood and organ donors behaviour. First, we make an analysis of the decision of to be or not to be a donor for any individual. We propose a model where individuals compare the expected utility of deciding to become a donor, with the utility of the alternative decision (not to become a donor). Second, we continue with the identification of the variables having influence over this decision, the expected effects of such a donation (positive and negative) and the importance of the expectations over individuals well-being and the subsequent decision. We work with rational individuals that behave altruistically when making a decision. The model is specific because the goods we consider can only cover vital needs. We posed hypothesis about some variables for each kind of the donations considered (blood and organ donations). This hypothesis can be useful to identify which are the variables having influence actually over this decision. We propose a pilot survey to test our model. First results from a university students survey show the relevant variables influencing blood an organ donations, and seem to confirm the model.