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
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
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
EQIS 1.0 user guide
(2011) Sánchez Iriso, Eduardo; Errea Rodríguez, María; Economía; Ekonomia
Where is QALY? The search of values for QALYs (Quality Adjusted Life Years) in the field of Health Economics is not easy. Economic Evaluations, particularly cost-utility analysis, should be of standard practice, but the tools to implement them are rare and require of specific expertise. In many occasions, colleagues approached to us to ask for measures of effectiveness that are used, and show interest in how to obtain it. Such a motivation has led us to generate EQIS 1.0, the friendly software that allows calculating Health Related Quality of Life weights. The following pages introduce EQIS 1.0, and are thought for a quick start using the software. Please do not hesitate to contact the authors for comments, suggestions or any problem you find in the program.
Open Access
Cost effectiveness analysis of the surgical treatment of female urinary incontinence using slings
(2013) Montesino Semper, Manuel F.; Jiménez Calvo, Jesús M.; Cabasés Hita, Juan Manuel; Sánchez Iriso, Eduardo; Hualde Alfaro, Antonio; García García, Diego; Economía; Ekonomia
Objective. To determine the cost-utility and cost-effectiveness of the surgical treatment of female urinary incontinence using suburethral slings compared with therapeutic abstention. Study Design. An economic analysis was performed on 69 women receiving surgical treatment for urinary incontinence using suburethral slings. To calculate the procedure´s cost-effectiveness, an incremental analysis up to 1 year was performed using the incremental cost-effectiveness ratio (ICER). The costs were calculated using a cost-by-process model. Answers to the health-related quality of life questionnaires EQ-5D (generic) and International Consultation Incontinence Questionnaire Short-form (specific) were collected before the operation and as well as 1 month and 1 year post-operation to calculate the utility, using quality-adjusted life years (QALY), and the effectiveness, respectively. A sensitivity analysis was performed by calculating the Incremental Cost-Effectiveness Ratio (ICER) at 5 years post-operation. To complete the economic evaluation, we derived confidence ellipses and acceptability curves. The analysis was conducted for the entire sample and also for each type of urinary incontinence. Results. In total, 45 women presented with stress incontinence, 15 with mixed incontinence and 9 with incontinence associated with prolapse. The average cost per patient at 1 year post-operation was 1,220 €. The QALY achieved at 1 year was 0.046. The results reveal an ICER at 1 year of 26,288 €/QALY, which is below the cost-effectiveness threshold considered acceptable, and this value was lower for stress incontinence (21,191 €/QALY). To achieve greater temporal perspective, we examined the ICER at 5 years, which was 10,141 €/QALY, demonstrating that the programme is clearly efficient. The cost-effectiveness was 106.5 €/ International Consultation Incontinence Questionnaire Short-form unit. Conclusion. Surgery for female urinary incontinence using slings is cost-effective compared with abstention in our public health environment.
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
Using bayesian techniques to build up an inconsistency free health status index
(2004) Cabasés Hita, Juan Manuel; Sánchez Iriso, Eduardo; Economía; Ekonomia
Objectives: 1-To obtain a set of values of health states of the EQ-5D based on self-related health VAS using linear and non- linear models Bayesian techniques. 2 - To analyse “logical consistency” in different models and to derive a model free from logical inconsistencies. 3 - To analyse and compare results of several models when using a priori sources of information. Methods: We apply the usual models and transformations of these, in order to attain logical consistency of the value set. Models proposed are: linear model (1); linear with dummy variables (2) and two models with a logistic structure with different distributions of the coefficients to be estimated (3 and 4). For two of these models new dummies are added in order to obtain logical consistency (2B and 4B). Results: We propose a modelling to guarantee consistency of values of the EQ-5D health states that may be applied to suitable samples at apparently low cost of fit. This model is nonlinear, has distribution Gamma in the coefficients and specific dummy variables. The introduction of priors may reduce the cost of forcing logical consistency.
Open Access
Valuing health using EQ-5D: the impact of chronic diseases on the stock of health
(Wiley, 2019) Sánchez Iriso, Eduardo; Errea Rodríguez, María; Cabasés Hita, Juan Manuel; Ekonomia; Institute for Advanced Research in Business and Economics - INARBE; Economía
Chronic diseases strongly affect individuals' health status. In aggregate terms, this impact is reflected by the stock of health, which measures the amount of health of a population in a given period of time. The objectives of this study were to measure the relative burden of chronic illnesses by assessing health-related quality of life using the EQ-5D-5L instrument, to rank diseases according to their associations with the stock of health, and to calculate the stock of health of the Spanish population and the amount of health loss attributable to each chronic disease from a social perspective. Data were gathered from the Spanish Health Survey (ENSE 2011–2012, N = 20,587). A population weighted least squares model was used. Chronic diseases represent 19.19% of the stock of health losses in Spain compared with a country free from those diseases. In Spain, the stock of health in 2011 was 31.86 million units on the visual analog scale. The diseases with the strongest impact in terms of loss of stock of health at the individual level were mental illness and embolism, stroke, or cerebral hemorrhage. Collectively, the diseases with the largest impact included osteoarthritis, arthritis, or rheumatism; chronic back pain; and high blood pressure.
Open Access
Self-perceived quality of life by institutionalised adults with cerebral palsy in Spain
(Elsevier, 2024) Nova Díaz, Diana Marcela; Errea Rodríguez, María; Cabasés Hita, Juan Manuel; Sánchez Iriso, Eduardo; Economía; Ekonomia; Universidad Pública de Navarra / Nafarroako Unibertisitate Publikoa
Objetivo: Evaluar la calidad de vida autopercibida de adultos con parálisis cerebral institucionalizados e identificar los factores que influyen en su bienestar, incluyendo características sociodemográficas, clínicas y diagnósticas, así como el grado de institucionalización. Método: Se realizó un estudio descriptivo transversal utilizando la Escala de Calidad de Vida de San Martín en adultos con parálisis cerebral. Los datos se recogieron en 2021 y 2022 en una muestra de adultos con parálisis cerebral de Navarra, España. ˜ Se utilizó regresión multivariante para explorar la relación entre la calidad de vida y diversos factores influyentes. Resultados: La dimensión de autodeterminación influyó positivamente en las puntuaciones de calidad de vida, en tanto que la dimensión de inclusión social tuvo el efecto contrario. Los análisis descriptivos y de regresión revelaron que factores como residir fuera de la ciudad y un alto grado de dependencia influían negativamente en la calidad de vida, mientras que el grado de institucionalización tenía un impacto positivo. Conclusiones: Es importante destacar los efectos positivos del grado de institucionalización sobre la rehabilitación y el bienestar, ya que este busca potenciar la autonomía y la integración social, cuando se habla de modelos de institucionalización centrados en el paciente.
Open Access
Cost-effectiveness and cost-utility of the ball-and-socket trapeziometacarpal prosthesis compared to trapeziectomy and ligament reconstruction: study protocol for a randomized controlled clinical trial
(BMC, 2024) Lirola-Palmero, Serafín; Salva-Coll, Guillem; Yáñez-Juan, Aina María; Sánchez Iriso, Eduardo; Economía; Ekonomia
Background: Trapeziometacarpal (TMC) osteoarthritis (OA) is a common cause of pain and weakness during thumb pinch leading to disability. There is no consensus about the best surgical treatment in unresponsive cases. The treatment is associated with costs and the recovery may take up to 1 year after surgery depending on the procedure. No randomized controlled trials have been conducted comparing ball and socket TMC prosthesis to trapeziectomy with ligament reconstruction. Methods: A randomized, blinded, parallel-group superiority clinical trial comparing trapeziectomy with abductor pollicis longus (APL) arthroplasty and prosthetic replacement with Maïa® prosthesis. Patients, 18 years old and older, with a clinical diagnosis of unilateral or bilateral TMC OA who fulfll the trial’s eligibility criteria will be invited to participate. The diagnosis will be made by experienced hand surgeons based on symptoms, clinical history, physical examination, and complementary imaging tests. A total of 106 patients who provide informed consent will be randomly assigned to treatment with APL arthroplasty and prosthetic replacement with Maïa® prosthesis. The participants will complete diferent questionnaires including EuroQuol 5D-5L (EQ-5D-5L), the Quick DASH, and the Patient Rated Wrist Evaluation (PRWE) at baseline, at 6 weeks, and 3, 6, 12, 24, 36, 48, and 60 months after surgical treatment. The participants will undergo physical examination, range of motion assessment, and strength measure every appointment. The trial’s primary outcome variable is the change in the visual analog scale (VAS) from baseline to 12 months. A long-term follow-up analysis will be performed every year for 5 years to assess chronic changes and prosthesis survival rate. The costs will be calculated from the provider’s and society perspective using direct and indirect medical costs. Discussion: This is the frst randomized study that investigates the efectiveness and cost-utility of trapeziectomy and ligament reconstruction arthroplasty and Maïa prosthesis. We expect the fndings from this trial to lead to new insights into the surgical approach to TMC OA. Trial registration: ClinicalTrials.gov NCT04562753. Registered on June 15, 2020.