Person: Sánchez Iriso, Eduardo
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Sánchez Iriso
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Eduardo
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Economía
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0000-0002-5320-8732
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2609
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Publication 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 KudeaketaEl 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.Publication 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 GobernuaBackground: 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.Publication 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; EkonomiaObjective: 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.Publication 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; EconomíaChronic 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.Publication 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; EkonomiaAims: 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.Publication 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; EkonomiaObjectives. 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.Publication Open Access Using bayesian techniques to build up an inconsistency free health status index(2004) Cabasés Hita, Juan Manuel; Sánchez Iriso, Eduardo; Economía; EkonomiaObjectives: 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.Publication 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; EkonomiaObjetivos. 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 esperaPublication 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; EkonomiaObjective. 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.