Open Access
Prostatic artery embolization versus transurethral resection of the prostate: a post hoc cost analysis of a randomized controlled clinical trial
(Springer Nature, 2021) Capdevila, Ferran; Insausti, Íñigo; Galbete Jiménez, Arkaitz; Sánchez Iriso, Eduardo; Montesino San Martín, Manuel; Estadística, Informática y Matemáticas; Estatistika, Informatika eta Matematika; Economía; Ekonomia
Purpose: to perform a post hoc analysis of patient-incurred costs in a randomized controlled clinical trial comparing prostatic artery embolization (PAE) and transurethral resection of the prostate (TURP). Materials and Methods: patients older than 60 years with indication of TURP were randomized to PAE or TURP procedure. After intervention and hospital discharge, patients were follow-up during 12 months The associated patient costs were categorized according to the study period: pre-intervention, intervention, hospitalization, and follow-up. Several items for both groups were analyzed within each study period. Results: the mean total costs per patient were lower for PAE (€ 3,192.87) than for TURP (€ 3,974.57), with this difference of € 781.70 being significant (p = 0.026). For most evaluated items, the mean costs were significantly higher for TURP. No significant differences were observed in the mean costs of PAE (€ 1,468.00) and TURP (€ 1,684.25) procedures (p = 0.061). However, the histopathology analysis, recovery room stay, and intraoperative laboratory analysis increased the interventional costs for TURP (€ 1,999.70) compared with PAE (€ 1,468.00) (p < 0.001). No cost differences were observed between PAE (€ 725.26) and TURP (€ 556.22) during the 12 months of follow-up (p = 0.605). None of patients required a repeat intervention during the study period. Conclusions: considering the short-term follow-up, PAE was associated with significantly lower costs compared with TURP. Future investigations in the context of routine clinical practice should be aimed at comparing the long-term effectiveness of both procedures and determining their cost-effectiveness.
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
How the relationship between physical activity and health changes with age
(Springer, 2018-03-28) Lera López, Fernando; Ollo López, Andrea; Garrués Irisarri, Mirian; Cabasés Hita, Juan Manuel; Sánchez Iriso, Eduardo; Economía; Ekonomia; Gestión de Empresas; Enpresen Kudeaketa
In the context of age-related declines in physical activity (PA) and the dramatic increase in ageing populations in many countries, this paper sheds further light on the link between PA and self-perceived health (SPH) by examining whether the magnitude of this relationship is age specific. With a sample of 14,456 Spanish individuals aged 18–69, we estimated three levels of intensity in PA using the International Physical Activity Questionnaire. Individuals who did more PA per week showed higher levels of SPH (β = 0.28; 95% CI 0.24–0.32), and age moderated this relationship, with a positive effect over age 49. People aged 50–59 and 60–69 who practiced PA had higher probabilities of better SPH compared with those aged 40–49 (β = 0.14; 95% CI 0.04–0.24) and (β = 0.32; 95% CI 0.21–0.43), respectively. This association between PA and SPH also depended on the intensity of PA, especially for walking (β = 0.14; 95% CI 0.04–0.24). In particular, in comparison with people age 40–49, a statistically significant relationship with SPH was found among people age 50–59 who walked (β = 0.22; 95% CI 0.07–0.36) and people age 60–69 who did moderate PA (β = 0.38; 95% CI 0.23–0.54). This paper provides a major rationale for the design, organisation and implementation of public policies promoting PA and healthy ageing for different age groups.
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
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
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
Epilepsy-related direct medical and direct non-medical cost in adult patients living with epilepsy at a tertiary neurology center in Rwanda
(Elsevier, 2023) Teuwen, Dirk E.; Sebera, Fidele; Murekeyiteto, Alphonsine; Garrez, Ieme; Sánchez Iriso, Eduardo; Umwiringirwa, Josiane; Umuhoza, Georgette; Boon, Paul AJM; Dedeken, Peter; Economía; Ekonomia
Objective: Up to one in four patients living with epilepsy (PwE) mentions financial constraints as a reason for loss to follow-up at the Ndera tertiary neuropsychiatry hospital. Therefore, we evaluated the annual direct medical cost (DMC) and direct non-medical cost (DnMC) of epilepsy and calculated costs assuming different follow-up frequency. Materials and Methods: DMC data were obtained from a descriptive retrospective study of medical records, pharmacy dispensation and hospital logs of PwE, following their initial consultation in 2018 and who adhered to the normal clinical practice of monthly consultations for one year. DnMC data were collected through structured interviews of PwE in a cross-sectional cohort in August 2020. DnMC included biomedical care costs (eg, transportation, hospitality) and non-biomedical costs (traditional healer visits). We report weighted means for total costs, health insurance costs, and out-of-pocket costs (OoP). Results: Mean annual total cost was 389.4 US$, of which 226.2 US$ was covered by the Rwandan Health Insurance co-payment for DMC and 163.2 US$ was OoP paid by patients. Mean weighted annual DMC (n = 55) was 248.9 US$. Mean weighted annual DMC for medical consultations and antiseizure medication accounted for 30.7 US$ and 161.7 US$, respectively. Based on structured interviews (n = 69), mean weighted annual DnMC for biomedical care was 73.0 US$. Mean DnMC for traditional healer care was 67.6 US$. Weighted annual total OoP was 163.2 US$ or 20% of the GDP per capita. OoP consisted of 14% DMC co-payment, 45% biomedical DnMC, and 41% traditional healer DnMC. Conclusion: Epilepsy-related costs at a tertiary center are an important economic burden for PwE and Rwandan Health Insurance. Biomedical and traditional healer DnMC constitute 86% of total OoP. Future prospective studies should evaluate outcomes and costs of reduced visit frequency, indirect costs, and costs of comorbidities.
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
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.