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San Miguel Elcano, Ramón

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https://academica-e.unavarra.es/handle/2454/49985

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San Miguel Elcano

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Ramón

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Ciencias de la Salud

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812299

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    PublicationOpen Access
    Cost-utility analysis of prostatic artery embolization for treatment of lower urinary tract symptoms
    (2023) Capdevila, Ferran; Insausti, Íñigo; San Miguel Elcano, Ramón; Sánchez Iriso, Eduardo; Montesino San Martín, Manuel; Ciencias de la Salud; Osasun Zientziak; Economía; Ekonomia
    Purpose: To perform a post hoc cost–utility analysis of a randomized controlled clinical trial comparing prostatic artery embolization (PAE) and transurethral resection of the prostate (TURP) in patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia. Materials and Methods: We conducted a cost–utility analysis over a 5-year period to compare PAE versus TURP from a Spanish National Health System perspective. Data were collected from a randomized clinical trial performed at a single institution. Effectiveness was measured as quality-adjusted life years (QALYs), and an incremental cost-effectiveness ratio (ICER) was derived from the cost and QALY values associated with these treatments. Further sensitivity analysis was performed to account for the impact of reintervention on the cost-effectiveness of both procedures. Results: At the 1-year follow-up, PAE resulted in mean cost per patient of €2904.68 and outcome of 0.975 QALYs per treatment. In comparison, TURP had cost €3846.72 per patient and its outcome was 0.953 QALYs per treatment. At 5 years, the cost for PAE and TURP were €4117.13 and €4297.58, and the mean QALY outcome was 4.572 and 4.487, respectively. Analysis revealed an ICER of €2121.15 saved per QALY gained when comparing PAE to TURP at long-term follow-up. Reintervention rate for PAE and TURP was 12% and 0%, respectively. Conclusions: Compared to TURP, in short term, PAE could be considered a cost-effective strategy within the Spanish healthcare system for patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia. However, in long term, the superiority is less apparent due to higher reintervention rates.
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    PublicationOpen Access
    Recaptación de pacientes con antecedente de diagnóstico incompleto de infección por el virus de la hepatitis C
    (Arán Ediciones, 2020) Burgui, Cristina; Martín Fernández, Carmen; Juanbeltz Zurbano, Regina; San Miguel Elcano, Ramón; Martínez Baz, Iván; Zozaya Urmeneta, José Manuel; Castilla Catalán, Jesús; Ciencias de la Salud; Osasun Zientziak
    Antecedentes: desde la década de 1990 se realizan determinaciones de anticuerpos del virus de la hepatitis C (anti-VHC) y los resultados positivos no siempre fueron seguidos de determinación del ARN-VHC. Algunos de estos pacientes podrían tener una infección activa y no conocerlo. Se describe una intervención de captación activa de estos pacientes para completar el diagnóstico. Métodos: se revisaron resultados históricos de laboratorio de Navarra y se identificaron pacientes con anti-VHC positivo que no se habían realizado ARN-VHC. En septiembre de 2018 se informó a cada médico de Atención Primaria de sus pacientes con instrucciones para completar el diagnóstico. Se ha evaluado esta actividad hasta diciembre de 2019. Resultados: se detectaron 289 pacientes con anti-VHC positivo en los que no se había descartado infección activa. Dos tenían infección por VIH y seis habían fallecido. El contacto con los 281 restantes fue encargado a sus médicos de Primaria. A final de 2019, 187 (67 %) se habían realizado una nueva analítica, el 5 % decidió no analizarse, el 4 % vivía fuera de Navarra, el 3 % no se consiguió contactar y en el 2 % de los casos el médico no lo consideró procedente. El 19 % estaba pendiente de contactar. De 187 pacientes analizados, en 52 (28 %) se confirmó infección activa, el 40 % eran falsos positivos y el 31 % tenía ARN-VHC no detectable. De los 52 casos con infección activa, 34 ya habían iniciado tratamiento antiviral, tres ingresaron por cirrosis descompensada y uno falleció. Conclusión: la recaptación de personas que habían quedado con un diagnóstico incompleto de infección por el VHC ha sido una estrategia eficiente de detección de infecciones activas para su tratamiento antiviral.
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    PublicationOpen 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.
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    PublicationOpen 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.