Gaceta sanitaria最新文献

{"title":"[Health economics in Spain: evidence for action beyond costs].","authors":"Beatriz González López-Valcárcel, Vicente Ortún, María Errea, Pilar Pinilla-Domínguez","doi":"10.1016/j.gaceta.2025.102516","DOIUrl":"https://doi.org/10.1016/j.gaceta.2025.102516","url":null,"abstract":"","PeriodicalId":94017,"journal":{"name":"Gaceta sanitaria","volume":" ","pages":"102516"},"PeriodicalIF":0.0,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Budget impact analysis of implementing a lung cancer screening in high-risk population in Spain.","authors":"Aránzazu Hernández-Yumar, Cristina Valcárcel-Nazco, Paula Cantero-Muñoz, Lidia García-Pérez","doi":"10.1016/j.gaceta.2025.102515","DOIUrl":"https://doi.org/10.1016/j.gaceta.2025.102515","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the cost of implementing a population-based lung cancer screening program using low-dose radiation computed tomography (CT) in a high-risk population in Spain.</p><p><strong>Method: </strong>A budget impact analysis (5 years) was performed from the National Health System' perspective, comparing 16 hypothetical scenarios with screening, based on different age ranges and screening frequencies (annual/biennial), with the current scenario without a lung cancer screening program. Diagnosis, treatment and follow-up costs were considered, as well as the screening costs in the hypothetical scenarios (measured in Euros 2024). From the resident population (50-80 years), the target population and the CT scanners needed to cover the program's demand were calculated. A one-way deterministic sensitivity analysis was performed.</p><p><strong>Results: </strong>The gross budget impact was estimated at €1708.19 million for the current scenario. Among the hypothetical scenarios, it can range from €3737.17 million (biennial screening, 55-65 years) to €10 009.54 million (annual screening, 50-80 years), resulting in a net budget impact of €2028.98-€8301.35 million. By acquiring 100% of the necessary scanners, the investment reached approximately 22% of the annual program's own costs in the first year. The net impact could be reduced to €1858-€7519 million, for 0% acquisition.</p><p><strong>Conclusions: </strong>Implementing a lung cancer screening program would generate a high cost for the Spanish National Health System, amounting more than one billion Euros compared to the scenario without screening.</p>","PeriodicalId":94017,"journal":{"name":"Gaceta sanitaria","volume":" ","pages":"102515"},"PeriodicalIF":0.0,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pricing and reimbursement of off-patent medicines dispensed in community pharmacies.","authors":"David Epstein","doi":"10.1016/j.gaceta.2025.102506","DOIUrl":"https://doi.org/10.1016/j.gaceta.2025.102506","url":null,"abstract":"<p><strong>Objective: </strong>After expiry of the patent, price competition can lead to savings. However, in Spain, competition in the retail price of prescription off-patent medicines in pharmacies is rare, while large discounts are negotiated in the wholesale market. Some countries have moved from \"competition by discount\" to \"competition by price\". This article compares retail prices in Spain with other countries, and the factors that promote price competition.</p><p><strong>Method: </strong>This article reviews the literature comparing prices and the factors influencing competition. A detailed analysis of the design of the market was conducted for Spain and Sweden. Interviews were conducted with experts. The systems were compared for the definition of exchange groups, prescription and substitution, how retail prices and profit margins are regulated, and safeguards to avoid risk of shortages.</p><p><strong>Results: </strong>Depending on sample and methodology, prices in Spain may be on average 51% to 109% greater than Sweden. Broadly, the literature recommends that the off-patent market should be regulated by competitive forces rather than price caps. Spain and Sweden have many features in common. Key differences are: 1) Sweden allows price differences between medicines, and for prices to rise as well as fall, 2) the tendering process, 3) patient choice, and 4) the architecture of the exchange groups CONCLUSIONS: In Spain, first generic or biosimilar entry provokes a 25-40% discount, but thereafter prices are static. In Sweden, price competition is dynamic. This includes, within limits, freedom to set prices, product differentiation, and patient choice.</p>","PeriodicalId":94017,"journal":{"name":"Gaceta sanitaria","volume":" ","pages":"102506"},"PeriodicalIF":0.0,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Loneliness as a determinant of health: evidence from the Health Survey of Catalonia.","authors":"Helena M Hernández-Pizarro, Albert Prades-Colomé, Guillem López-Casasnovas","doi":"10.1016/j.gaceta.2025.102491","DOIUrl":"10.1016/j.gaceta.2025.102491","url":null,"abstract":"<p><strong>Objective: </strong>This study investigates the health effects of loneliness among adults (18+ years) and elderly adults (60+ years).</p><p><strong>Method: </strong>Using data from the Health Survey of Catalonia (ESCA), 2013-2019, the effects of loneliness on health and healthcare utilization outcomes are estimated. Ordinary least squares estimates are provided to explore the channels affecting such relationships.</p><p><strong>Results: </strong>Loneliness is significantly associated to worse health outcomes in all age groups. Among adults, it reduces self-perceived health by 7.1%, increases multi-morbidities by 22.1%, and raises the probability of depression and anxiety by 65.8%. Consequently, a positive and strong association between suffering from loneliness and the use of healthcare resources is documented: with a 7.4% rise in medication use, 20.9% more emergency care visits, and 6.1% higher primary care use. Results for the elderly are aligned with adults, although the magnitude associated to self-perceived health is substantially greater (13.2%). Channels exploration identifies living alone (with a 97.3% increase) and poor household habitability (33.5% increase) as key predictors in all the analysis. Being foreign (60.3% increase in the adult population and 106% in the elderly population) and gender (women, 26.8% for the adult population and 27.5% in the elderly population) become relevant factors explaining loneliness.</p><p><strong>Conclusions: </strong>This study documents the impact of loneliness in Catalonia. Loneliness is associated to significant worse health and more use of healthcare. Tackling individuals with higher risk factors for loneliness could help preventing its concerning consequences on health and healthcare system.</p>","PeriodicalId":94017,"journal":{"name":"Gaceta sanitaria","volume":" ","pages":"102491"},"PeriodicalIF":0.0,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Resource use and healthcare costs in long-term breast cancer survivors (CONCEPT-COSTS)].","authors":"Cristina Valcárcel Nazco, Benjamín Rodríguez Díaz, David Abbad Gómez, Carmen Guirado Fuentes, Francisco Estupiñán Romero, Enrique Bernal Delgado, María Sala Serra","doi":"10.1016/j.gaceta.2025.102507","DOIUrl":"10.1016/j.gaceta.2025.102507","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the use of resources and healthcare costs of a cohort of long-term survivors of breast cancer in four autonomous communities in Spain (Aragon, Catalonia, Madrid and Navarre) by assessing their pathways in the National Health System.</p><p><strong>Method: </strong>Patient pathways were analyzed based on their interactions with the National Health System between 2012 and 2016. Healthcare pathways were obtained from the CONCEPT project and were use to examine resource use, associated costs, and to analyze potential differences between cohorts and regions. A total of 18,527 women were included, of whom 6115 were long-term survivors of breast cancer and 12,412 formed the control group, consisting of women with no history of the disease, matched by age and healthcare area with the survivors. Regression models were applied to analyze factors associated with the cost of trajectories.</p><p><strong>Results: </strong>Long-term survivors of breast cancer had a higher use of healthcare resources, and a higher number of comorbidity and drug use compared to the control group, with statistically significant differences. Costs were also higher for survivors, especially in outpatient clinics. Factors such as the number of drugs, comorbidity and the Charlson index were identified as the main factors associated with higher healthcare costs in both groups.</p><p><strong>Conclusions: </strong>This study identified the costs of healthcare pathways in long-term breast cancer survivors and suggests that the methodology used could help healthcare professionals allocate resources more efficiently.</p>","PeriodicalId":94017,"journal":{"name":"Gaceta sanitaria","volume":" ","pages":"102507"},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144334733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Differential seasonality in surgical waiting list discharges in Spain: implications for management].","authors":"Jaime Pinilla, Francisco José Estupiñán-Romero, Beatriz González López-Valcárcel, Manuel Ridao-López, Enrique Bernal-Delgado","doi":"10.1016/j.gaceta.2025.102499","DOIUrl":"https://doi.org/10.1016/j.gaceta.2025.102499","url":null,"abstract":"<p><strong>Objective: </strong>To analyse the seasonal variability of surgical procedures with guaranteed maximum waiting times with a view to figure out whether there are differences between urgent admissions and need-sensitive procedures, and those supply-sensitive.</p><p><strong>Method: </strong>Retrospective longitudinal observational study with administrative data on hospital episodes of the National Health System for 14 autonomous communities, years 2003 to 2022, aggregated monthly. The elective supply-sensitive surgical procedures with guaranteed times were selected. Then, as to conduct, the comparative analyses, we selected need-sensitive elective procedures for aortic-coronary bypass surgery in patients over 40 years of age, percutaneous transluminal coronary angioplasty in patients over 40 years of age, and breast cancer surgery in adult women up to 85 years of age to compare differences in seasonal variability. Finally, in order to get a basal level of seasonal variation we used emergency admissions for hip fracture in patients over 65 years of age and admission for acute myocardial infarction in patients over 40 years of age. A multiplicative decomposition of the series was applied to calculate the seasonal rate of change, and a placebo test was applied to test the seasonal variability of health care delivery across comparison groups.</p><p><strong>Results: </strong>Supply-sensitive elective surgery showed a marked seasonal variability, with rates of variation above 1.20 in months such as February, March, May and June, and very low values in the summer months, 0.42 in August. The placebo test confirmed significant differences with respect to the expected distribution according to working days. In contrast, in those need-sensitive procedures and emergency admissions, the seasonal variability was found to be almost non-existent.</p><p><strong>Conclusions: </strong>A reasonable management objective for hospitals could be to reduce the monthly variability in elective supply-sensitive surgical activity through improving indication, re-organizing of human resources and incentives to reduce activity.</p>","PeriodicalId":94017,"journal":{"name":"Gaceta sanitaria","volume":" ","pages":"102499"},"PeriodicalIF":0.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Comparative price analysis of healthcare interventions between autonomous communities].","authors":"Luísa Serpa Dos Santos Gonçalves Ferreira, Rosa María Urbanos-Garrido","doi":"10.1016/j.gaceta.2025.102494","DOIUrl":"https://doi.org/10.1016/j.gaceta.2025.102494","url":null,"abstract":"<p><strong>Objective: </strong>To highlight the differences in pricing applied to health interventions by the autonomous communities, as well as the heterogeneous definition of the basic list of services.</p><p><strong>Method: </strong>A comparative analysis of the prices of representative procedures included in the common basket of health services was conducted, based on information from official publications of the autonomous communities.</p><p><strong>Results: </strong>Significant prices variations for the same intervention were identified across autonomous communities, along with notable heterogeneity in service definitions.</p><p><strong>Conclusions: </strong>The Interterritorial Council should promote transparency in the criteria used to set prices and enhance the coordination of regional health services in the definition, implementation, and development of analytical accounting systems. Additionally, it should standardize the specification of services included in the common basket of benefits to facilitate the analysis of regional differences in production costs.</p>","PeriodicalId":94017,"journal":{"name":"Gaceta sanitaria","volume":" ","pages":"102494"},"PeriodicalIF":0.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Linear points system for prioritizing the waiting list in a general surgery service].","authors":"Fernando-Ignacio Sánchez-Martínez, José-María Abellán-Perpiñán, Jorge-Eduardo Martínez-Pérez","doi":"10.1016/j.gaceta.2025.102483","DOIUrl":"https://doi.org/10.1016/j.gaceta.2025.102483","url":null,"abstract":"<p><strong>Objective: </strong>To design a linear points system to prioritize patients on the waiting list for a general surgery service.</p><p><strong>Method: </strong>Using a mixed technique (nominal groups and pretesting), criteria and levels for the prioritization system were selected based on the preferences expressed by surgeons and patients in a general surgery service. A subset of the possible combinations of criteria and levels was evaluated by two samples of general population (n=474) and surgical professionals (n=20), through a ranking exercise. The model coefficients (system scores) were estimated using ordered logistic regression. A second sample from the general population (n=120) was used to validate the points system.</p><p><strong>Results: </strong>A linear points system was developed with five criteria or attributes, each with two or three levels. The scores, calculated as averages from the samples, assigned significant importance to clinical aspects (e.g., risk of deterioration while waiting), but also considered patients' quality of life (pain/discomfort and limitations in daily activities), as well as social criteria (work-related limitations).</p><p><strong>Conclusions: </strong>Prioritization systems help improve equity in access to healthcare and can contribute to reducing waiting times. Considering social criteria, alongside strictly clinical ones, aligns with the World Health Organization's definition of health.</p>","PeriodicalId":94017,"journal":{"name":"Gaceta sanitaria","volume":" ","pages":"102483"},"PeriodicalIF":0.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Allocating socioeconomic census data to primary care areas: an improvement in small-area analyses.","authors":"Francisco Estupiñán-Romero, Santiago Royo-Sierra, Javier González-Galindo, Manuel Ridao-López, Enrique Bernal-Delgado","doi":"10.1016/j.gaceta.2025.102464","DOIUrl":"https://doi.org/10.1016/j.gaceta.2025.102464","url":null,"abstract":"<p><strong>Objective: </strong>Provide a method for reusing National Institute of Statistics (INE) socioeconomic data and reconstructing the Spanish National Health System primary care areas (PCA) from INE census tracts.</p><p><strong>Method: </strong>The reconstruction of PCA boundaries entailed aligning, assigning, and integrating census tracts within the limits of the PCA using 2022 INE and 2018 Atlas VPM digital maps.</p><p><strong>Results: </strong>36,282 census tracts were assigned to 2,405 PCA. The alignment of digital maps showed a programmatic assignment of 99.7% of the census tracts within PCA; just ten census tracts must be manually assigned. The net average income per capita distribution from INE was consistent along the newly reconstructed PCA.</p><p><strong>Conclusions: </strong>We have proposed a reliable solution to integrate socioeconomic data from INE census statistics into PCA, enhancing data researchers' capacities in joint analyses of socioeconomic determinants and healthcare.</p>","PeriodicalId":94017,"journal":{"name":"Gaceta sanitaria","volume":" ","pages":"102464"},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healthy nudges: exploring their variability, limitations, and future challenges.","authors":"José-María Abellán-Perpiñán, Fernando-Ignacio Sánchez-Martínez, Jorge-Eduardo Martínez-Pérez, Eduardo Martínez-Gabaldón","doi":"10.1016/j.gaceta.2025.102468","DOIUrl":"https://doi.org/10.1016/j.gaceta.2025.102468","url":null,"abstract":"<p><strong>Objective: </strong>To review several behavioral economics-based interventions (\"healthy nudges\") aimed at mitigating the overuse and underuse of healthcare resources -phenomena associated with poorer health outcomes and increased costs.</p><p><strong>Method: </strong>A comparative case study approach is used to assess the effectiveness of ten studies designed to improve treatment adherence and prevent underuse, as well as those focused on improving prescribing practices to address overuse.</p><p><strong>Results: </strong>First, healthy nudges are generally effective, although there is considerable variability in their outcomes. Effectiveness compared to the control group ranges from 5% to over 30%. Second, similar strategies may yield divergent results depending on the context (e.g., medication adherence vs. vaccination uptake). Third, the effect of healthy nudges appears to diminish after the intervention ends, especially for economic incentives. However, default options seem to remain persistent over time.</p><p><strong>Conclusions: </strong>The article examines the pros and cons of healthy nudges in the use and provision of healthcare services. The evidence gathered from the selected studies suggests that nudges may help rationalize healthcare use. However, challenges remain, such as ensuring the long-term persistence of effects and evaluating their impact on well-being and cost-effectiveness.</p>","PeriodicalId":94017,"journal":{"name":"Gaceta sanitaria","volume":" ","pages":"102468"},"PeriodicalIF":0.0,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143618110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}