Gaceta sanitaria最新文献

{"title":"Hospitalizations and doctor visits among older adults in Europe: cross-country differences using a multilevel approach.","authors":"Elisa Amo-Saus, Roberto Martinez-Lacoba, Isabel Pardo-García, Pablo Moya-Martínez","doi":"10.1016/j.gaceta.2025.102465","DOIUrl":"https://doi.org/10.1016/j.gaceta.2025.102465","url":null,"abstract":"<p><strong>Objective: </strong>To analyse the individual and country-level determinants of the use of healthcare systems by populations over 50 years of age in Europe.</p><p><strong>Method: </strong>We conducted a cross-sectional study using data from Wave 7 (2017) of the Survey of Health, Ageing, and Retirement in Europe. The analysis included 27 countries. We fitted multilevel mixed-effects logistic regression models with hospitalization and doctor visits per person per year as dependent variables.</p><p><strong>Results: </strong>The findings suggest that country-level variables explain between 3.3% and 4.9% of the differences in the likelihood of hospitalizations and approximately 10% of the likelihood of visiting a doctor at least once a year. Life expectancy and number of beds were the country-level variables most strongly associated with a reduced probability of hospitalization and doctor visits, respectively. The study also found that comorbidity and employment status were risk factors associated with hospitalization and doctor visits, while physical activity was a protective factor.</p><p><strong>Conclusions: </strong>Country-level factors positively associated with higher health service use are the number of beds, health expenditure per capita and preventable mortality. Life expectancy and treatable mortality are negatively associated with the use of these services. Greater comorbidity increase the likelihood of hospitalization and medical visits, while higher muscular strength or regular physical activity reduce them.</p>","PeriodicalId":94017,"journal":{"name":"Gaceta sanitaria","volume":" ","pages":"102465"},"PeriodicalIF":0.0,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588962","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":"[Effectiveness and cost-effectiveness of non-pharmacological interventions for functional somatic disorders: systematic review of meta-analyses and economic evaluations].","authors":"Inmaculada Boluda-Verdú, Ferrán Catalá-López","doi":"10.1016/j.gaceta.2025.102457","DOIUrl":"https://doi.org/10.1016/j.gaceta.2025.102457","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the effectiveness and cost-effectiveness of non-pharmacological interventions for functional somatic disorders through a review of systematic reviews with meta-analysis and economic evaluations.</p><p><strong>Method: </strong>Searches were carried out in PubMed/MEDLINE, EMBASE, Cochrane Database of Systematic Reviews and PsycINFO (until June 2024). Outcome measures were improvement in symptoms (for systematic reviews) and incremental cost-effectiveness ratio (for economic evaluations). Methodological quality was assessed with AMSTAR-2 for systematic reviews and with QHES for economic evaluations. A narrative synthesis of the studies was performed, without meta-analysis.</p><p><strong>Protocol registration: </strong>Open Science Framework (https://osf.io/u3w2b/).</p><p><strong>Results: </strong>32 studies were included (27 systematic reviews and 5 economic evaluations). All systematic reviews included randomized trials, except 2 that also included non-randomized studies. In systematic reviews, the most studied conditions were gastrointestinal disorders (12/27) and physical symptoms not explained by an organic pathology (6/27), while in economic evaluations they were undifferentiated somatoform disorders (2/5). The systematic reviews that included comparisons of psychological therapies, mindfulness and herbal medicine seemed to indicate improvements in symptoms. However, those systematic reviews that included acupuncture were inconclusive. All economic evaluations were associated with randomized trials. The incremental cost-effectiveness ratios were dominant (less costs, more effective) in 2 studies evaluating cognitive behavioral therapy. Of the systematic reviews, 20 presented critically low quality, 5 low quality and 2 moderate quality, while the 5 economic evaluations presented high quality.</p><p><strong>Conclusions: </strong>The evidence on the effectiveness and cost-effectiveness of non-pharmacological interventions for functional somatic disorders should be interpreted with caution since the majority of the systematic reviews were of low or critically low methodological quality, and with a high level of uncertainty in the case of economic evaluations. The diversity of definitions of the diagnosis and interventions makes it difficult to generalize these results.</p>","PeriodicalId":94017,"journal":{"name":"Gaceta sanitaria","volume":" ","pages":"102457"},"PeriodicalIF":0.0,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588959","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":"Cost-effectiveness of direct oral anticoagulants in non-valvular atrial fibrillation.","authors":"Inigo Gorostiza, Amaia Bilbao-Gonzalez, Javier Mar","doi":"10.1016/j.gaceta.2025.102451","DOIUrl":"https://doi.org/10.1016/j.gaceta.2025.102451","url":null,"abstract":"<p><strong>Objective: </strong>There is evidence on the efficiency of new direct oral anticoagulants (DOAC), mostly based on experimental efficacy data, but there is also a need to assess their cost-effectiveness in routine clinical practice using patient-level data. We designed a retrospective cohort study to assess the cost-effectiveness of DOAC compared to acenocoumarol in patients with non-valvular atrial fibrillation (NVAF) with a follow-up of up to 7 years.</p><p><strong>Method: </strong>Basque Health Service-registered patients who started oral anticoagulant treatment between 2013 and 2016 were included in the study and followed up until the end of 2019. Data were extracted from an electronic medical record management system. Effectiveness was expressed in terms of life years gained and adjusted for health-related quality of life (i.e., quality-adjusted life years [QALY]). Propensity score techniques were used to adjust the estimates for differences between groups in baseline characteristics.</p><p><strong>Results: </strong>A total of 10,843 new users of oral anticoagulants with a mean follow-up of 4.1 years were included. The incremental cost-effectiveness ratio of DOAC compared to acenocoumarol ranged from €1,732 to €2,556/QALY, while the incremental net benefit for different willingness-to-pay thresholds was only negative for values below €3,000/QALY.</p><p><strong>Conclusions: </strong>Based on the analysis of data from clinical practice and the similarity of results using several different techniques to adjust for bias associated with observational studies, we conclude that DOAC would be an efficient alternative for the treatment of patients with NVAF.</p>","PeriodicalId":94017,"journal":{"name":"Gaceta sanitaria","volume":" ","pages":"102451"},"PeriodicalIF":0.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143461157","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":"[Analysis of equity and budgetary sustainability of the pharmaceutical co-payment system in Spain].","authors":"Jaime Pinilla, Christian González-Martel, Beatriz González López-Valcárcel, Félix Lobo, Jaume Puig-Junoy","doi":"10.1016/j.gaceta.2024.102427","DOIUrl":"https://doi.org/10.1016/j.gaceta.2024.102427","url":null,"abstract":"<p><strong>Objective: </strong>To estimate the impact of a more equitable pharmaceutical co-payment system by eliminating the distinction between active workers and pensioners, using only personal income as an adjustment parameter, defining more detailed income brackets, and introducing protective limits on personal expenditure.</p><p><strong>Method: </strong>Data from a random sample of 4,505,483 individuals residing in Spain were used, matching pharmaceutical consumption information from the Ministry of Health with economic data from the Tax Agency. Five microsimulation scenarios were designed, modifying co-payment percentages and monthly limits, and the effects on public pharmaceutical spending, the economic burden between patients and the Spanish National Health System, and the redistribution of the burden among patient groups were evaluated. The Kakwani index was used to measure the progressivity of each scenario.</p><p><strong>Results: </strong>The results show that equalizing active workers and pensioners and introducing more detailed income brackets can increase the progressivity of the co-payment system. In scenarios 2, 3, 4, and 5, the Kakwani index was higher than 0.2, indicating greater vertical equity. Public budgetary costs ranged from 48 million euros to 710.2 million euros. In all scenarios, the user's share of pharmaceutical expenditure decreased, especially for lower-income groups.</p><p><strong>Conclusions: </strong>A more progressive and equitable pharmaceutical co-payment system is feasible and can better protect low-income individuals without disproportionate budgetary impact. Eliminating the distinction between active workers and pensioners and exempting co-payments for incomes below 6,000 euros can significantly increase the system's equity.</p>","PeriodicalId":94017,"journal":{"name":"Gaceta sanitaria","volume":" ","pages":"102427"},"PeriodicalIF":0.0,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142735415","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}