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Search Results: 1 - 10 of 144416 matches for " Anto?anzas F. "
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Artículos de evaluación económica en Gaceta Sanitaria: algunas reflexiones
Antoanzas F.
Gaceta Sanitaria , 2003,
Abstract:
Evaluación económica del empleo de terapias farmacológicas para la cesación en el hábito tabáquico
Antoanzas,F.; Portillo,F.;
Gaceta Sanitaria , 2003, DOI: 10.1590/S0213-91112003000500008
Abstract: introduction: public policies for smoking cessation are mainly based on advice from the primary care physician and group therapy. several pharmacological treatments to reduce tobacco addiction are currently available. one of these treatments, bupropion, has remarkable efficacy (30% over 1 year) compared with nicotine replacement therapies (chewing gum 8%, patches 17% over 1 year). the objective of this study was to assess the efficiency of three smoking cessation strategies based on pharmacotherapies in spain. material and methods: the current situation of methods for smoking cessation in spain includes a mixture of primary care physician advice, group therapy and willpower, combined with the use of drugs in a small proportion of individuals. this situation was compared with three scenarios in which the use of the available pharmacotherapies was increased (by up to 10%) for 1 year. a cost-effectiveness evaluation was used to calculate the cost per death prevented and per year of life saved in each scenario. the analysis used a time horizon of 20 years and was based on an adaptation of the hecos model, sponsored by who-euro, which enables comparison of distinct pharmacotherapy interventions. epidemiological data were based on the national health survey (1997) and the national institute of statistics (1999). results: the cost-effectiveness ratio of bupropion at 5 years was 70,939 euros per death prevented and was 37,305 euros per year of life saved. when the time horizon was increased to 20 years, these figures became net savings of 28,166 and 3,265 euros, respectively. the cost-effectiveness ratios for both nicotine gums and patches were higher than that for bupropion: 171,834 euros per death prevented at 5 years and 90,362 euros per year of life saved for patches and 513,004 euros per death prevented and 269,772 euros per year of life saved at 5 years. furthermore, bupropion treatment for 1 year would prevent a greater number of deaths than the alternative strategie
Evaluación económica del empleo de terapias farmacológicas para la cesación en el hábito tabáquico
Antoanzas F.,Portillo F.
Gaceta Sanitaria , 2003,
Abstract: Introducción: Las intervenciones públicas dirigidas a ayudar a los fumadores que desean cesar en el hábito tabáquico consisten principalmente en el consejo médico y la terapia de grupo. Actualmente, existen varios tratamientos farmacológicos que reducen la adicción al tabaco. Uno de ellos, el bupropión, tiene una destacada eficacia (30% en un a o) en comparación con las terapias sustitutivas de nicotina (chicles [8%] y parches [17%] en un a o). El objetivo de este estudio es analizar la eficiencia del empleo de farmacoterapias para la cesación en el consumo del tabaco. Material y métodos: Para ello, partimos de la situación actual en Espa a en cuanto a los métodos utilizados por los fumadores que desean dejar el hábito tabáquico, que consiste en una mezcla del consejo médico, la terapia de grupo y la fuerza de voluntad, combinada con el uso de fármacos en una proporción reducida. Dicha situación se compara con tres escenarios en los cuales, alternativamente, se amplía (hasta el 10%) el uso durante un a o de las distintas farmacoterapias disponibles, realizando un análisis de coste-efectividad para calcular el coste por muerte evitada y por a o de vida ganado en cada uno de ellos. Este análisis contempla un horizonte temporal de 20 a os y se basa en una adaptación del modelo HECOS, promovido por WHO-Euro, que permite comparar distintas farmacoterapias. Los datos epidemiológicos empleados proceden de la Encuesta Nacional de Salud (1997) y del Instituto Nacional de Estadística (1999). Resultados: La estrategia basada en el empleo de bupropión como método de cesación tiene una ratio coste-efectividad de 70.939 euros por muerte evitada y 37.305 euros por a o de vida ganado, transcurridos 5 a os. Cuando el horizonte temporal se amplía a 20 a os, estos resultados se tornan en beneficios netos de 28.166 y 3.265 euros, respectivamente. Tanto los parches como los chicles de nicotina tienen unos cocientes de coste-efectividad superiores a la anterior estrategia: 171.834 euros por muerte evitada y 90.362 euros por a o de vida ganado para los parches, y 513.004 euros por muerte evitada y 269.772 euros por a o de vida ganado para los chicles, en el quinto a o. Además, la intervención basada en el tratamiento con bupropión en un a o evitaría un mayor número de muertes que las estrategias alternativas (alrededor de 3.000 muertes en un horizonte temporal de 20 a os) debido al mayor descenso en el número de fumadores que produce. Conclusiones: Algunos métodos de cesación tienen bajos costes -como el consejo médico y la terapia de grupo- pero también una eficacia reducida
La Atención Primaria de Salud: descentralización y eficiencia
Pinillos,M; Antoanzas,F;
Gaceta Sanitaria , 2002, DOI: 10.1590/S0213-91112002000500006
Abstract: objective: the purpose of this study was to evaluate whether the productive behavior of health centers in autonomous communities with competence in health is more efficient than that among centers belonging to spanish public health system (insalud). methods: the technical efficiency of 66 health centers in álava, navarre and la rioja was analyzed. centers in autonomous communities that in 1997 had been granted complete authority from the central government to manage their healthcare services were compared with centers whose administration, in the same year, was still in the hands of insalud. the method used to measure and quantify the efficiency of these centers was data envelopment analysis. results: nonparametric contrast of the health centers' mean efficiency rates revealed no significant differences in the (in)efficiency of centers from la rioja, navarre and alava conclusions: the results obtained from the model of efficiency measurement used did not indicate that decentralization improves the productive efficiency of primary care centers.
La Atención Primaria de Salud: descentralización y eficiencia
Pinillos M,Antoanzas F
Gaceta Sanitaria , 2002,
Abstract: Objetivo: El propósito de este artículo es comprobar si el comportamiento productivo de los centros de salud pertenecientes a comunidades autónomas con competencias en sanidad es más eficiente que el de los centros dependientes del INSALUD. Métodos: Se lleva a cabo un análisis comparado de la eficiencia técnica de 66 centros de salud de álava, Navarra y La Rioja; centros pertenecientes a comunidades autónomas que, en el a o objeto de estudio (1997), tenían totalmente transferidas las competencias sanitarias, y centros cuya gestión, en dicho a o, estaba en manos del INSALUD. El método utilizado para medir y cuantificar la eficiencia de dichos centros es el análisis envolvente de datos (AED). Resultados: El contraste no paramétrico de las tasas de eficiencia media de los centros de salud riojanos, navarros y alaveses no evidencia diferencias significativas en el comportamiento (in)eficiente de dichos centros. Conclusiones: Los resultados obtenidos a partir del modelo de medición de la eficiencia considerado no detectan una mayor eficiencia en el comportamiento productivo de los centros de salud descentralizados.
El coste de la diabetes tipo 2 en Espa?a: El estudio CODE-2
Mata,M.; Antoanzas,F.; Tafalla,M.; Sanz,P.;
Gaceta Sanitaria , 2002, DOI: 10.1590/S0213-91112002000600009
Abstract: objective: to estimate the cost of providing health care to patients with type 2 diabetes, by differentiating costs of the disease, costs of complications, and other unrelated health costs. methods: data on resource use were retrospectively collected from medical records and personal interviews in 29 primary health care centers in spain. patients were randomly selected from each center's diabetes registry. results: we evaluated 1004 patients (561 women) with a mean age of 67.42 years and a mean disease duration of 10.07 years. a total of 50.9% had no complications, 17.7% had macrovascular complications only, 19.5% had microvascular complications only and 11.9% presented both types of complication. the annual health cost per patient was 1305.15 euros. of this cost, 28.6% (373.27 euros) was directly related to diabetes control, 30.51% (398.20 euros) was related to complications of the disease, and 40.89% (533.68 euros) was unrelated. the mean cost of patients with no complications was 883 euros compared with 1403 euros for those with microvascular complications, 2022 euros for those with macrovascular complications and 2133 euros for patients with both types of complication. conclusions: because of the high cost of treating type 2 diabetes and its complications, preventive measures should be implemented and control of the disease should be improved to reduce the costs associated with chronic complications.
El coste de la diabetes tipo 2 en Espa a: El estudio CODE-2
Mata M.,Antoanzas F.,Tafalla M.,Sanz P.
Gaceta Sanitaria , 2002,
Abstract: Objetivo: Estimar el coste de la atención sanitaria al paciente diabético tipo 2, diferenciando el gasto derivado del control de la enfermedad, de la atención de sus complicaciones y de otros costes directos asociados. Métodos: Recogida retrospectiva del consumo de recursos a partir de la historia clínica y la entrevista personal en 29 centros de atención primaria de todo el territorio nacional de una muestra de pacientes seleccionados de forma aleatoria a partir del registro de diabéticos de cada centro. Resultados: Se evaluó a 1.004 pacientes (561 mujeres) con una media de edad de 67,42 a os y una media de evolución de la enfermedad de 10,07 a os. El 50,9% no presentaba complicaciones, el 17,7% sólo macrovasculares, el 19,5% sólo microvasculares y el 11,9% ambas. El coste anual sanitario por paciente fue de 1.305,15 euros. De este coste el 28,6% (373,27 euros) estaba relacionado directamente con el control de la diabetes, el 30,51% (398,20 euros) con sus complicaciones y el 40,89% (533,68 euros) no estaba relacionado. El coste medio de un paciente sin complicaciones fue de 883 euros frente a 1.403 de un paciente con complicaciones microvasculares, 2.022 cuando existían complicaciones macrovasculares y 2.133 cuando coexistían ambos tipos de complicaciones. Conclusiones: El elevado coste del tratamiento de la diabetes tipo 2 y sus complicaciones, sugiere la posibilidad de que la mejora del control de la enfermedad pueda no sólo mejorar la supervivencia y la calidad de vida, sino reducir los costes asociados con las complicaciones crónicas.
Coste-efectividad de la combinación dutasterida y tamsulosina en el tratamiento de la hiperplasia benigna de próstata en Espa?a
Antoanzas,F.; Brenes,F.; Molero,J.M.; Fernández-Pro,A.; Huerta,A.; Palencia,R.; Cozar,J.M.;
Actas Urológicas Espa?olas , 2011, DOI: 10.4321/S0210-48062011000200001
Abstract: objectives: to evaluate the incremental cost-effectiveness ratio (icer) of the combination therapy with dutasteride and tamsulosin (dut+tam) as initiation treatment versus the most used drug in spain, tamsulosin (tam), in the treatment of moderate to severe benign prostatic hyperplasia (bph) with risk of progression. methods: a semi-markov model was developed using 4-year and 35-year time horizons and from the spanish national healthcare service perspective. data were obtained from the combat trial. effectiveness was measured in terms of quality adjusted life years (qalys). health care resources were defined by an experts' panel, and unitary costs were obtained from published spanish sources. pharmacologic cost is expressed in ptpwat; in the case of tam, the generic price is used, in the case of dut+tam the price of a fixed dose combination is used. costs are expressed in 2010 euros. results: combination therapy with dut+tam produces an incremental effectiveness of 0.06qaly at year 4 and 0.4qaly at year 35. dut+tam represents an incremental cost of € 810.53 at 4 years and € 3,443.62 at 35 years. therefore, the icer for dut+tam versus tam is € 14,023.32/qaly at year 4 and € 8,750.15/qaly at year 35. conclusions: initiation treatment with dut+tam represents a cost-effective treatment versus tam, the most used treatment in spain, due to the fact the icer is below the threshold that usually allows a technology to be considered as cost-effective.
Los modelos de Markov probabilísticos en la evaluación económica de tecnologías sanitarias: una guía práctica
Mar,Javier; Antoanzas,Fernando; Pradas,Roberto; Arrospide,Arantzazu;
Gaceta Sanitaria , 2010, DOI: 10.1590/S0213-91112010000300006
Abstract: objective: markov models are the standard method used in cost-effectiveness studies to represent the natural history of disease. the objective of this study was to show the key elements in building probabilistic markov models. methods: we used the example of a new treatment for a generic disease. a probabilistic markov model was constructed using statistical distributions. monte carlo simulations were carried out to obtain the probabilistic sensitivity analysis. the results were analyzed in terms of the cost-effectiveness plane and acceptability curve. results: the incremental cost-effectiveness rate for the average patient was €22,855/quality adjusted life years (qaly). in the probabilistic sensitivity analysis, the results from all simulations were located in the northeast quadrant, corresponding to positive cost and effectiveness. however, 67% of the simulations were below the threshold of €30,000/qaly. conclusion: the use of probabilistic markov models requires the integration of concepts from economics, epidemiology, statistics, and the clinical setting. some stages of the process, such as the construction and processing of these models, the management of absolute and relative risks and of statistical distributions, often pose major difficulties but are key steps required to reproduce the disease with validity.
Modelos matemáticos para la evaluación económica: los modelos dinámicos basados en ecuaciones diferenciales
Pradas Velasco,Roberto; Antoanzas Villar,Fernando; Mar,Javier;
Gaceta Sanitaria , 2009, DOI: 10.1590/S0213-91112009000500020
Abstract: the joint utilization of both decision trees and epidemiological models based on differential equations is an appropriate method for the economic evaluation of preventative interventions applied to infectious diseases. these models can combine the dynamic pattern of the disease together with health resource consumption. to illustrate this type of model, we adjusted a dynamic system of differential equations to the epidemic behavior of influenza in spain, with a view to projecting the epidemiologic impact of influenza vaccination. the results of the epidemic model are implemented in a diagram with the structure of a decision tree so that health resource consumption and the economic implications can be calculated.
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