Search

Background: Inflammatory bowel disease (IBD) has a major economic impact on healthcare costs. Objectives: The aim of this study was to evaluate the current healthcare expenditure associated with IBD in a population-wide study in Catalonia. Design: Retrospective observational study. Methods: All patients with IBD included in the Catalan Health Surveillance System (CHSS) were considered eligible. The CHSS compiles data on more than 7 million individuals in 2020 (34,823 with IBD). Data on the use of healthcare resources and its economic impact were extracted applying the International Classification of Diseases, 10th revision, Clinical Modification codes (ICD-10-CM codes). Health expenditure, comorbidities, and hospitalization were calculated according to the standard costs of each service provided by the Department of Health of the Catalan government. The data on the IBD population were compared with non-IBD population adjusted for age, sex, and income level. IBD costs were recorded separately for Crohn's disease (CD) and ulcerative colitis (UC). Results: Prevalence of comorbidities was higher in patients with IBD than in those without. The risk of hospitalization was twice as high in the IBD population. The overall healthcare expenditure on IBD patients amounted to 164M€. The pharmacy cost represents the 60%. The average annual per capita expenditure on IBD patients was more than 3.4-fold higher (IBD 4200€, non-IBD 1200€). Average costs of UC were 3400€ and 5700€ for CD. Conclusion: The risk of comorbidities was twice as high in patients with IBD and their use of healthcare resources was also higher than that of their non-IBD counterparts. Per capita healthcare expenditure was approximately 3.4 times higher in the population with IBD. Trial registration: The study was not previously registered. Plain language summary: Economic impact of inflammatory bowel disease in Catalonia The manuscript includes data of the most recent epidemiologic data about the high economic impact of IBD in Catalonia. [ABSTRACT FROM AUTHOR]

Heterogeneity in the treatment of a disease is a marker of suboptimal quality of care. The aim of this study is to evaluate the heterogeneity in the treatment used and the outcomes for Crohn's disease (CD) in Catalonia. All patients with CD included in the Catalan Health Surveillance System (data on more than seven million individuals from 2011 to 2017) were identified. The different Catalonian health areas were grouped into 19 district groups (DG). Treatments used rates (systemic corticosteroids, non-biological and biological immunosuppressant) and outcomes rates (hospitalization and surgery) were calculated. The use of systemic corticosteroids presented a decreasing trend over the study period, with an average rate of use in the different territories between 11% and 17%. The use of non-biological immunosuppressant treatment has remained stable, with an average rate of use ranging from 22% to 40% per year depending on the DG. The use of biological immunosuppressant treatment increased with an average rate of use in the different territories ranging from 10 to 23%. Hospitalizations for any reason showed an increasing trend between 2011 and 2017 with an average rate of between 23% and 32% per year depending on the area. Hospitalizations for CD presented a decreasing trend, with an average rate of between 5% and 11% per year. Surgical treatment remained stable over time, rates per year were between 0.5% and 2%. A remarkable geographical heterogeneity in the use of different treatments and in outcomes of CD was observed between different geographical areas of Catalonia. There is a notable geographical heterogeneity in the administration of biological and immunosuppressive treatments to Crohn's disease patients in Catalonia. There is also a geographical heterogeneity in their rates of hospitalization and surgical intervention. [ABSTRACT FROM AUTHOR]

The use of gold coinage in the Medieval Catalonian counties has received considerable academic attention over the past forty years. A crucial factor, the characterisation of individuals using gold currency as their basis of accountancy, however, has to date been neglected. The main aim of this paper is to tackle this issue on the basis of the Diplomatari of Santes Creus. After crossing the data with those extracted from seven other documental sets in the Catalonian counties, the kinship and social links and the properties of 86% of users of gold currency in Santes Creus have been identified. Results show that accounting solutions based on gold weight or gold coinage were essentially used by a closed and not too extensive group of magnates of variable status, connected by kinship, vassalage and proximity links. [ABSTRACT FROM AUTHOR]

Abstract: The present paper applies and adapts the methodology of integrated assessment focus groups (IA-FGs) in order to understand and analyse the enhancing factors, as well as the constraints which drive or limit the take-off and development of sustainable forest biomass energy systems in a selected large forested area of the Mediterranean basin. Our study provides both quantitative and qualitative data from Catalonia, Northeast Spain. We provide historical trends in forest expansion; an assessment of technological, socio-economic and ecological options of forest management; and plausible scenarios of its future evolution. Results show that while the opportunities and stakes are high, in Mediterranean countries, specific socio-ecologic factors need to be taken into account if forest biomass is to contribute decisively to securing renewable sources of energy in Europe, integrating landscape planning with resource policies or mitigating climate change. Among these key factors identified are property regimes, low productivity of Mediterranean forests and weak institutional capacity. Other elements such as logistics and supply difficulties and the lack of economic profitability of forest products constitute limitations identified in the implementation of bioenergy systems. Technological solutions alone, while important, are insufficient to ensure a prominent role of Southern Europe forest biomass management in the climate, landscape and sustainability energy policy challenge. [Copyright &y& Elsevier]