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Objectives: The objectives of the study were to identify the current standards of clinical practice regarding prostate cancer screening in western Europe, Canada, and the United States, and to highlight major characteristics of current prostate cancer screening programs or patterns of practice.Methods: We performed a semi-structured interview by means of a self-administered questionnaire sent by fax to 26 institutes pertaining to the International Network of Agencies for Health Technology Assessment.Results: None of the countries surveyed had a formal national screening policy. Despite that, all the countries answering the questionnaire had discretionary, public-financed screening practices. Moreover, some scientific and professional organizations recommended population screening for prostate cancer, and few of the surveyed countries offered it as experimental practice within a randomized controlled trial. Survey results showed variation regarding screening policies, in particular test of choice, age cut-off points, and treatment prescribed for positive test results.Conclusions: Despite the lack of conclusive evidence on the benefits of prostate cancer screening, the availability of simple and easy-to-administer tests has lead to an enormous variation on screening policies around the world. Practice variations also affect prostate cancer therapy.

Objetivo. Analizar la evolucion y las caracteristicas metodologicas de los estudios de evaluacion economica sobre enfermedades neurologicas y mentales publicados en Espana entre 1983 y 2008. Materiales y metodos. Revision sistematica y analisis comparativo calculando odds ratios (OR). Se realizaron busquedas de estudios publicados en PubMed/Medline, Scopus, ISI Web of Knowledge, CRD, IME e IBECS, y ademas manualmente en revistas especializadas e informes tecnicos. Resultados. Los 52 estudios incluidos en la revision combinan heterogeneidad en la calidad de la informacion comunicada respecto a los metodos de analisis y las fuentes de datos. Los trabajos sobre enfermedades neurologicas y mentales mostraron las siguientes asociaciones, respecto a los estudios en otras causas (n = 425): con analisis coste-utilidad (OR = 1,57; intervalo de confianza del 95%, IC 95% = 0,77-3,22), tratamientos (OR = 3,02; IC 95% = 1,33-6,88), modelos matematicos de simulacion (OR = 2,51; IC 95% = 1,30-4,87) y perspectiva del sistema sanitario (OR = 1,43; IC 95% = 0,80-2,54). Conclusiones. Se observa que hay poca investigacion en evaluacion economica sobre enfermedades neurologicas y mentales en Espana. Seria de esperar que en el futuro aumentara el numero de estudios en enfermedades neurologicas y mentales -en relacion con la carga de enfermedad que generan- y su calidad metodologica.

ResumenLa mejora de la calidad y la transparencia del gobierno sanitario tiene un impacto en la salud de la población a través de las políticas, de la gestión de las organizaciones y de la práctica clínica. Además, la comparación entre centros sanitarios y la retroalimentación de los resultados de forma transparente a los profesionales y a la ciudadanía contribuyen directamente a una mejora en los resultados. La Central de Resultados del sistema sanitario catalán mide y difunde los resultados alcanzados en el ámbito de la asistencia sanitaria por los diferentes proveedores a fin de facilitar una toma de decisiones corresponsable al servicio de la calidad de la atención sanitaria prestada a la población de Cataluña. Esta es una iniciativa pionera en España y está alineada con los países más avanzados en políticas de transparencia y rendición de cuentas.AbstractImproving the quality and transparency of governmental healthcare decision-making has an impact on the health of the population through policies, organisational management and clinical practice. Moreover, the comparison between healthcare centres and the transparent feedback of results to professionals and to the wider public contribute directly to improved results. The “Results Centre” of the Catalan healthcare system measures and disseminates the results achieved by the different healthcare centres in order to facilitate a shared decision-making process, thereby enhancing the quality of healthcare provided to the population of Catalonia (Spain). This is a pioneering initiative in Spain and is aligned with the most advanced countries in terms of policies of transparency and accountability.

ResumenLa evaluación económica de tecnologías sanitarias se ha convertido en los últimos años en Europa en una herramienta de primer orden para los gestores sanitarios en sus estrategias de asignación de recursos sanitarios y de adopción de nuevas tecnologías. España fue uno de los países pioneros en realizar propuestas de estandarización metodológica aplicable a estudios de evaluación económica. No obstante, la falta de decisión política y de apoyo de los gestores sanitarios a este tipo de herramientas hizo que las propuestas cayeran en desuso. Sin embargo, lo esperable es que a medio plazo sea cada vez más habitual que las nuevas tecnologías sanitarias financiadas por el Sistema Nacional de Salud deban aportar una adecuada evidencia de su valor terapéutico y social en comparación con su coste. Llegado ese momento, los actores del sistema requerirán una serie de reglas claras y consensuadas por parte de los agentes del sistema sobre las cuestiones técnicas o metodológicas que deben respetar los estudios de evaluación de tecnologías sanitarias. Por este motivo, las presentes recomendaciones orientan sobre cómo realizar y analizar los estudios de evaluación económica de calidad. Las recomendaciones aparecen bajo 17 encabezamientos o dominios, y bajo cada recomendación hay además un comentario, en el cual se justifican y discuten las propuestas en relación con otras opciones posibles.AbstractOver the last few years, economic evaluation of health technologies has become a major tool used by European health policy decision-makers to create strategies for prioritizing the allocation of health resources and the approval of new technologies. Spain was a pioneer in proposing the standardization of methodology applicable to economic evaluation studies. However, because health policy decision-makers refused to support the initiative, the methodology was never put into practice.In the medium term, evidence of the economic value of new health technologies financed by the national health system will probably be increasingly required. At that time, stakeholders and decision-makers will have to agree upon a clear and concise set of rules on the technical and methodological issues that must be followed by economic evaluations of health technologies. Consequently, we have provided guidelines and recommendations for producing first-rate economic evaluations. The recommendations appear under seventeen headings or sections. In each case, the recommended requirements to be satisfied by an economic evaluation of health technologies are provided and each recommendation is followed by a commentary, providing a justification and comparing and contrasting the proposal with other available alternatives.

ObjetivoEvaluar la reforma de la atención primaria (RAP) en Barcelona durante el año 2000 mediante 3 prácticas preventivas: el consejo antitabaco, la toma de la presión arterial y la vacunación antigripal. Además, se quiere evaluar las desigualdades de sexo, edad o clase social en la recepción de estas prácticas.DiseñoEstudio observacional, descriptivo, transversal.EmplazamientoEncuesta de Salud de Barcelona del año 2000, atención primaria de salud.ParticipantesPersonas mayores de 15 años no institucionalizadas residentes en la ciudad de Barcelona el año 2000 (n = 10.000 personas).Mediciones principalesLos indicadores utilizados fueron las prevalencias de recepción de las 3 prácticas preventivas. Se realizaron análisis descriptivos y de regression logística multivariante.ResultadosLa recepción de las practices preventivas estudiadas es mayor en las areas con mayor tiempo de instauración de la RAP respecto a los centros no reformados (el 63,7 frente al 53,2%, respectivamente). El consejo antitabaco, en el caso de las mujeres, es menos frecuente en las clases sociales más desfavorecidas (odds ratio [OR] = 0,72; intervalo de confianza [IC] del 95 %,0,55-1).ConclusionesLa RAP es un factor asociado con la realización de las practices preventivas. No se han encontrado desigualdades significativas de clase social o sexo en la recepción de las 3 prácticas preventivas.ObjectiveTo evaluate primary care reform (PCR) in Barcelona during the year 2000 using 3 preventive practices: anti-smoking advice, blood pressure measurement, and flu vaccination. Any inequalities of gender, age, or social class in receiving these practices are also assessed.DesignCross-sectional, descriptive, observational study.SettingBarcelona Health Survey, primary health care, Spain, year 2000.ParticipantsNon-institutionalised residents of the city of Barcelona over 15 years old in the year 2000 (N=10 000 people).Main measurementsThe indicators used were the prevalences of receiving the 3 practices. Descriptive and multivariate logistic regression analyses were performed.ResultsReceiving the preventive practices studied is greater in areas where PCR was established longer, compared to the centres that had not begun the reforms (63.7% as opposed to 53.2%, respectively).Anti-smoking advice, for women, is less frequent in the more disadvantaged classes (odds ratio [OR] = 0.72; 95% confidence interval [CI], 0.55-1).ConclusionsPCR is a factor associated with carrying out preventive practices. No significant disparities between social class or gender were found for those who received the preventive practices.

There are different phenotypes of obstructive sleep apnoea (OSA), many of which have not been characterised. Identification of these different phenotypes is important in defining prognosis and guiding the therapeutic strategy. The aim of this study was to characterise the entire population of continuous positive airway pressure (CPAP)-treated patients in Catalonia and identify specific patient profiles using cluster analysis. A total of 72,217 CPAP-treated patients who contacted the Catalan Health System (CatSalut) during the years 2012 and 2013 were included. Six clusters were identified, classified as “Neoplastic patients” (Cluster 1, 10.4%), “Metabolic syndrome patients” (Cluster 2, 27.7%), “Asthmatic patients” (Cluster 3, 5.8%), “Musculoskeletal and joint disorder patients” (Cluster 4, 10.3%), “Patients with few comorbidities” (Cluster 5, 35.6%) and “Oldest and cardiac disease patients” (Cluster 6, 10.2%). Healthcare facility use and mortality were highest in patients from Cluster 1 and 6. Conversely, patients in Clusters 2 and 4 had low morbidity, mortality and healthcare resource use. Our findings highlight the heterogeneity of CPAP-treated patients, and suggest that OSA is associated with a different prognosis in the clusters identified. These results suggest the need for a comprehensive and individualised approach to CPAP treatment of OSA. This study was supported by the Spanish Respiratory Society (SEPAR), Associació Lleidatana de Respiratori (ALLER) and ResMed, a company that provides diagnostic services and treatment for sleep apnoea.

Índice de privación; Desigualdades en salud; Datos administrativos; Financiación de la atención primaria Índex de privació; Desigualtats en salut; Dades administratives; Finançament de l'atenció primària Deprivation index; Health inequalities; Administrative data; Primary care financing Objetivo Construir un índice de privación para la asignación del presupuesto de los equipos de atención primaria de Cataluña, válido tanto para entornos urbanos como rurales y actualizable con más frecuencia que los índices construidos con las variables censales. Método A partir de la revisión de los índices de privación más comunes se seleccionaron las variables existentes de fuentes que permiten una actualización frecuente y que son representativas del ámbito territorial de las áreas básicas de salud. Se calcularon las correlaciones entre las variables escogidas y las variables de utilización de atención sanitaria y morbilidad. Se aplicó el análisis de componentes principales. Finalmente, se calcularon las correlaciones entre el índice construido y el índice MEDEA, y con variables de utilización de recursos y morbilidad para diferentes tramos de dispersión poblacional. Resultados Las variables de renta, ocupación y nivel de estudios son las que tienen más correlación con la utilización de atención sanitaria y la morbilidad. El índice socioeconómico compuesto (ISC) tiene un rango de −0,01 a 5,68, una media de 2,60 y una desviación estándar de 0,91. La correlación entre el ISC y el MEDEA es de 0,89. El ISC se correlaciona con la utilización de atención sanitaria tanto en los entornos urbanos como en los rurales, aunque en estos últimos la asociación es menor. Conclusiones El ISC se ha construido con datos que permiten una actualización frecuente, y se ha integrado en el modelo de asignación de recursos de la atención primaria a partir de 2017. Objective To build a deprivation index for the assignation of the budgets of the primary healthcare teams in Catalonia (Spain) valid for both urban and rural environments and updatable with greater frequency than indices built from census variables. Method Starting from a review of the most common deprivation indices, variables were selected from sources that allow frequent updating and are representative at the territorial level of primary care. The correlations were calculated between the chosen variables and variables of need for healthcare and morbidity. principal components analysis was applied. Finally, the correlations of the index built with the MEDEA index and with variables of use of healthcare resources and morbidity was calculated stratifying by geographical dispersion. Results The variables of income, occupation and education are the ones with the highest correlation with the need for healthcare and morbidity. The composed socioeconomic index (CSI) ranges from −.01 to 5.68, with an average value of 2.60 and a standard deviation of .91. The correlation between the CSI and the MEDEA index is .89. The CSI correlates with use for healthcare in both urban and rural environments, although in rural environments the association is lower. Conclusions The CSI was built with data that allow frequent updating and was integrated in the model for allocating resources to primary healthcare starting in 2017.

Background Since 1995, approval for many new medicinal products has been obtained through a centralized procedure in the European Union. In recent years, the use of summary measures of population health has become widespread. We investigated whether efforts to develop innovative medicines are focusing on the most relevant conditions from a global public health perspective. Methods We reviewed the information on new medicinal products approved by centralized procedure from 1995 to 2009, information that is available to the public in the European Commission Register of medicinal products and the European Public Assessment Reports from the European Medicines Agency. Morbidity and mortality data were included for each disease group, according to the Global Burden of Disease project. We evaluated the association between authorized medicinal products and burden of disease measures based on disability-adjusted life years (DALYs) in the European Union and worldwide. Results We considered 520 marketing authorizations for medicinal products and 338 active ingredients. New authorizations were seen to increase over the period analyzed. There was a positive, high correlation between DALYs and new medicinal product development (ρ = 0.619, p = 0.005) in the European Union, and a moderate correlation for middle-low-income countries (ρ = 0.497, p = 0.030) and worldwide (ρ = 0.490, p = 0.033). The most neglected conditions at the European level (based on their attributable health losses) were neuropsychiatric diseases, cardiovascular diseases, respiratory diseases, sense organ conditions, and digestive diseases, while globally, they were perinatal conditions, respiratory infections, sense organ conditions, respiratory diseases, and digestive diseases. Conclusions We find that the development of new medicinal products is higher for some diseases than others. Pharmaceutical industry leaders and policymakers are invited to consider the implications of this imbalance by establishing work plans that allow for the setting of future priorities from a public health perspective.

Background: The paradox of health refers to the improvement in objective measures of health and the increase in the reported prevalence of chronic conditions. The objective of this paper is to test the paradox of health in Catalonia from 1994 to 2006. Methods: Longitudinal cross-sectional study using the Catalonia Health Interview Survey of 1994 and 2006. The approach used was the three-fold Blinder - Oaxaca decomposition, separating the part of the differential in mean visual analogue scale value (VAS) due to group differences in the predictors (prevalence effect), due to differences in the coefficients (severity effect), and an interaction term. Variables included were the VAS value, education level, labour status, marital status, all common chronic conditions over the two cross-sections, and a variable for non-common chronic conditions and other conditions. Sample weights have been applied./n/nResults: Results show that there is an increase in mean VAS for men aged 15-44, and a decrease in mean VAS for women aged 65-74 and 75 and more. The increase in mean VAS for men aged 15-44 could be explained by a decrease in the severity effect, which offsets the increase in the prevalence effect. The decrease in mean VAS for women aged 65-74 and 75 and more could be explained by an increase in the prevalence effect, which does not offset the decrease in the severity effect. Conclusions: The results of the present analysis corroborate the paradox of health hypothesis for the population of Catalonia, and highlight the need to be careful when measuring population health over time, as well as their usefulness to detect population's perceptions. The authors are grateful the Agència de Salut Pública de Barcelona (ASPB) for providing the data, to Maarten Lindeboom (Department of General and Development Economics, Free University, Amsterdam) for his valuable suggestions on the statistical analysis, and all the members of the Centre for Health Economics (CHE), and the Health, Econometrics and Data Group (HEDG) of the University of York, for their comments on a previous version of this paper.