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Background: Frequent monitoring of patients declined during the COVID-19 pandemic, harming patients with chronic diseases who critically needed correct monitoring. We evaluated the impact of the COVID-19 pandemic in patients with non-valvular atrial fibrillation (NVAF) receiving treatment with vitamin K antagonists (VKA) or non-vitamin K antagonist oral anticoagulants (NOAC) in clinical practice in Spain. Methods: This observational, retrospective study analyzed prevalent patients treated with NOAC/VKA on 14/03/2019 (pre-COVID-19 period) and 14/03/2020 (COVID-19 period), who were followed up to 12 months. The study also considered incident patients who started treatment with NOAC/VKA between 15/03/2019 and 13/03/2020 (pre-COVID-19 period) and from 15/03/2020 to 13/03/2021 (COVID-19 period). Demographic characteristics, comorbidities, effectiveness, treatment patterns, and healthcare resource utilization were considered. Results: Prevalent patients amounted to 12,336 and 13,342 patients, whereas 1,612 and 1,602 incident patients were included in the pre-COVID-19 and COVID-19 periods, respectively. Prevalent patients treated with VKA had more strokes, thromboembolism, and major bleeding compared to those receiving NOAC, particularly during the COVID-19 period. NOAC patients had a 12 % lower risk of death than those on treatment with VKA (Hazard ratio = 0.88 [95 % CI: 0.81 – 0.95], p = 0.033). In addition, VKA patients were less persistent after 12 months than NOAC patients (pre-COVID-19 period: 52.1 % vs. 78.9 %, p

ObjectiveThis study aims to compare the hospitalization rate in individuals with schizophrenia who started their treatment with aripiprazole once monthly (AOM400) or atypical oral antipsychotics (OA) in Spain.MethodsThis is an observational and retrospective study based on the electronic medical records from the BIG-PAC database. The study population consisted of individuals diagnosed with schizophrenia who initiated their treatment with AOM400 (AOM cohort) or atypical OA (OA cohort) from 01/01/2017 to 31/12/2019. A 1:1 propensity score matching (PSM) procedure was conducted to match individuals of both cohorts. The number and duration of hospitalizations, persistence to treatment, healthcare resources use, and costs were analyzed after 12 months.ResultsAfter the PSM, 1,017 individuals were included in each cohort [age: 41.4 years (SD: 10.6); males: 54.6%]. During the follow-up period, the AOM cohort had a 40% lower risk of hospitalization than the OA group [HR: 0.60 (95% confidence interval, CI: 0.49–0.74)]. The median time to the first hospitalization was longer in individuals with AOM400 compared to those with OA (197 days compared to 174 days; p < 0.004), whereas hospital admissions were shorter (AOM400: 6 compared to OA: 11 days; p < 0.001). After 12 months, individuals receiving AOM400 were more persistent than those with OA (64.9% compared to 53.7%; p < 0.001). The OA cohort required more healthcare resources, mainly visits to primary care physicians, specialists, and emergency rooms than those receiving AOM400 (p ≤ 0.005 in all comparisons). AOM400 reduced the costs of hospitalizations, and emergency room, specialist and primary care visits by 50.4, 36.7, 16.1, and 10.9%, respectively, in comparison to the treatment with atypical OA. AOM400 led to annual cost savings of €1,717.9 per individual, from the societal perspective.ConclusionAripiprazole once monthly reduces the number and duration of hospitalizations, together with the treatment costs of schizophrenia, as it reduces the use of healthcare resources and productivity losses in these individuals.

Aim: Healthcare resources usage and costs associated to nonvalvular atrial fibrillation (NVAF) were analyzed in Spain. Methods: This is an observational and retrospective study on patients with NVAF who started their treatment with apixaban or acenocoumarol between 1 January 2015 and 31 December 2017. Results: 2160 patients treated with apixaban were paired (1:1) with patients treated with acenocoumarol (propensity score matching). Apixaban reduced the incidence of strokes and systemic embolisms, minor and major bleedings and deaths, versus acenocoumarol. Apixaban led to reductions of 80, 55 and 43% in costs related to nursing visits, hospitalizations, and emergency visits, respectively, leading to annual cost savings of €274/patient, from the perspective of society. Conclusion: Our results suggested that apixaban is a cost-effective alternative for patients with NVAF.

Abstract Background Migraine represents a serious burden for national health systems. However, preventive treatment is not optimally applied to reduce the severity and frequency of headache attacks and the related expenses. Our aim was to assess the persistence to traditional migraine prophylaxis available in Spain and its relationship with the healthcare resource use (HRU) and costs. Methods Retrospective observational study with retrospective cohort design of individuals with migraine treated with oral preventive medication for the first time from 01/01/2016 to 30/06/2018. One-year follow-up information was retrieved from the Big-Pac™ database. According to their one-year persistence to oral prophylaxis, two study groups were created and describe regarding HRU and healthcare direct and indirect costs using 95% confidence intervals (CI). The analysis of covariance (ANCOVA) was performed as a sensitivity analysis. Patients were considered persistent if they continued on preventive treatment until the end of the study or switched medications within 60 days or less since the last prescription. Non-persistent were those who permanently discontinued or re-initiated a treatment after 60 days. Results Seven thousand eight hundred sixty-six patients started preventive treatment (mean age (SD) 48.2 (14.8) and 80.4% women), of whom 2,545 (32.4%) were persistent for 6 months and 2,390 (30.4%) for 12 months. Most used first-line preventive treatments were antidepressants (3,642; 46.3%) followed by antiepileptics (1,738; 22.1%) and beta-blockers (1,399; 17.8%). The acute treatments prescribed concomitantly with preventives were NSAIDs (4,530; 57.6%), followed by triptans (2,217; 28.2%). First-time preventive treatment prescribers were mostly primary care physicians (6,044; 76.8%) followed by neurologists (1,221; 15.5%). Non-persistent patients required a higher number of primary care visits (mean difference (95%CI): 3.0 (2.6;3.4)) and days of sick leave (2.7 (0.8;4.5)) than the persistent ones. The mean annual expenditure was €622 (415; 829) higher in patients who not persisted on migraine prophylactic treatment. Conclusions In this study, we observed a high discontinuation rate for migraine prophylaxis which is related to an increase in HRU and costs for non-persistent patients. These results suggest that the treatment adherence implies not only a clinical benefit but also a reduction in HRU and costs.

Introduction: Adding LAMA to LABA/ICS is recommended to improve control in patients with persistent asthma. Methods: This observational, retrospective, before-and-after study considered patients diagnosed with asthma who started LABA/ICS + LAMA treatment (triple therapy, TT) between 1 January 2017 and 31 December 2018 and had been treated with LABA/ICS (dual therapy, DT) in the year before. Changes in lung function and exacerbation rates, healthcare resource utilization, and healthcare and non-healthcare costs (€2019) were estimated in patients with asthma in clinical practices in Spain. Data from computerized medical records from seven Spanish regions were collected ±1 year of LAMA addition. Results: 4740 patients (64.1 years old [SD: 16.3]) were included. TT reduced the incidence of exacerbations by 16.7% (p < 0.044) and the number of patients with exacerbations by 8.5% (p < 0.001) compared to previous DT. The rate of patients with severe exacerbations requiring systemic corticosteroids and their hospitalization rates significantly decreased by 22.5% and 29.5%. TT significantly improved FEV1, FVC, and FEV1/FVC, saving €571/patient for society. Younger patients with asthma (18–44 years old) and patients with severe asthma (FEV1 < 60%) performed better upon the initiation of TT. Conclusions: TT reduced asthma exacerbations, improved lung function and reduced healthcare costs vs. DT, particularly in patients requiring systemic corticosteroids to treat severe exacerbations.

Introduction and Objectives: Previous studies have evaluated the risk of drug-drug interactions (DDI) in HCV patients receiving pangenotypic direct-acting antivirals (pDAA). This study aimed to describe the prevalence of the risk of potential multiple DDI (multi-DDI) and its clinical impact in patients treated with pDAAs. Materials and Methods: A retrospective observational study from a Spanish database of 1.8 million inhabitants, including patients treated with Sofosbuvir/Velpatasvir [SOF/VEL] or Glecaprevir/Pibrentasvir [GLE/PIB] (2017- 2020). Demographics, comorbidities, comedications, and DDIs were evaluated. The severity and impact of the DDIs were evaluated using the University of Liverpool tool. Additionally, the ICD-9 coding system was used to identify the presence of suspected adverse drug reactions (SADR) during the treatment. An indirect indicator of effectiveness was evaluated (requirement of a new DAA in the six months after the end of the pDAA). Results: 1620 patients were included; 730 with SOF/VEL (median age: 55 y; 62% men; 37.8% F3/4) and 890 with GLE/PIB (53 y; 60% men; 28% F3/4). The most prescribed drugs were neurological (35.8%), digestive (24.1%) and cardiovascular (14.2%). 77.5% of patients received ≥2 comedications. The number of patients receiving ≥ 2 comedications at risk of multi-DDI with pDAAs was 123 (9.8%, 123/1256), 52 with SOF/VEL and 71 with GLE/PIB. Patients showing increased risk in comedication as a DDI outcome were 31% (22) with GLE/PIB and 11% (6) with SOF/VEL (p

Objectives: To describe the epidemiology, clinical profile, treatments, and to determine cardiovascular and renal outcomes after two years of follow-up in a contemporary chronic kidneay disease (CKD) population in Spain. This was also analyzed among the DAPA-CKD-like population (patients who met most inclusion criteria of DAPA-CKD trial). Methods: Observational, retrospective, population-based study using BIG-PAC database. The CKD population was defined as patients ≥18 years, with at least one diagnostic code of CKD prior to the index date (January 1st, 2018). CKD was defined as estimated glomerular filtration rate (eGFR) 30 mg/g. Results: We identified 56,435 CKD patients after exclusions (76.4 years, 52.2% men, urine albumin-to-creatinine ratio 390.8 mg/g, eGFR 49.7 mL/min/1.73 m2). CKD prevalence was 4.91% and incidence 2.10 per 1000 patient-years. Regarding treatments, 69.2% were taking renin-angiotensin system inhibitors (only 4.2% at maximal doses) and 3.5% of diabetic patients SGLT-2 inhibitors. During the two years of follow-up, rates of heart failure, all-cause death, myocardial infarction, stroke, and CKD were 17.9, 12.1, 7.2, 6.3, and 5.9 events per 100 patient-years, respectively. During this period, 44% of patients were hospitalized, and 6.8% died during hospitalization. Cardiovascular outcomes were more common in the DAPA-CKD-like population. Conclusions: In Spain, CKD population is older and comorbidities, including diabetes and heart failure, are common. Cardiovascular and renal outcomes are frequent. There is room for improvement in CKD management, particularly through the use of drugs with proven cardiovascular and renal benefit. Resumen: Objetivos: Describir la epidemiología, el perfil clínico, los tratamientos y los eventos cardiovasculares y renales, tras 2 años de seguimiento en una población contemporánea con enfermedad renal crónica (ERC) en España. También se analizó en la población tipo DAPA-CKD (pacientes que cumplían la mayoría de criterios del estudio DAPA-CKD). Métodos: Estudio observacional, retrospectivo, poblacional, empleando la base de datos BIG-PAC. La población con ERC se definió como pacientes ≥ 18 años, con al menos un código diagnóstico de ERC antes de la fecha índice (01/01/2018). La ERC se definió como filtrado glomerular estimado (FGe) 30 mg/g. Resultados: Se identificaron 56.435 pacientes con ERC, tras exclusiones (76,4 años, 52,2% varones, cociente albúmina-creatinina 390,8 mg/g, FGe 49,7 ml/min/1,73 m2). La prevalencia fue del 4,91% y la incidencia 2,10/1.000 pacientes/año. El 69,2% tomaba inhibidores del sistema renina-angiotensina (solo el 4,2% a dosis máximas) y el 3,5% de los diabéticos inhibidores SGLT-2. Tras 2 años, las tasas de insuficiencia cardiaca, muerte, infarto de miocardio, ictus y ERC fueron 17,9; 12,1; 7,2; 6,3; 5,9 eventos/100 pacientes/año, respectivamente. Además, el 44% hospitalizaron y el 6,8% murieron durante la hospitalización. Los eventos cardiovasculares fueron más frecuentes en la población tipo DAPA-CKD. Conclusiones: En España, la población con ERC es mayor, y las comorbilidades, incluyendo diabetes e insuficiencia cardiaca, comunes. Los eventos cardiovasculares y renales son frecuentes. Hay margen de mejora en el manejo de la ERC, especialmente a través del empleo de fármacos con beneficio cardiovascular y renal.

Background: Impetigo is a common dermatological paediatric infection that can be treated with topical antibiotics: the common are mupirocin (MUP), fusidic acid (FA) and, most recently, ozenoxacin (OZ). Aim: This study assesses the clinical and economic consequences of the use of OZ vs. MUP and vs. FA for the treatment of impetigo in routine clinical practice in Spain. Methods: This is a retrospective observational study using real-life data from electronic medical records of patients with impetigo who started treatment with OZ, MUP or FA (maximum follow-up: 3 months; n = 10,974). We compared treatment duration, comorbidities, use of systemic medication, complications, utilization of resources and associated costs across treatments (p

BackgroundAtherosclerotic cardiovascular diseases (ASCVD) and dyslipidemia are associated to a higher risk of cardiovascular events, mortality, use of healthcare resources and costs. In Spain, the evidence about the administration of lipid-lowering treatments in clinical practice, and their clinical effectiveness in patients with ASCVD and hypercholesterolemia and patients with FH is scarce. Therefore, a multidisciplinary working group of cardiologists, family physicians, internal medicine specialists and neurologists was gathered for the Reality study. The aim of this study is to describe the demographic and clinical characteristics, comorbidities, and concomitant medication of patients with ASCVD and hypercholesterolemia and of patients with familial hypercholesterolemia (FH). The use of healthcare resources and costs associated to the management of these diseases after their diagnosis were also considered.MethodsThis is an observational and retrospective study, based on the BIG-PAC® database, which includes the electronic medical registries (EMRs) of 1.8 million people from 7 Autonomous Communities in Spain (including public primary care centers and hospitals). The study includes patients who had a new or recurrent episode of ASCVD during the recruitment period (from 01/01/2017 to 31/12/2018). The index date will be defined as the date of the ASCVD event, and the follow-up period will be 24 months. According to their first diagnosis in the database, patients will be classified as ASCVD (5 groups: stable/unstable angina, acute myocardial infarction, ischemic stroke, transient ischemic attack, and peripheral arterial disease) or FH.DiscussionThis study aims to analyze the treatment patterns and use of healthcare resources of ASCVD and FH in Spain. The prevalence of these disorders will also be estimated. Due to the high morbidity and mortality associated with these diseases, it is expected that our study will provide useful information for healthcare systems and decision makers to improve the management of these disabling diseases.

Abstract Background Data about the impact of chronic kidney disease (CKD) on health care costs in Spain are scarce This study was aimed to evaluate cumulative costs and healthcare utilisation in CKD in Spain. Methods Observational, retrospective, population-based study, which included adults who received care for CKD between 2015 and 2019. Healthcare and medication costs were summarized on a yearly basis starting from the index date (1st January 2015), and then cumulatively until 2019. Results We identified 44,214 patients with CKD (year 2015: age 76.4 ± 14.3 years, 49.0% women, albumin-to-creatinine ratio 362.9 ± 176.8 mg/g, estimated glomerular filtration rate 48.7 ± 13.2 mL/min/1.73 m2). During the 2015–2019 period, cumulative CKD associated costs reached 14,728.4 Euros, being cardiovascular disease hospitalizations, particularly due to heart failure and CKD, responsible for 77.1% of costs. Total medication cost accounted for 6.6% of the total cost. There was a progressive decrease in cardiovascular disease hospital costs per year (from 2741.1 Euros in 2015 to 1.971.7 Euros in 2019). This also occurred with cardiovascular and diabetic medication costs, as well as with the proportion of hospitalizations and mortality. Costs and healthcare resources use were higher in the DAPA-CKD like population, but also decreased over time. Conclusions Between 2015 and 2019, costs of patients with CKD in Spain were high, with cardiovascular hospitalizations as the key determinant. Medication costs were responsible for only a small proportion of total CKD costs. Improving CKD management, particularly with the use of cardiovascular and renal protective medications may be helpful to reduce CKD burden.

Abstract Background Increasing the knowledge about heart failure (HF) costs and their determinants is important to ascertain how HF management can be optimized, leading to a significant decrease of HF costs. This study evaluated the cumulative costs and healthcare utilisation in HF patients in Spain. Methods Observational, retrospective, population-based study using BIG-PAC database, which included data from specialized and primary care of people ≥18 years, from seven autonomous communities in Spain, who received care for HF between 2015 and 2019. The healthcare and medication costs were summarized on a yearly basis starting from the index date (1st January 2015), and then cumulatively until 2019. Results We identified 17,163 patients with HF (year 2015: mean age 77.3 ± 11.8 years, 53.5% men, 51.7% systolic HF, 43.6% on NYHA functional class II). During the 2015–2019 period, total HF associated costs reached 15,373 Euros per person, being cardiovascular disease hospitalizations the most important determinant (75.8%), particularly HF hospitalizations (51.0%). Total medication cost accounted for 7.0% of the total cost. During this period, there was a progressive decrease of cardiovascular disease hospital costs per year (from 2834 Euros in 2015 to 2146 Euros in 2019, P

Objective To determine treatment persistence and exacerbations in patients initiating inhaler treatment with fixed-dose combinations of inhaled corticosteroids/long-acting beta-2-adrenergic agonists (ICS/LABA) for the treatment of asthma.Design Retrospective observational study conducted by review of electronic medical records (database: Fundación RediSS).Setting Retrospective cohort study. The follow-up period was 1 year.Participants The study included patients aged ≥18 years who started treatment with ICS/LABA and met the inclusion/exclusion criteria.Main outcomes and measures The study groups were fluticasone propionate/salmeterol (FP/SAL), beclomethasone/formoterol (BDP/FORM), budesonide/formoterol (BUD/FORM), fluticasone furoate/vilanterol (FF/VI) and fluticasone propionate/formoterol (FP/FORM). The main measurements were persistence, medication possession ratio (MPR) and exacerbations. Statistical significance was established as p

Background: Opioids are widely used in moderate-to-severe chronic pain which is non-responsive to standard analgesics. Prescriptions have increased in Europe in the last decade, although remain lower than in USA. This work projected the future utilization and costs of opioids in chronic osteoarthritis (OA) pain in the Spanish National Health System (NHS). Methods: An epidemiological model was populated with the opioid dispensing trends from 2010 to 2019 using Spanish Medicinal Agency rates of opioid utilization in subjects over 18 years of age and the real-world OPIOIDS study to estimate chronic-OA-pain patients receiving opioids. A best-fitted trend analysis model was applied estimating the likely number of DHD (defined daily dose/1000 inhabitants per day) to calculate projected opioid utilization and costs for the period 2020–2029. Results: In 2010, an estimated 5.67 DHD were dispensed for the equivalent of 217,076 chronic OA pain patients per day [1.99 DHD, 76,084 refractory to non-steroidal anti-inflammatory drugs (NSAIDs)]. From these trends and OA prevalence, the projected number of DHDs is expected to increase more than threefold to 17.98 DHDs by the year 2029 for the equivalent of 727,356 chronic OA pain patients per day (8.18 DHD, 330,720 refractory to NSAIDs); 41.8% on strong opioids. The estimated cost was €116.9m (€45.0m in NSAID-refractory OA) in 2010 rising by 222% to €376.1m (€199.7m refractory to NSAIDs) by 2029. Conclusion: Chronic-OA-pain-related opioid dispensing and costs to the NHS are set to increase more than threefold from 2010 to 2029 in Spain. Using opioids for OA pain is concerning given disease chronicity and other related costs not computed in these projections. Plain language summary • Opioids are widely used in chronic pain which is non-responsive to standard analgesics. Prescriptions have increased in Europe, although remain lower than in USA. Osteoarthritis (OA) is a degenerative joint disease usually accompanied by pain. Despite not recommended, opioids use in OA have been expanded because this health condition is increasing with ageing and, also, because physicians both primary and specialist boosted their use. • This study aimed to quantify the current burden of opioids used for chronic moderate-to-severe OA pain by estimating the number of defined daily doses per 1000 inhabitants per day (DHD) and associated costs, and to forecast the likely burden on the National Health System (NHS) in Spain for the years 2020–2029. • In 2010, an estimated 5.67 DHDs were dispensed for the equivalent of 217,076 chronic OA pain patients per day. From these trends, the projected number of DHDs is expected to increase more than threefold to 17.98 DHDs by the year 2029 for the equivalent of 727,356 chronic OA pain patients per day; 41.8% on strong opioids. The estimated cost was €116.9m in 2010 rising by 222% to €376.1m by 2029. • Chronic OA-pain-related opioid dispensing and costs to the NHS are set to increase substantially (threefold to more than fourfold) from 2010 to 2029 in Spain. Thus, using opioids for OA pain is concerning given disease chronicity, aging population and other related costs not computed in these projections. Our findings can inform payors and clinicians about ongoing discussions on appropriate analgesic management for longer-term OA pain, including resource requirements at a national level. Clinicians who prescribe opioids for OA pain should consider the potential implications of side effects such as sedation, cognitive deterioration, incremental need of caregivers, particularly in older people, and carefully consider the risk–benefit balance.

Resumen: Introducción: Existen diferentes tipos de heparina de bajo peso molecular con distintas posologías para el tratamiento de la tromboembolia venosa (TEV). Material y métodos: Estudio multicéntrico observacional-retrospectivo con inclusión de pacientes con TEV tratados con enoxaparina y con seguimiento de un año. Los pacientes fueron divididos en 2 grupos: hospitalario y ambulatorio. El objetivo del estudio es describir el uso de las 2 pautas de enoxaparina (150 UI/kg al día y 100 UI/kg cada 12 h) en el tratamiento de la TEV en ambos grupos. Resultados: Se incluyó a 896 pacientes; el 44,5% iniciaron enoxaparina en el hospital y el 55,6% de forma ambulatoria. Los pacientes hospitalarios respecto a los ambulatorios mostraron mayor edad (69,6 vs. 66,1), presentación como embolia pulmonar (63,1 vs. 5,8%), comorbilidad medida por el índice Charlson (3,0 vs. 2,5) y uso de antiagregantes (68,8 vs. 51,4%) y corticoesteroides (25,1 vs. 13,7%). La posología utilizada fue de una vez al día en el 78,3% y de 2 veces al día en el 21,7% de los pacientes, sin diferencias entre ambos grupos. La duración media del tratamiento (84,7 vs. 59,1 días) fue superior en los pacientes hospitalarios. El porcentaje de pacientes que modificaron la pauta posológica (22,6 vs. 20,9%) fue similar en ambos grupos. Los pacientes con TEV y cáncer mayoritariamente fueron del ámbito ambulatorio y recibieron la pauta de una vez al día. Conclusiones: La pauta de una vez al día resultó la más utilizada tanto en el ámbito hospitalario como en el ambulatorio. En una quinta parte de los pacientes se modifica la pauta de enoxaparina durante el seguimiento. Abstract: Introduction: There are various types of low molecular weight heparins with different dosages for the treatment of venous thromboembolism (VTE). Material and methods: Multicentre observational-retrospective study including patients with VTE treated with enoxaparin and followed for one year. Patients were divided into 2 groups: hospital and outpatient. The objective of the study was to describe the use of 2 enoxaparin dosages (150 IU/kg per day and 100 IU/kg per 12 hours) in the treatment of VTE in the 2 groups. Results: A total of 896 patients were included: 44.5% initiated enoxaparin in hospital and 55.6% as outpatients. The hospital patients compared with outpatients were older (69.6 vs. 66.1 years), had a higher Charlson index (3.0 vs. 2.5), and more pulmonary embolism (63.1 vs. 5.8%), and antiplatelet agent (68.8 vs. 51.4%) and corticosteroid use (25.1 vs. 13.7%). The dosage was once a day in 78.3% and twice a day in 21.7% of patients, with no between-group differences. Mean treatment duration (84.7 vs. 59.1 days) was higher in the hospital patients. The percentage of patients in whom the dosage was modified (22.6 vs. 20.9%) was similar between groups. Patients with VTE and cancer were mostly outpatients and received enoxaparin once a day. Conclusions: The once-a-day dosage was the most widely used in both hospital patients and outpatients. In one fifth of patients, the enoxaparin dosage was modified during follow up.

Objective To identify potential drug interactions (DIs) between pangenotypic direct-acting antivirals (pDAAs) and concomitant cardiovascular (CV) therapies in patients with chronic hepatitis C (CHC). Methods A retrospective observational study was carried out. Patients ≥18 years of age diagnosed with CHC and treated with pDAAs during 2017 were included. Information was collected on concomitant CV therapies and potential DIs [ www.hep-druginteractions.org ]. The pDAAs analyzed were sofosbuvir/velpatasvir (SOF/VEL), glecaprevir/pibrentasvir (GLE/PIB) and sofosbuvir/velpatasvir/voxilaprevir (SOF/VEL/VOX). An analysis including lipid-lowering drugs was also performed. Results In total, 1286 patients (mean age 64.9 years, 56.6% men) were recruited. The percentages of potential DIs with CV drugs were 1.9% contraindications, 38.1% clinically significant and 2.4% weak. When lipid-lowering drugs were included, the percentages of potential DIs with CV drugs were 10.3% contraindications, 46.3% clinically significant and 3.2% weak. Potential DIs associated with each pDAA were as follows (contraindications; clinically significant; weak): SOF/VEL (1.4%; 23.0%; 0.9%), GLE/PIB (12.8%; 60.8%; 4.7%) and SOF/VEL/VOX (16.6%; 55.1%; 4.9%). Conclusions Approximately on third of patients with CHC are concomitantly treated with CV drugs. SOF/VEL may have fewer DIs with CV drugs than other pDAAs.

Objective: The objective of this study was to analyze health outcomes, resource utilization, and costs in osteoarthritis patients with chronic nociceptive pain who began treatment with an opioid in real-world practice in Spain. Methods: We designed a non-interventional, retrospective, longitudinal study with 36 months of follow-up using electronic medical records (EMRs) from primary care centers, of patients aged 18+ years who began a new treatment with an opioid drug in usual practice for chronic pain due to osteoarthritis. Health/non-health resource utilization and costs, treatment adherence, pain change, cognitive functioning, and dependence for basic activities of daily living (BADL) were assessed. Results: A total of 38,539 EMRs [mean age (SD); 70.8 (14.3) years, 72.3% female; 53.3% hip/knee, 25.0% spine, and 21.7% other sites] were recruited. A total of 19.1% of patients remained on initial opioid at 36 months, without significant differences by osteoarthritis site ( p = 0.125). Mean total adjusted cost was €17,915, with 27.7% corresponding to healthcare resources and 72.3% to lost productivity. Hospital admissions for osteoarthritis-related surgical interventions accounted for 15.8% of total healthcare cost. A slight mean pain reduction was observed: –1.3 points, –16.9%, p

Abstract Background Multiple sclerosis (MS) is a chronic disease with a high socioeconomic impact. The aim of this study was to assess healthcare resources utilization and costs in a sample of patients with MS. Methods A retrospective, cohort study was conducted using electronic medical records from 19 primary care centres in Asturias and Catalonia, Spain. Adult patients diagnosed with MS were distributed into two groups according to the Expanded Disability Status Scale (EDSS) score: 0–3.5 (no-moderate disability) and 4–9.5 (severe disability). Healthcare (direct cost) and non-healthcare costs (work productivity losses) were analysed. An analysis of covariance (ANCOVA) was used for correction, p

Abstract Background There has been a change in the focus of attention from prostate to bladder, as the etiology of lower urinary tract symptoms (LUTS) makes the bladder an additional therapeutic target. This study aims to evaluate the use of resources and costs associated with the addition of an antimuscarinic (AM) in patients receiving an alpha-adrenergic-blocker (AAB) for the treatment of LUTS linked to benign prostatic hyperplasia (BPH). Methods A multicentre, retrospective study was conducted using patient records from the databases of six primary care centers in Spain. Men with moderate-to-severe LUTS (IPSS > 7) who were initiated on AM treatment between January 2010 and December 2012 without previous treatment with an AM or 5-alpha reductase inhibitor (5-ARI) and had been on treatment with an AAB for a minimum of 6 months prior to the addition of the AM with a minimum of two records in the database were included. Comorbidity, treatment persistence, and use of resources and costs (direct and indirect) during monotherapy (AAB alone) and following the introduction of combination therapy (AAB + AM) over a treatment period of up to a year were compared. A paired sample Student t-test was performed where p

Abstract Background The impact of comorbidity on multiple sclerosis (MS) is a new area of interest. Limited data on the risk factors of metabolic syndrome (MetS) is currently available. The aim of this study was to estimate the presence of comorbid conditions and MetS in a sample of adult patients with MS. Methods A retrospective, cohort study was conducted using electronic medical records from 19 primary care centres in Catalonia and Asturias, Spain. The number of chronic diseases (diagnoses), the Charlson Comorbidity Index and the individual Case-mix Index were used to assess general comorbidity variables. MetS was defined using the National Cholesterol Education Program Adult Treatment Panel III. Patients were distributed into two groups according to the Expanded Disability Status Scale (EDSS) score: 0–3.5 and 4–10. Results A total of 222 patients were studied (mean age = 45.5 (SD 12.5) years, 64.4% were female and 62.2% presented a diagnosis of relapsing-remitting MS). Mean EDSS score was 3.2 (SD 2.0). Depression (32.4%), dyslipidaemia (31.1%), hypertension (23.0%) and obesity (22.5%) were the most common comorbidities. Overall MetS prevalence was 31.1% (95% CI: 25.0–37.2%). Patients with an EDSS ≥ 4.0 showed a significantly higher number of comorbidities (OR=2.2; 95% CI: 1.7–3.0; p

BackgroundTo evaluate resource use and health costs due to the combination of metformin and dipeptidyl peptidase-4 (DPP-4) inhibitors in patients with diabetes and renal impairment in routine clinical practice.MethodsAn observational, retrospective study was performed. Patients aged ≥30 years treated with metformin who initiated a second oral antidiabetic treatment in 2009 to 2010 were included. Two groups of patients were analysed: metformin+DPP-4 inhibitors and other oral antidiabetics. The main measures were: compliance, persistence, metabolic control (glycosylated hemoglobin< 7%) and complications (hypoglycemia, cardiovascular events) and total costs. Patients were followed up for 2 years.ResultsWe included 395 patients, mean age 70.2 years, 56.5% male: 135 patients received metformin+DPP-4 inhibitors and 260 patients received metformin+other oral antidiabetics. Patients receiving DPP-4 inhibitors showed better compliance (66.0% vs. 60.1%), persistence (57.6% vs. 50.0%), and metabolic control (63.9% vs. 57.3%), respectively, compared with those receiving other oral antidiabetics (P

El objetivo del estudio fue determinar el uso de recursos y costos debidos a fracturas óseas en mujeres españolas mayores de 50 años en un ámbito poblacional. Se realizó un estudio observacional y retrospectivo, en seis centros de atención primaria y dos hospitales urbanos de España. Se registró datos sociodemográficos, de comorbilidad, uso de recursos (consultas médicas en atención primaria, pruebas complementarias, medicación, atención especializada, hospitalizaciones, visitas, urgencias), costos y pérdida de productividad. Se incluyeron los registros de 19 022 mujeres de los cuales el 7% presentó algún tipo de fractura entre el 2003 y 2007. Las fracturas se asociaron mayoritariamente con osteoporosis (OR: 3,2), fibromialgia (OR: 2,4) y alteraciones tiroideas (OR: 2,2). En el modelo corregido, el costo total para las pacientes que tuvieron fractura fue de USD 3727 mientras que en las que no la tuvieron fue USD 2705,5 (pThe objective of the study was to determine the use of resources and costs due to bone fractures in Spanish women above 50 years of age in the population scope. An observational and retrospective study was conducted in six primary care centers and two urban hospitals in Spain. Socio-demographic and co-morbidity data, use of resources (primary care consultations, complementary tests, medications, specialized care, hospitalizations, visits, urgencies), costs and productivity losses were registered. Records of 19 022 women were included, 7% showed some type of fracture between 2003 and 2007. Fractures were mostly associated with osteoporosis (OR: 3.2), fibromyalgia (OR: 2.4) and thyroid changes (OR: 2.2). In the corrected model, the total cost for patients who had a fracture was USD 3727 compared to USD 2705.5 (p

Objetivo: Determinar el cumplimiento terapéutico al sustituir amlodipino y simvastatina de marca por genéricos (especialidad farmacéutica genérica [EFG]), y conocer la opinión de médicos y pacientes sobre ello. Pacientes y métodos: Diseño observacional con grupo control, realizado mediante revisión de los registros de seis centros de atención primaria. Pacientes >40 años de edad que iniciaron tratamiento con marca (periodo inicial) y posteriormente se cambió por una EFG (periodo final). Subgrupos de estudio: hipertensión arterial (amlodipino) y dislipidemia (simvastatina). Principales mediciones: comorbilidad, cumplimiento, tiempo de tratamiento, determinaciones bioquímicas y opinión de los profesionales y los pacientes (entrevistas). Seguimiento: antes de la fecha de la sustitución, cada paciente estuvo como mínimo 1 año con un medicamento de marca, y luego al menos 1 año con una EFG (seguimiento mínimo por paciente: 24 meses). Resultados: De los 1.252 pacientes, el 49,5% recibían amlodipino y el 50,5% simvastatina. Los tratados con amlodipino (comparando los periodos) muestran un mejor cumplimiento (65,8 frente a 61,3%; p=0,037) y un mejor control de la presión arterial (48,5 frente a 45,8%; p=0,039) con el tratamiento de marca. Con simvastatina los porcentajes fueron del 62,8 frente al 58,4% (p=0,041), respectivamente. Un 73,6% de los médicos entrevistados prescriben EFG y un 59,2% creen que tienen igual eficacia. De los pacientes entrevistados, el 79,8% (intervalo de confianza del 95% [IC95%]: 74,3-85,3%) aceptaron la sustitución; un 55,3% (IC95%: 48,5-62,1%) recibió la información adecuada y a un 61,5% les generan confusión los diferentes productos. Un 18,2% manifiestan que incumplen el tratamiento. Conclusión: En los pacientes en tratamiento con amlodipino o simvastatina, el cumplimiento desciende con el tiempo independientemente de que se cambie o no a una EFG.Objective: To determine therapeutic compliance when brand name amlodipine and simvastatin are substituted for generic drugs, and to determine patients´ and physicians´ opinions of this substitution. Patients and methods: We performed an observational study with a control group, based on a review of the medical records in six primary care centers. Participants consisted of patients >40 years old initiating treatment with a brand name drug (initial period), which was later substituted by a generic drug (final period). The study subgroups consisted of patients with hypertension (amlodipine) or dyslipidemia (simvastatin). The main measures were comorbidity, compliance, treatment length, biochemistry determinations, and patients´ and physicians´ opinions (interviews). All patients received a brand name drug for a minimum of 1 year followed by a generic drug for a minimum of 1 year (minimum continuation/patient: 24 months). Results: There were 1,252 patients (groups: 49.5% amlodipine; 50.5% simvastatin). Patients treated with amlodipine (period comparison) showed better compliance (65.8 vs. 61.3%; p=0.037) and blood pressure control (48.5 vs. 45.8%; p=0.039) with the brand name drug. The percentages with simvastatin were 62.8 vs. 58.4% (p=0.041), respectively. A total of 73.6% of the physicians interviewed prescribed generic drugs and 59.2% believed that both types of drug had the same efficacy. Most of the patients interviewed (79.8%; CI: 74.3-85.3%) accepted the substitution; 55.3% (CI: 48.5-62.1%) received the appropriate information but 61.5% were confused by the different products. Lack of compliance was reported by 18.2%. Conclusions: In patients receiving amlodipine or simvastatin, compliance decreased with time, independently of the change from a band name to a generic drug.

Objetivo: Determinar el impacto de la comorbilidad, el uso de recursos y los costes (sanitarios y en pérdidas de productividad laboral) en el mantenimiento de la remisión de la depresión en un ámbito poblacional español. Métodos: Diseño observacional, prospectivo, multicéntrico, realizado con bases de datos poblacionales. Los criterios de inclusión fueron: edad >18 años, inicio del episodio depresivo entre enero de 2003 y marzo de 2007, prescripción de antidepresivos >60 días después de la primera prescripción y duración del seguimiento de 18 meses (estudio: 12 meses; continuación: 6 meses). Se consideraron 2 subgrupos: pacientes en remisión y sin remisión. Las principales mediciones fueron sociodemográficas, episodios, bandas de utilización de recursos, costes sanitarios (directos) y en pérdidas de productividad (indirectos). Se realizó análisis de regresión logística y de análisis de la covarianza (ajuste Bonferroni). Resultados: Se reclutaron 4.572 sujetos. El 54,6% (intervalo de confianza del 95%: 53,2-56,0%) se consideraron en remisión. Los pacientes en remisión mostraron menor edad (52,6 frente a 60,7 años), mayor proporción de mujeres (71,7% frente a 78,2%), más morbilidad general (6,2 frente a 7,7 episodios/año), menos bandas de utilización de recursos/año (2,7 frente a 3,0), menor incapacidad laboral (31,0 frente a 38,5 días) y menor duración del tratamiento antidepresivo (146,6 frente a 307,7 días); pObjective: To determinate the impact of comorbidity, resource use and cost (healthcare and lost productivity) on maintenance of remission of major depressive disorder in a Spanish population setting. Methods: We performed an observational, prospective, multicenter study using population databases. The inclusion criteria were age >18 years, first depressive episode between January 2003 and March 2007, with antidepressant prescription >60 days after the first prescription and a follow-up of at least 18 months (study: 12 months; continuation: 6 months). Two subgroups were considered: patients with/without remission. Main measures: sociodemographic data, episodes, resource utilization bands, healthcare costs (direct) and lost productivity (indirect). Logistic regression and analysis of covariance (Bonferroni correction) were used for analysis. Results: A total of 4,572 patients were analyzed and 54.6% (95% confidence interval: 53.2-56.0%) were considered in remission. Patients in remission were younger (52.6 vs. 60.7), with a lower proportion of women (71.7% vs. 78.2%), and showed less general morbidity (6.2 vs. 7.7 episodes/year), lower resource utilization bands/year (2.7 vs. 3.0), fewer sick leave days (31.0 vs. 38.5) and shorter treatment duration (146.6 vs. 307.7 days); p

Introducción: Validar la aplicación retrospectiva de los Adjusted Clinical Groups (ACG) en varios centros de atención primaria y especializada en la población española. Métodos: Estudio restrospectivo-multicéntrico, realizado a partir de los registros de sujetos atendidos en 5 equipos de atención primaria (AP) y dos hospitalarios, durante el año 2005. Las principales mediciones fueron dependientes (visitas, episodios, coste en AP y coste total) y de casuística/morbilidad con el ACG Case-Mix-System. Cálculo del poder explicativo: cociente de determinación, pPurpose: To validate the Johns Hopkins ACG case-mix system used in various primary and specialized care centers attending a defined population in Spain. Methods: A retrospective, multicenter study was carried out by applying the ACG case-mix system to the clinical records of patients attending five primary care teams and two hospitals over a 1-year period in 2005. The main measurements were dependent variables (visits, episodes, primary care costs, and total costs), and morbidity. The determination coefficient (R²; p

Antoni Sicras-Mainar1, Ruth Navarro-Artieda2, Javier Rejas-Gutiérrez3, Milagrosa Blanca-Tamayo41Planning Management, Badalona Serveis Assistencials S.A., Badalona, Barcelona, Spain; 2Medical Documentation Service, Hospital Germans Trías i Pujol, Badalona, Barcelona, Spain; 3Health Outcomes Research Derpartment, Medical Unit, Pfizer Spain, Alcobendas, Madrid, Spain; 4Department of Psychiatry, Badalona Serveis Assistencials S.A., Badalona, Barcelona, SpainObjective: To describe the association between obesity and the use of antipsychotic drugs (APDs) in adult outpatients followed-up on in five Primary Care settings.Methods: A longitudinal, retrospective design study carried out between July 2004 and June 2005, in patients who were included in a claim database and for whom an APD treatment had been registered. A body mass index (BMI)

Fundamento. La hipertensión arterial (HTA) es uno de los principales motivos de consulta de los centros de atención primaria (AP). El objetivo del estudio fue determinar la asociación entre el grado de control de la HTA, la comorbilidad y los costes directos en atención primaria. Métodos. Diseño retrospectivo-multicéntrico. Se incluyó a sujetos mayores de 30 años pertenecientes a cinco equipos de AP (año 2006). Criterios: buen control (

Objetivos: Determinar el patrón de uso de servicios y costes en pacientes que demandan atención por problemas mentales (PM) en asistencia primaria en situación de práctica clínica habitual. Métodos: Estudio retrospectivo. Se incluyeron pacientes mayores de 15 años, con al menos una demanda de atención por PM, atendidos por 5 equipos de atención primaria durante el año 2004. Se formó un grupo comparativo con el resto de pacientes sin PM. Las variables fueron: edad, sexo, casuística/comorbilidad, utilización de recursos sanitarios y costes ambulatorios correspondientes (medicamentos, procedimientos diagnósticos y visitas). Se empleó el análisis de regresión logística múltiple y modelos de ANCOVA. Resultados: Se incluyeron 64.072 pacientes, de los cuales 11.128 presentaron algún PM (17,4%; intervalo de confianza [IC] del 95%, 16,7-18,1). Los pacientes que demandaron atención por PM presentaron un mayor número de problemas de salud (6,7 frente a 4,7; p < 0,0001) y de utilización de recursos sanitarios, particularmente visitas médicas/paciente/año (10,7 frente a 7,2; p < 0,0001). El coste medio anual en pacientes con PM fue significativamente superior (851,5 frente a 519,2 euros; p < 0,0001) y se mantuvo después de corregir por edad, sexo y comorbilidades, con un coste diferencial de 72,7 euros (IC del 95%, 59,2-85,9). Todos los componentes del coste por paciente fueron mayores en el grupo de pacientes con PM. Conclusiones: Los pacientes que han demandado atención por algún PM presentan un elevado número de comorbilidades y un mayor coste anual por paciente en el ámbito de la atención primaria.Objectives: To determine the pattern of services use and costs of patients requiring care for mental disorders (MD) in primary care in the context of routine clinical practice. Methods: We performed a retrospective study of patients older than 15 consulting primary care at least once for MD, attended by 5 primary care teams in 2004. A comparative group was formed with the remaining outpatients without MD. The main measurements were age, gender, case-mix/comorbidity and health resource utilization and corresponding outpatient costs (drugs, diagnostic tests and visits). Multiple logistic regression analysis and ANCOVA models were applied. Results: A total of 64,072 patients were assessed, of which 11,128 had some type of MD (17.4%; 95% CI, 16.7-18.1). Patients consulting for MD had a greater number of health problems (6.7 vs. 4.7; p < 0.0001) and higher resource consumption, mainly all-type medical visits/patient/year (10.7 vs. 7.2; p < 0.0001). The mean annual cost per patient was higher for patients with MD (851.5 vs. 519.2 euros; p < 0.0001), and this difference remained significant after adjusting by age, sex and comorbidities, with a differential cost of euros 72.7 (95% CI, 59.2-85.9). All components of outpatient management costs were significantly higher in the MD group. Conclusions: Outpatients seeking care for some type of MD had a high number of comorbidities and showed greater annual cost per patient in the primary care setting.

Objetivo: El objeto del estudio es obtener los pesos relativos medios de los costes de la asistencia con la aplicación retrospectiva de los adjusted clinical groups (ACG) en población atendida por equipos de atención primaria en situación de práctica clínica habitual. Métodos: Estudio descriptivo de carácter retrospectivo. Fueron incluidos en el estudio todos los pacientes atendidos por 4 equipos de atención primaria durante el año 2003. Las principales mediciones fueron: variables universales (edad y sexo), dependientes (visitas y costes) y de casuística o comorbilidad. El modelo de costes para cada paciente se estableció diferenciando los costes fijos y los variables. Se efectuó un análisis de regresión lineal múltiple para la predicción de los modelos. El coste relativo de cada ACG se obtuvo dividiendo el coste medio de cada categoría entre el coste medio de toda la población de referencia. Resultados: El número total de pacientes estudiados fue de 62.311 (intensidad de uso del 76,7%), con una media de 4,8 ± 3,2 episodios y 7,8 ± 7,5 visitas/paciente/año. La distribución de los costes fue de 24.135.236,41 €, el 28,9% fijos. El coste unitario total por visita/año fue de 49,62 ± 24,71 € y el promedio paciente/año de 387,34 ± 145,87 € (pesos relativos de referencia). El poder explicativo de la clasificación ACG fue del 50,1% en las visitas y del 54,9% para los costes totales. Conclusiones: Los ACG se muestran como un aceptable sistema de clasificación de pacientes en situación de práctica clínica habitual. De confirmarse los resultados posibilitarían una mejora en la aplicación práctica de los ACG como una posible herramienta para la gestión clínica en los centros de atención primaria.Objective: The objective of the study is to obtain the cost's relative average weights of the assistance with the retrospective application of the Adjusted Clinical Groups (ACG's) in four teams of Primary Care with an attended population in the habitual clinical practice situation. Methods: Descriptive study of retrospective character. It was included in the study all attended patients by four teams of Primary Care during year 2003. The main measures were: universal variables (age and gender), dependents (visits and costs) and casuistic and co morbidity. The model of cost per each patient was established differencing the fix costs and the variable ones. Was effected a multiple lineal regression analysis for the prediction of models. The relative cost of each ACG was obtained dividing the average cost of each category among the average cost of each population of reference. Results: The total number of the studied patients was 62,311 (intensity of use: 76.7%), with an average 4.8 ± 3.2 episodes and 7.8 ± 7.5 visits/patient/year. The distribution of costs was 24,135,236.41 €, 28.9% for fix. The total unitary cost per visit/year was 49.62 ± 24.71 € and the average of the total cost per patient/year 387.34 ± 145.87 € (relative weights of reference). The explicative power of the classification of ACG was 50.1% in visits and 54.9% for total costs. Conclusions: The ACG are an acceptable system of classification of patients in situation of habitual clinic practice. In case results were confirmed will make possible an improvement in the practice application of ACG as a possible tool for the clinical management in Primary Care centers.

Fundamento: La mayoría de los sistemas de clasificación de pacientes han sido diseñados en Estados Unidos con la finalidad de disponer de una herramienta que facilite una medida en la utilización de los recursos. El objeto del estudio fue obtener los pesos relativos (PR) medios del coste de la asistencia en varios equipos de atención primaria de salud, en comparación con los americanos, mediante la aplicación de los Grupos Clínicos Ajustados (ACGs), como un posi- ble ajuste de riesgos de pago capitativo. Métodos: Estudio descriptivo. Se incluyeron todas las historias clínicas generadas por cuatro equipos de atención primaria durante el año 2003. Las principales mediciones fueron: edad y sexo, recursos (visitas y costes) y casuística. El modelo de costes para cada pacien- te se estableció diferenciando los costes fijos y variables. Se efectuó un análisis de regresión para la corrección del modelo. El coste rela- tivo de cada ACG se obtuvo dividiendo el coste medio de cada cate- goría entre el coste medio de toda la población de referencia. Resultados: El número total de historias estudiadas fue de 62.311, con una media de 4,8±3,2 diagnósticos y 7,8±7,5 visitas/paciente/año. El gasto total fue de 24,1 millones de euros, los costes fijos o semifijos representan el 28,9% y los variables el 71,1%. El promedio de coste total por paciente/año fue de 387,34±145,87 ? (referencia). El poder explicativo corregido del coste de la asistencia entre las dos clasificaciones (estadounidense respecto a la estudiada) fue del 64,3%; p=0,000). Conclusiones: La generalización de los resultados debe de inter- pretarse con prudencia. Los ACGs se muestran como un instrumen- to adecuado y podrían utilizarse los PR medios estadounidenses para el ajuste del riesgo en el pago capitativo, ante la dificultad de tener bases de datos amplias y consistentes en nuestro medio. Sería nece- sario esperar nuevas investigaciones que refuercen la consistencia de los resultados.

Objetivo: Conocer el efecto de la entidad proveedora (EP) de referencia en la prescripción farmacológica realizada en residencias geriátricas. Métodos: Diseño descriptivo que incluye todas las recetas ambulatorias facturadas a cargo del Servei Català de la Salut, realizadas en 106 residencias geriátricas de una región sanitaria durante el año 2001. Se agruparon las EP en concertadas (n = 23; 1.158 residentes) y públicas (n = 83; 3.163 residentes). Se estableció un sistema de indicadores de evaluación cuantitativos, cualitativos y de uso relativo, por grupos terapéuticos o principios activos. Resultados: El gasto en las residencias ha sido de 7,7 millones de euros, que supone el 6,3% del generado por las EP. Los resultados obtenidos muestran diferencias en el gasto por residente, que fue de 1.601,56 ± 317,20 € en las concertadas y de 1.843,49 ± 516,56 € en las públicas (p = 0,000). El porcentaje en valor intrínseco elevado fue del 89,0 y el 82,9% (p = 0,043), respectivamente. Conclusiones: Las limitaciones del estudio obligan a ser cautelosos en la generalización de los resultados; el volumen de prescripción en las residencias geriátricas es alto, y se evidencia una moderada contención del gasto y de relativa mejora en la calidad de la prescripción de las EP concertadas.Objective: To identify the effect of the provider company (PC) of reference on drug prescriptions in nursing homes. Methods: We performed a descriptive study of all ambulatory prescriptions invoiced by the Catalan Health Service from 106 nursing homes in a health region in 2001. The PCs were grouped into private (n = 23; 1,158 residents) and public (n = 83; 3,163 residents). A system of evaluating quantitative, qualitative and relative use indicators was established according to therapeutic group or active principles. Results: Expenditure in the nursing homes was € 7.7 million, representing 6.3% of that generated by the PCs. The results obtained show differences in expenditure per resident, which amounted to € 1,601.56 ± 317.20 in the private sector and € 1,843.49 ± 516.56 in the public sector (p = 0.000). The percentage spent on drugs of high intrinsic value was 89.0 and 82.9% (p = 0.043), respectively. Conclusions: Because of the study's limitations, the results should be generalized with caution. The volume of prescriptions in nursing homes was high. Moderate cost containment and a relative improvement in the quality of prescriptions in private PCs were observed.

Objectives. Determine the clinical repurcussions of adherence, metabolic control, hypoglycemia and cardiovascular events (CVE) and economics (resources and costs) in the combination therapy of metformin vs DPP-4 (dipeptidyl peptidase-4) inhibitors and sulfonylureas in patients with type 2 diabetes. Materials and methods. Observational-multicenter and retrospective design. We evaluated patients ≥ 30 years of age in treatment with metformin and who started a second oral antidiabetic treatment during 2008-2009. 2 study groups were established: a) metformin + DPP-4 inhibitors, and b) metformin + sulfonylurea. Main measures: comorbidity, metabolic control (HbA1c 7%), compliance and complications (hypoglycemia, CVE). Follow up was conducted over two years. The cost model differentiated between direct healthcare costs (primary/ specialty care), and indirect costs (labor productivity). Statistical analysis: logistic regression and ANCOVA models. Results. 1,405 patients were recruited (average age 67.1 years old; 56.2% male). 37.0% started a second treatment with DPP-4 inhibitors, and 63.0% with sulfonylureas. After two years of follow up, patients treated with DPP-4 inhibitors showed greater treatment adherence (70.3% vs. 60.6%; p 0.001); better metabolic control (64.3% vs. 60.6%; p0.001), and a lower proportion of hypoglycemia (13.9% vs. 40.4%; p 0.001, respectively). The average/unit of adjusted total costs was € 2,341 vs. € 2,512; p = 0.038. CVE and renal failure rates were 3.7% vs. 6.4%; p = 0.027. Vildagliptin was the most used drug among DPP-4 inhibitors. Conclusions. Sulfonylureas were the most used drug for diabetes treatment. Patients treated with DPP-4 inhibitors had higher adherence and control of diabetes, with lower rates of hypoglycemia and CVE, resulting in lower healthcare costs.

Antidepressant drugs are the mainstay of drug therapy for sustained remission of symptoms. However, the clinical results are not encouraging. This lack of response could be due, among other causes, to factors that alter the metabolism of the antidepressant drug.to evaluate the impact of concomitant administration of CYP2D6 inhibitors or substrates on the efficacy, tolerability and costs of patients treated with venlafaxine for major depressive disorder in clinical practice.We designed an observational study using the medical records of outpatients. Subjects aged ≥ 18 years who started taking venlafaxine during 2008-2010 were included. Three study groups were considered: no combinations (reference), venlafaxine-substrate, and venlafaxine-inhibitor. The follow-up period was 12 months. The main variables were: demographic data, comorbidity, remission (Hamilton

Background: The aim of this study was to analyse the economic impact of nonadherence to the Global Initiative for Obstructive Lung Disease (GOLD) guidelines in patients with chronic obstructive pulmonary disease (COPD). Methods: A retrospective analysis was carried out on a claim database. Patients aged at least 40 years with a diagnosis of COPD were eligible for this analysis. Demographics, medical data and use of resources were collected and direct and indirect costs were analysed (from January 2008 to June 2009). A probabilistic multivariate sensitivity analysis of avoided costs was carried out. All results are presented in annualized form and costs are expressed in Euros (2009). Results: A total of 1365 patients were included, 79.5% were men. The mean age (±standard deviation) was 71.4 (±10.3) years, the mean forced expiratory volume in 1 s (FEV 1 ) was 65.3% and they had a COPD history of 5.5 (±2.9) years. Patients were divided into an adherent group and a nonadherent group depending on whether therapeutic recommendations according to severity defined in the GOLD guidelines (2007) were followed. Patients in both groups were also classified as having stage II (FEV 1 < 80% and < 50%) or stage III disease (FEV 1 < 50% and ≥ 30%). The total annual drug cost per patient in the nonadherent group was €771.5 while it was only €426.4 for the adherent group. The average direct cost per patient per year in the nonadherent stage II group was €1465 (±971) and it rose to €2942 (±1918) for patients in the nonadherent group with stage III disease. The potential saving from the implementation of the GOLD guidelines in stage II COPD amounted to €758 per patient per year (68% saving on drug cost). In contrast, the cost for patients with stage III disease was higher in the adherent group versus the nonadherent group (€2468). Conclusions: The cost of COPD may vary according to compliance with the GOLD guidelines. The cost observed for patients with stage II disease is higher than expected in patients who adhere to treatment, but patients with stage III disease treated according to the GOLD guidelines had significantly higher treatment costs.

ObjectivesThe primary objective of this study was to identify the existence of chronic disease multimorbidity patterns in the primary care population, describing their clinical components and analysing how these patterns change and evolve over time both in women and men. The secondary objective of this study was to generate evidence regarding the pathophysiological processes underlying multimorbidity and to understand the interactions and synergies among the various diseases.MethodsThis observational, retrospective, multicentre study utilised information from the electronic medical records of 19 primary care centres from 2008. To identify multimorbidity patterns, an exploratory factor analysis was carried out based on the tetra-choric correlations between the diagnostic information of 275,682 patients who were over 14 years of age. The analysis was stratified by age group and sex.ResultsMultimorbidity was found in all age groups, and its prevalence ranged from 13% in the 15 to 44 year age group to 67% in those 65 years of age or older. Goodness-of-fit indicators revealed sample values between 0.50 and 0.71. We identified five patterns of multimorbidity: cardio-metabolic, psychiatric-substance abuse, mechanical-obesity-thyroidal, psychogeriatric and depressive. Some of these patterns were found to evolve with age, and there were differences between men and women.ConclusionsNon-random associations between chronic diseases result in clinically consistent multimorbidity patterns affecting a significant proportion of the population. Underlying pathophysiological phenomena were observed upon which action can be taken both from a clinical, individual-level perspective and from a public health or population-level perspective.

Objetivos. Determinar las repercusiones clínicas: adherencia, control metabólico, hipoglucemias y eventos cardiovasculares (ECV) y económicas (recursos y costes) de la combinación de metformina frente a IDPP4 (inhibidores dipeptidil-peptidasa-4) y sulfonilureas en pacientes con diabetes tipo 2. Materiales y métodos. Diseño observacional-multicéntrico de carácter retrospectivo. Se evaluaron pacientes ≥ 30 años, en tratamiento con metformina y que iniciaron un segundo tratamiento antidiabético oral durante 2008-2009. Se establecieron 2 grupos de estudio: a) metformina+IDPP4 y b) metformina+sulfonilureas. Principales medidas: comorbilidad, control metabólico (HbA1c

Objetivos. Determinar las repercusiones clínicas: adherencia, control metabólico, hipoglucemias y eventos cardiovasculares (ECV) y económicas (recursos y costes) de la combinación de metformina frente a IDPP4 (inhibidores dipeptidil-peptidasa-4) y sulfonilureas en pacientes con diabetes tipo 2. Materiales y métodos. Diseño observacional-multicéntrico de carácter retrospectivo. Se evaluaron pacientes ≥ 30 años, en tratamiento con metformina y que iniciaron un segundo tratamiento antidiabético oral durante 2008-2009. Se establecieron 2 grupos de estudio: a) metformina+IDPP4 y b) metformina+sulfonilureas. Principales medidas: comorbilidad, control metabólico (HbA1c