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Background: Diagnostic testing for respiratory tract infections is a tool to manage the current COVID-19 pandemic, as well as the rising incidence of antimicrobial resistance. At the same time, new European regulations for market entry of in vitro diagnostics, in the form of the in vitro diagnostic regulation, may lead to more clinical evidence supporting health-economic analyses., Objective: The objective of this systematic review was to review the methods used in economic evaluations of applied diagnostic techniques, for all patients seeking care for infectious diseases of the respiratory tract (such as pneumonia, pulmonary tuberculosis, influenza, sinusitis, pharyngitis, sore throats and general respiratory tract infections)., Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, articles from three large databases of scientific literature were included (Scopus, Web of Science and PubMed) for the period January 2000 to May 2020., Results: A total of 70 economic analyses are included, most of which use decision tree modelling for diagnostic testing for respiratory tract infections in the community-care setting. Many studies do not incorporate a generally comparable clinical outcome in their cost-effectiveness analysis: fewer than half the studies (33/70) used generalisable outcomes such as quality-adjusted life-years. Other papers consider outcomes related to the accuracy of the test or outcomes related to the prescribed treatment. The time horizons of the studies generally are limited., Conclusions: The methods to economically assess diagnostic tests for respiratory tract infections vary and would benefit from clear recommendations from policy makers on the assessed time horizon and outcomes used., (© 2021. The Author(s).)

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.

Objective: To describe self-perceived health status and health-related quality of life (HRQoL) in healthy individuals of working age, to measure changes due to influenza infection, and to evaluate the effect of influenza infection on HRQoL in monetary terms., Method: We performed a descriptive observational study through questionnaires administered to 50 patients of working age infected with the influenza virus during the epidemiologic year 2004-2005 and living in private homes of the city of Logroño (Spain). The patients completed the questionnaires twice: with and without influenza. The dimensions and HRQoL indicators of the European Quality of Life-5 Dimensions (EQ-5D) questionnaire were evaluated. HRQoL utility indices were used to calculate lost quality-adjusted life years (QALYs)., Results: On average, the reduction in the HRQoL utility index caused by influenza infection was between 0.37 and 0.65, on a scale from 0 (death) to 1 (perfect health). An influenza epidemic in 100,000 individuals could imply a loss of 137 QALYs, which in monetary terms could represent 2,722,609euro., Conclusions: The EQ-5D dimension most negatively affected by influenza was <> while the least affected dimension was <>. Influenza causes substantial losses in HRQoL among the population of working age. The results of the sensitivity analysis of the monetary effects of influenza infection yielded intervals showing a range of more than 5 times the mean value.

Background and Purpose: Chagas disease (CD) is frequently associated with cardioembolic stroke in South America. Our objective was to identify the predictors of stroke in a region where CD is endemic., Methods: We screened 305 consecutive cardiopathy patients. Significant predictors of stroke in univariable analyses were included in a multivariable model., Results: Stroke was more frequent in CD (15.0%) compared with other cardiopathies (6.3%; P=0.015). Other predictors of stroke in univariable analyses were previous diabetes or cardioversion and use of amiodarone, antiplatelet agents, and warfarin. In multivariable analysis, remaining predictors of stroke were CD (odds ratio [OR], 1.09; 95% CI, 1.02 to 1.17), cardioversion (OR, 1.07; 95% CI, 1.02 to 1.13), and diabetes (OR, 1.12; 95% CI, 1.01 to 1.24)., Conclusions: In conclusion, CD is a risk factor for stroke, independent of systolic dysfunction or presence of cardiac arrhythmias.

Objective: The objective of this study was to determine the cost-effectiveness of thromboprophylaxis with enoxaparin versus no thromboprophylaxis in patients with acute medical illness in Spain from the society perspective., Methods: Markov process analysis techniques were used to model the health economic outcomes. Clinical data were derived mainly from the MEDENOX trial, while health-care utilization was derived from Delphi panels., Results: An analysis over the MEDENOX trial period shows that the cost per event avoided is currency 432, while the cost per life saved is currency 1527. The cost per event includes all medical resource utilization costs associated with the event. The lifetime model, which assumes no higher risk for recurrence of venous thromboembolism (VTE) and mortality in asymptomatic patients, shows that the use of enoxaparin leads a cost per event avoided of currency 270 and cost per life-year gained of currency 71. If the lifetime model assumes a higher risk for recurrence of VTE in asymptomatic patients, enoxaparin is dominant over no thromboprophylaxis., Conclusion: The results showed that the favorable clinical benefit of enoxaparin as thromboprophylaxis in patients with acute medical illness, which was observed in the MEDENOX trial, results in a positive health economic benefit in both the short term and the long term in the health-care setting of Spain.

Introduction and Objectives: The aim of this study was to perform an economic evaluation of the PURSUIT trial in Spain, and to measure the cost per year of life saved in patients treated with this drug. PURSUIT is a large, randomised multicentric study on the treatment of unstable angina or non Q wave myocardial infarction with eptifibatide versus placebo,, Methods: The data on resource consumption provided by the PURSUIT trial were grouped in several populations according to geographical and resource consumption criteria. Unitary costs of these resources were calculated using an "upward" approach that combines individual costs to obtain total costs of several processes and lengths of hospital stay. Cost analysis compares the costs of the initial admission and of the following six months (total cost per patient) for both placebo and eptifibatide. Cost-effectiveness analysis is calculated from total costs and years of life saved calculated according to projections made from results of PURSUIT for Western Europe., Results: The average 6 month cost for the patients who received placebo varies from 0.91 to 1.41 million pesetas, and from 0.96 to 1.45 million pesetas for those treated with eptifibatide. The mean survival was 16.07 years in the placebo group versus 16.11 years in eptifibatide group; 2.9 years of life were saved for every 100 patients treated. The incremental cost of each year of life saved ranges from 1.3 to 3.3 million pesetas., Conclusions: Results vary depending on resource consumption data used. The cost per year of life saved is within the limits considered acceptable for a new technology.