Spanish National Health System Research Articles

Cost-effectiveness analysis of second-line pharmacological treatment of acromegaly in Spain

ABSTRACT Objective To estimate the cost-effectiveness of second-line pharmacological treatments in patients with acromegaly resistant to first-generation somatostatin analogues (FG SSA) from the Spanish National Health System (NHS) perspective. Methods A Markov model was developed to analyze the cost-effectiveness of pegvisomant and pasireotide in FG SSA-resistant acromegaly, simulating a cohort of patients from the treatment beginning to death. Treatment with pegvisomant or pasireotide was compared to FG SSA retreatment. Efficacy data were obtained from clinical trials and utilities from the literature. Direct health costs were obtained from Spanish sources (€2018). Results The Incremental Cost Effectiveness Ratio (ICER) of pegvisomant vs. FG SSA was €85,869/Quality-adjusted life years (QALY). The ICER of pasireotide vs. FG SSA was €551,405/QALY. The ICER was mainly driven by the incremental efficacy (4.41 QALY for pegvisomant vs. FG SSA and 0.71 QALY for pasireotide vs. FG SSA), with a slightly lower increase in costs with pegvisomant (€378,597 vs. FG SSA) than with pasireotide (€393,151 vs. FG SSA). Conclusion The ICER of pasireotide compared to FG SSA was six times higher than the ICER of pegvisomant vs. FG SSA. Pegvisomant is a more cost-effective alternative for the treatment of acromegaly in FG SSA-resistant patients in the Spanish NHS.

B-type natriuretic peptide in the Emergency Department: the impact of restricted policies on requesting patterns and cost

Background: The intent of this study was to investigate the requesting pattern of B-type natriuretic peptide (BNP) in the Emergency Department (ED) and the expenses associated with it. Methods: Clinical laboratories of the Spanish National Health System were invited to report the number of BNP requested in the ED during 2016. The number of BNP requested per 1,000 ED admissions was calculated, and compared between laboratories. Laboratories were divided in two groups; those where BNP could be freely requested in the ED (free availability group), and those where it was regulated by algorithms/internal policies. We calculated the costs based on the provided BNP reagent prices. Results: Sixty-five laboratories participated in the study. In 21 (32.3%) BNP was not offered in the ED. The median rate of BNP request per 1,000 ED admissions in the remaining 44 was 32.2 (IQR: 47.6). Twenty-three (52.3%) laboratories measured the BNP in the ED without any restriction. Twenty-one (17.7%) followed certain internal guidelines. The rate of request was lower in the former (21.4 vs . 47.9) (P=0.013). To measure a total of 154,702 BNP, 1,665,833€ were spent. If the demand in the free-availability group would have been the same as in the restricted-availability counterpart, 42,962 VNP requests could have been not measured, with potential savings of 462,615€. Conclusions: One third of laboratories did not offer BNP in the ED, despite current recommendations. Institutions with policies regulating the BNP request had a lower rate of requests that those with no such regulations. If the latter would have similar policies, more than 400,000€ could have been saved in reagent costs alone.

Extended-pulsed fidaxomicin versus vancomycin in patients 60\xa0years and older with Clostridium difficile infection: cost-effectiveness analysis in Spain

The cost of treating Clostridium difficile infection (CDI) in Spain is substantial. Findings from the randomised, controlled, open-label, phase 3b/4 EXTEND study showed that an extended-pulsed fidaxomicin (EPFX) regimen was associated with improved sustained clinical cure and reduced recurrence of CDI versus vancomycin in patients aged 60 years and older. We assessed the cost-effectiveness of EPFX versus vancomycin for the treatment of CDI in patients aged 60 years and older from the perspective of the National Health System (NHS) in Spain. We used a Markov model with six health states and 1-year time horizon. Health resources, their unit costs and utilities were based on published sources. Key efficacy data and transition probabilities were obtained from the EXTEND study and published sources. A panel of Spanish clinical experts validated all model assumptions. In the analysis, 0.638 and 0.594 quality-adjusted life years (QALYs) per patient were obtained with EPFX and vancomycin, respectively, with a gain of 0.044 QALYs with EPFX. The cost per patient treated with EPFX and vancomycin was estimated to be €10,046 and €10,693, respectively, with a saving of €647 per patient treated with EPFX. For willingness-to-pay thresholds of €20,000, €25,000 and €30,000 per QALY gained, the probability that EPFX was the most cost-effective treatment was 99.3%, 99.5% and 99.9%, respectively. According to our economic model and the assumptions based on the Spanish NHS, EPFX is cost-effective compared with vancomycin for the first-line treatment of CDI in patients aged 60 years and older.

RECALMIN. Four years of growth of the internal medicine units of the Spanish National Health System (2013–2016)

ObjectivesTo compare the structure, resources and activity of the internal medicine units (IMUs) of the Spanish National Health System (SNHS) in 2013 and 2016. To analyze the differences between IMUs in 2016 by hospital size. Material and methodsWe conducted a comparison of 2 descriptive cross-sectional studies of IMUs in general acute care hospitals of the Spanish National Health System, with data referring to 2013 and 2016. The variables were collected via an ad hoc questionnaire (RECALMIN survey). ResultsBetween 2013 and 2016, the demand for care increased dramatically (with an annual average of 11% in hospital discharges and 16% in first consultations), and comorbidity slightly increased (2%). During this period, the mean productivity of IMUs increased 16.7% (0.6±0.3 vs. 0.7±0.3; p=.09), and the mean stay decreased 10% (9±2.2 vs. 8.1±2.1 days; p=.001). Progress in implementing good practices and systematic care for complex chronic patients was scarce. Both surveys found variability among IMUs and marked differences among IMUs of hospitals of different sizes. ConclusionsIMUs responded to the increased burden of care they supported during 2013–2016 by improving their efficiency and productivity; however, advances in implementing good practices, including care for chronic complex patients, were scare. The significant variability in the indicators of structure, activity and management models found in 2013 remained in 2016.

Analysis of a clinical pathway for home enteral nutrition in the Region of Murcia. Consumption and associated expenses and adaptation to the National Health System Guide

ObjectiveTo analyze the compliance with the Guide for home enteral nutrition (HEN) of the Spanish national health system of the prescriptions made in a specific area (Health Area I of the Region of Murcia) before and after implementation of a clinical pathway based on that guide, and to compare the changes in healthcare costs of diet therapy during the 2007–2014 period in the Regional and National Health system. MethodA descriptive study to quantify compliance with the main criteria of the HEN guide before (2010) and after (2013–2014) implementation of the clinical pathway. Changes in health expenditure and consumption during the 2007–2014 period were also analyzed. ResultsAll markers of compliance with the national HEN guide improved after implementation of the clinical pathway. In addition, Murcia has one of the Spanish lowest expenditures per population, below the national average. ConclusionThe clinical pathway implemented improves compliance with the national guide of prescriptions to patients in the Region of Murcia while containing health resources expenditure and consumption, thus making diet therapy prescription more sustainable.

In-hospital Mortality and Readmissions for Heart Failure in Spain. A Study of Index Episodes and 30-Day and 1-year Cardiac Readmissions.

Heart failure (HF) is a major health care problem in Spain. Epidemiological data from hospitalized patients are scarce and the association between hospital characteristics and patient outcomes is largely unknown. The aim of this study was to identify the factors associated with in-hospital mortality and readmissions and to analyze the relationship between hospital characteristics and outcomes. A retrospective analysis of discharges with HF as the principal diagnosis at hospitals of the Spanish National Health System in 2012 was performed using the Minimum Basic Data Set. We calculated risk-standardized mortality rates (RSMR) at the index episode and risk-standardized cardiac diseases readmissions rates (RSRR) and in-hospital mortality at 30 days and 1 year after discharge by using a multivariate mixed model. We included 77 652 HF patients. Mean age was 79.2±9.9 years and 55.3% were women. In-hospital mortality during the index episode was 9.2%, rising to 14.5% throughout the year of follow-up. The 1-year cardiovascular readmissions rate was 32.6%. RSMR were lower among patients discharged from high-volume hospitals (> 340 HF discharges) (in-hospital RSMR, 10.3±5.6%; 8.6±2.2%); P <.001). High-volume hospitals had higher 1-year RSRR (32.3±3.7%; 33.7±4.5%; P=.006). The availability of a cardiology department at the hospital was associated with better outcomes (in-hospital RSMR, 9.9±3.8%; 9.2±2.4%; P <.001). High-volume hospitals and the availability of a cardiology department were associated with lower in-hospital mortality.

The effect of a change in co-payment on prescription drug demand in a National Health System: The case of 15 drug families by price elasticity of demand.

ObjectivesTo test the heterogeneity of the effect of a change in pharmaceutical cost-sharing by therapeutic groups in a Spanish region.MethodsData: random sample (provided by the Canary Islands Health Service) of 40,471 people covered by the Spanish National Health System (SNHS) in the Canary Islands. The database includes individualised monthly-dispensed medications (prescribed by the SNHS) from one year before (August 2011) to one year after (June 2013) the Royal Decree Law 16/2012 (RDL 16/2012). Sample: two intervention groups (low-income pensioners and middle-income working population) and one control group (low-income working population). Empirical model: quasi-experimental difference-in-differences design to study the change in consumption (measured in number of monthly Defined Daily Dose (DDDs) per individual) among 13 therapeutic groups. The policy break indicator (three-level categorical variable) tested the existence of stockpiling between the reform’s announcement and its implementation. We ran 16 linear regression models (general, by therapeutic groups and by comorbidities) that considered whether the exclusion of some drugs from public provision impacted on consumption more than the co-payment increase.ResultsGeneral: Reduction (-13.04) in consumption after the reform’s implementation, which was fully compensated by a previous increase (16.60 i.e., stockpiling) among low-income pensioners. The middle-income working population maintained its trend of increasing consumption. Therapeutic groups: Reductions in consumption after the reform’s implementation among low-income pensioners in 7 of the 13 groups, which were fully compensated for by a previous increase (i.e., stockpiling) in 4 groups and partially compensated for in the remaining 3. The analysis without the excluded medicines provided fewer negative coefficients. Comorbidities: Reduction in consumption that was only slightly compensated for by a previous increase (i.e., stockpiling).ConclusionsThe negative impact of cost-sharing produced, among low-income pensioners, a risk of loss of adherence to treatments, which could deteriorate the health status of individuals, especially among pensioners within the most inelastic therapeutic groups (associated with chronic diseases) and patients with comorbidities (also, associated with chronic diseases). Notwithstanding the above, this risk was more related to the exclusion of some drugs from provision than to the cost-sharing increase.

Evaluating the long‐term cost‐effectiveness of fixed‐ratio combination insulin degludec/liraglutide (IDegLira) for type 2 diabetes in Spain based on real‐world clinical evidence

AimTo evaluate the long‐term cost‐effectiveness of fixed‐ratio combination insulin degludec/liraglutide (IDegLira) versus comparator regimens for type 2 diabetes in Spain, based on real‐world evidence.Materials and methodsClinical data were taken from the European Xultophy Treatment Retrospective Audit (EXTRA) real‐world evidence study in which patients failing to meet glycaemic targets were switched to IDegLira. Baseline regimens (prior to IDegLira treatment) were categorized as: multiple daily insulin injections (MDI; 28%); glucagon‐like peptide‐1 (GLP‐1) receptor agonists in combination with insulin (24%); basal insulin (19%); GLP‐1 receptor agonists (10%); and non‐injectable medications (19%). The IQVIA CORE Diabetes Model was used to project long‐term outcomes for patients switching to IDegLira or continuing their baseline regimens (excluding non‐injectable regimens). Costs were accounted from a Spanish National Health System perspective. Future costs and clinical benefits were discounted at 3% annually and sensitivity analyses were performed.ResultsIDegLira was projected to reduce the incidence of diabetes‐related complications and improve quality‐adjusted life expectancy versus all four comparators. IDegLira reduced direct medical costs versus GLP‐1 receptor agonists in combination with insulin, and versus GLP‐1 receptor agonist therapy, and was therefore considered dominant (cost saving while improving outcomes). IDegLira was found to be cost‐effective versus MDI and basal insulin with incremental cost‐effectiveness ratios of EUR 3013 per quality‐adjusted life‐year (QALY) gained and EUR 6890 per QALY gained, respectively.ConclusionsLong‐term projections based on real‐world evidence indicated that IDegLira is likely to improve clinical outcomes and reduce costs or be cost‐effective compared with other injectable regimens in people with type 2 diabetes in Spain.

Hemorrhage in patients under oral anticoagulation for atrial fibrillation. The other side of the coin

Introduction and objectivesOral anticoagulation therapy is prescribed to most patients with atrial fibrillation. The main limitation of anticoagulant treatment is the occurrence of bleeding episodes. We sought to assess the type of hemorrhages and mortality in patients anticoagulated for nonvalvular atrial fibrillation. MethodsObservational retrospective study analyzing 2081138 hospitalization reports from 2014 corresponding to 151 hospitals of the Spanish National Health System. Patients were selected with the diagnosis of hemorrhage, nonvalvular atrial fibrillation, and oral anticoagulation. ResultsA total of 5783 hospitalizations were analyzed. Most hemorrhages were digestive (43.6%), followed by cerebral (30.6%). Among the digestive, only 27% were high. Mean age was 79.8 years, 57.1% were males, the mean hospital stay was 7.7 days. Complexity assessed by the mean diagnostic related group was 2.39 (versus 1.83 of the total hospitalizations). In-hospital mortality was 15.2% versus 10.8% of the hospitalization for hemorrhages and 3.9% of the total hospitalizations (P<.05). ConclusionsHemorrhages in patients anticoagulated for nonvalvular atrial fibrillation have a high sociosanitary impact. The most frequent hemorrhages were digestive, only a fourth part of them was high. A third of hemorrhages were cerebral. In-hospital mortality in this population was high.

RECALMIN. Cuatro años de evolución de las Unidades de Medicina Interna del Sistema Nacional de Salud (2013-2016)

ObjectivesTo compare the structure, resources and activity of the internal medicine units (IMUs) of the Spanish National Health System (SNHS) in 2013 and 2016. To analyse the differences between IMUs in 2016 by hospital size. Material and methodsWe conducted a comparison of 2 descriptive cross-sectional studies of IMUs in general acute care hospitals of the Spanish National Health System, with data referring to 2013 and 2016. The variables were collected via an ad hoc questionnaire (RECALMIN survey). ResultsBetween 2013 and 2016, the demand for care increased dramatically (with an annual average of 11% in hospital discharges and 16% in first consultations), and comorbidity slightly increased (2%). During this period, the mean productivity of IMUs increased 16.7% (0.6±0.3 vs. 0.7±0.3; P=.09), and the mean stay decreased 10% (9±2.2 vs. 8.1±2.1 days; P=.001). Progress in implementing good practices and systematic care for complex chronic patients was scarce. Both surveys found variability among IMUs and marked differences among IMUs of hospitals of different sizes. ConclusionsIMUs responded to the increased burden of care they supported during 2013-2016 by improving their efficiency and productivity; however, advances in implementing good practices, including care for chronic complex patients, were scare. The significant variability in the indicators of structure, activity and management models found in 2013 remained in 2016.

Public-private partnerships in the Spanish National Health System: The reversion of the Alzira model

In the statutory Spanish National Health System (SNHS), the role of public provision is prominent. Nonetheless, since the inception of the SNHS, Regional Health Authorities have also purchased hospital care from private not-for-profit or for-profit providers, usually complementing public provision. Over the years, the autonomous community of Valencia has championed the use of Public Private Partnerships (PPP) in the form of administrative concessions (AC) awarded to private providers. In the La Ribera Health Department, which includes Alzira, the company Ribera Salud held the concession to provide hospital and primary care to the registered population since 1999 - and this became known as the Alzira model. In April 2018, when the administrative concession was expected to be renewed, Valencia's Health Authority decided to terminate the concession and to revert to direct public provision. While most stakeholders - and in particular the left-wing regional government - were in favour of reverting to public provision, advocates of the Alzira model argued that it was superior in terms of productivity, per capita expenditure and quality. The termination of the Alzira model led to further regulatory changes enacted in the Law for Health 8/2018, which clearly states that public provision is the preferred model of service delivery and new (tighter) requirements are defined for any future PPPs aiming to settle in the autonomous community of Valencia. This paper describes the process and provides background information to understand the underlying reasons of this policy development.

Alcohol consumption in Spanish primary health care providers: a national, cross-sectional study

AimTo estimate the prevalence of alcohol consumption and analyse the drinking patterns among primary healthcare (PHC) providers.DesignObservational, cross-sectional, descriptive study.SettingPHC centres in the Spanish National Health System (SNHS).ParticipantsDoctors and nurses...

Neurological Disorders in Central Spain, Second Survey: Feasibility Pilot Observational Study.

BackgroundThe Neurological Disorders in Central Spain, second survey (NEDICES-2) is a population-based, closed-cohort study that will include over 8000 subjects aged ≥55 years. It will also include a biobank.ObjectiveThe objective of this study was to evaluate all major aspects of the NEDICES-2 (methods, database, screening instruments, and questionnaires, as well as interexpert rating of the neurological diagnoses) in each one of the planned areas (all of them in central Spain) and to test the possibility of obtaining biological samples from each participant.MethodsA selection of patients and participants of the planned NEDICES-2 underwent face-to-face interviews including a comprehensive questionnaire on demographics, current medications, medical conditions, and lifestyle habits. Biological samples (blood, saliva, urine, and hair) were also obtained. Furthermore, every participant was examined by a neurologist.ResultsIn this pilot study, 567 study participants were enrolled (196 from hospitals and 371 from primary care physician lists). Of these 567, 310 completed all study procedures (questionnaires and the neurological evaluation). The study was time-consuming for several primary care physicians. Hence, a few primary care physicians from some areas refused to participate, which led to a reconfiguration of study areas. In addition, the central biobank needed to be supplemented by the biobanks of local Spanish National Health System hospitals.ConclusionsPopulation-based epidemiological surveys, such as the NEDICES-2, require a pilot study to evaluate the feasibility of all aspects of a future field study (population selection, methods and instruments to be used, neurological diagnosis agreement, and data collection).

Budget impact analysis of the XEN® gel stent implant for glaucoma treatment

ABSTRACTObjective: To determine the economic impact of the XEN® Gel Stent implant inclusion into the therapeutic arsenal for surgical treatment of open-angle glaucoma in Spain.Methods: A budget-impact analysis was designed to estimate the costs of surgical intervention in patients with not-controlled glaucoma from the perspective of the Spanish National Health System (NHS).A hypothetical cohort (135 patients with glaucoma) was analyzed and subdivided into three subgroups considering the appropriate interventions: cataracts, iStent®+cataracts, ExPRESS®±cataracts, trabeculectomy±cataracts, and non-penetrating deep sclerectomy (NPDS)±cataracts.The current scenario was compared along a 3-years, with a future scenario considering XEN® for mild glaucoma+cataracts cases (3%) and moderate glaucoma+cataracts and glaucoma without cataracts cases; 30% (year 1), 35% (year 2) and 40% (year 3).The estimation of total cost (€,2016) included the following components: device costs, surgical interventions, follow-up visits, complications management, and additional procedures costs.An expert panel provided proportions of use and resource consumption for each intervention. Unitary costs derived from a national database.Results: The current cost for surgical treatment of glaucoma resulted €4,665.41/patient. The inclusion of the XEN® implant would generate savings of €465.24 in year 1 and €618.82 (years 2–3).Conclusion: XEN® implant inclusion for surgical treatment of glaucoma would result in cost-savings for the NHS.

Real need for headache services and their resource consumption: a retrospective observational study on a cohort in Cantabria

Headache services arise out of a need to improve care for patients with different types of headache; however, some important aspects of clinical management that demonstrate their efficiency remain unknown. To estimate the need for headache services in our area. We conducted a retrospective study in two phases: identification of the first visits due to headache during three consecutive months and collection of care data during one year. The care criteria in headache services considered were: chronic migraine, rare headaches, need for special techniques and headaches with poor therapeutic response. Of the 1,418 first visits, in 298 cases (20.38%) the reason for seeking medical attention was headache. Of these, 82.9% were from primary care. The distribution of the diagnoses was: 54%, migraine; 11%, tension-type headache; and 35%, other headaches. Altogether 108 patients met the criteria for referral to headache services: 63 for chronic migraine; 13 for nerve blocks; 9 for frequent migraine; 8 for trigeminal-autonomic cephalgias; 5 due to a need for botulinum toxin; and 10 for other reasons. The patients attended by headache services went to the emergency department less often than those who visited the general outpatient department, had fewer brain scans and more botulinum toxin was indicated. Headache services are justified because they offer better management of patients with the most severe variants of headache. In our country, at least two visits a week are needed to cover an area of 350,000 users of the Spanish National Health System.

Patient satisfaction in the Spanish National Health System

Determine which key indicators of the Spanish National Health Service (NHS) influence patient satisfaction with the Spanish NHS and physicians (family doctors and specialists). The mean for each indicator for each autonomous community, published by the Ministry of Health, Social Services and Equality, corresponding to the years 2005 to 2014, was related to patient satisfaction by means of multiple linear regression. Patient satisfaction with the NHS was ascertained at 57.32%, with general practitioners at 54.45% and specialist doctors at 55.11%. In the three types of satisfaction, the number of specialist doctors, hospital admissions and in-hospital mortality had a positive and significant influence, while the number of surgical interventions had a negative influence. The greater use of computerized tomography equipment and the hospital infection rate had a negative effect on satisfaction with the NHS and with specialist physicians, while the percentage of outpatient surgery had a positive effect. The average hospital stay shows a negative relationship with satisfaction with family doctors and specialists. Health policies should consider an increase in the number of medical specialists, favour ambulatory surgery, facilitate hospital treatment, monitor the effectiveness of surgical interventions, control hospital infections and moderate the prescription of drugs through the use of alternatives in order to increase patient satisfaction.

A comparative performance analysis of a renowned public private partnership for health care provision in Spain between 2003 and 2015

BackgroundRecently, the once archetype of the public private partnership (PPP) in the Spanish National Health System (SNHS), namely the Alzira’s Model, has come to an end. Advocates defended the superiority of PPPs over public-tenured provision, in terms of quality and technical efficiency. This paper profiles and compares Alzira’s life-cycle performance with similar public-tenured providers. MethodsObservational study on secondary data from virtually all hospital care episodes produced in 51 integrated providers (i.e., administrative healthcare areas) and 67 hospitals, in 2003 and 2015. Alzira’s 2015 performance (and its variation since 2003) was compared with all public-tenured peers in the SNHS, using 26 indicators analysing the differences in age-sex standardized rates of events or risk-adjusted mortality, severity-adjusted hospital expenditure and hospital technical efficiency. ResultsIn comparison with the corresponding public-tenured peers, Alzira’s 2015 performance was statistically worse than the benchmark in the majority of indicators (15 out of 26); yet, its performance was one of the best in the SNHS in adjusted-mortality after Percutaneous Coronary Intervention (PCI). Over time, Alzira showed a statistically greater 2003–2015 improvement than its peers’ average in eleven of the indicators, and a lower improvement in nine. ConclusionsIn this comprehensive comparative study on Alzira’s performance, this PPP has not generally outperformed public-tenured providers, although in some areas of care its developments have been outstanding.

Análisis de la vía clínica de nutrición enteral domiciliaria de la Región de Murcia. Consumo y gastos asociados y adecuación a la Guía del Sistema Nacional de Salud

ObjectiveTo analyze the compliance with the Guide for home enteral nutrition (HEN) of the Spanish national health system of the prescriptions made in a specific area (Health Area I of the Region of Murcia) before and after implementation of a clinical pathway based on that guide, and to compare the changes in healthcare costs of diet therapy during the 2007-2014 period in the Regional and National Health system. MethodA descriptive study to quantify compliance with the main criteria of the HEN guide before (2010) and after (2013-2014) implementation of the clinical pathway. Changes in health expenditure and consumption during the 2007-2014 period were also analyzed. ResultsAll markers of compliance with the national HEN guide improved after implementation of the clinical pathway. In addition, Murcia has one of the Spanish lowest expenditures per population, below the national average. ConclusionThe clinical pathway implemented improves compliance with the national guide of prescriptions to patients in the Region of Murcia while containing health resources expenditure and consumption, thus making diet therapy prescription more sustainable.

Satisfacción de los usuarios en 2 hospitales con diferente modelo de gestión

BackgroundPublic, private, and mixed care management models coexist in the Spanish National Health System, in addition to those private models with state-funded financial support since the General Health Law was enacted. In order to function well, health systems must include quality management systems, and they must use patient satisfaction evaluations as an outcome indicator. ObjectiveThe objective of this article was to compare the level of satisfaction of users with conventional hospitalisation in 2hospitals in Elche (Spain) with different management models. MethodAn observational, descriptive-analytical, and cross-sectional study was carried out in hospital units with the same type of patients in 2health centres with a different management model: Vinalopó Hospital (government franchise) and IMED in Elche (a private institution with service arrangement). Users discharged during June 2017 were included. User satisfaction was measured with a model used to evaluate the perceived quality of hospital care (SERVQHOS questionnaire). ResultsA total of 80% of Vinalopo users, and 75% of IMED users evaluated their care as better than expected. Almost all (97.1%) of users in Vinalopo, and 94.3% in IMED were satisfied or very satisfied with care received, and 97.1% of users in Vinalopo and 92.5% in IMED would not hesitate to recommend them. Global satisfaction and SERVQHOS questionnaire showed a narrow relationship with significance at a global level (R2=0.386; P=.055). However, the results of evaluations at each hospital were not significant (IMED: R2=0.639; P=.092; Vinalopó: R2=0.63; P=.282). ConclusionsHigh satisfaction levels were found, with little differences between the 2hospitals, and higher rates in some areas compared to other studies. As quality indicators, there are factors such as time, flexibility in systems and in information, probably due to changes in needs and user expectations. There are only a few studies that compare satisfaction between different management models.

Cost effectiveness of ixekizumab versus secukinumab in the treatment of moderate-to-severe plaque psoriasis in Spain.

BackgroundCurrently, several biologic agents are available for the treatment of moderate-to-severe plaque psoriasis, including newer agents with similar mechanisms of action and efficacy; therefore, there is a need to evaluate their efficiency in terms of cost effectiveness.ObjectiveThis study evaluates the cost effectiveness of recently approved interleukin (IL)-17A antagonists, ixekizumab and secukinumab, for the treatment of moderate-to-severe plaque psoriasis from the perspective of the Spanish National Health System (NHS).Materials and methodsA Markov model with a lifetime horizon was developed to compare the cost effectiveness of ixekizumab vs. secukinumab in a hypothetical cohort of patients with moderate-to-severe plaque psoriasis. The model used monthly cycles and included four health states: a 12-week induction period, treatment maintenance, best supportive care (BSC), and death. Patients meeting response criteria at the end of the induction period transitioned to maintenance therapy, whereas non-responders transitioned to BSC. It was assumed that, each year, 20% of patients receiving maintenance therapy would discontinue treatment. The model incorporated data from various sources, including published literature, a network meta-analysis, and expert opinion for some variables.ResultsIxekizumab was dominant over secukinumab in that it gained 0.037 more quality-adjusted life years (QALYs) and saved €1951 in total costs over the lifetime horizon. Probabilistic sensitivity analysis showed a 96.6% likelihood that ixekizumab would be cost effective at a threshold of €30,000 per QALY gained.ConclusionFor the treatment of moderate-to-severe plaque psoriasis in Spain, ixekizumab provided additional QALYs and potential savings for the Spanish NHS compared with secukinumab. Since the magnitude of the differences in costs and QALYs was modest, other factors such as patient preferences (eg, for number of injections) and long-term safety (eg, related to time on the market) may also be important for guiding clinical decisions.