viernes, 10 de marzo de 2017

Socioeconomic Costs of Asthma in the European Union, United States and Canada: A Systematic Review

Socioeconomic Costs of Asthma in the European Union, United States and Canada: A Systematic Review

[Article in Spanish; Abstract available in Spanish from the publisher]


Asthma is responsible for a large number of doctor and emergency visits due to exacerbations and inadequate control of the disease, which give rise to very high associated economic costs. The social cost of asthma comprises both the healthcare and non-healthcare costs. The purpose of this study was to analyse up-to-date estimates of the social cost of asthma, with special reference to the influence of level of severity and degree of control.


A systematic review of original cost-of-illness studies of asthma published in English or Spanish between January 2004 and December 2014 and indexed in PubMed, IBECS or IME was conducted.


29 cost-of-illness studies of asthma were identified, 21 of which used the societal perspective. Only 10 studies estimated the incremental cost of asthma with a control group, and none of them refers to EU countries. Of these 10, only 4 were regarded as high-quality evidence, insofar as they combined a matched control with regression models. The annual incremental cost of asthma in adults ranged from €416 to €5,317. The incremental healthcare cost of asthma increased with level of severity, from €964 for intermittent asthma to €11,703 for severe persistent asthma in adults. In adults, the incremental non-healthcare cost of asthma ranged from €136 to €3,461.


Selected studies in this review show great heterogeneity due to different population characteristics, study designs and valuation methods, which limits their comparability. However, it can be concluded that incremental healthcare costs of asthma, compared to people without asthma, exceeds seven hundred Euros (valued in 2013) in most of the reviwed estimation for several countries. This figure is greater for studies from the United States. The incremental cost per patient increases very rapidly with level of severity and decreases with asthma patient control.


Asthma; Bronchial Asthma; Canada; Chronic Disease; Cost of illness; Economics, Medical; European Union; Health Expenditures; Healthcare costs; Socioeconomic Factors; Spain; United States

jueves, 2 de marzo de 2017

Effect of cost sharing on adherence to evidence-based medications in patients with acute coronary syndrome

Original research article HEART BMJ
Impact Factor 5.693
Published online 1st March 2017

1.    Beatriz González López-Valcárcel
2.    Julián Librero
3.    Aníbal García-Sempere
4.    Luz María Peña
5.    Sofía Bauer
6.    Jaume Puig-Junoy
7.    Juan Oliva
8.    Salvador Peiró
9.    Gabriel Sanfélix-Gimeno

Objectives. Cost-sharing scheme for pharmaceuticals in Spain changed in July 2012. Our aim was to assess the impact of this change on adherence to essential medication in patients with acute coronary syndrome (ACS) in the region of Valencia.
Methods. Population-based retrospective cohort of 10,563 patients discharged alive after an ACS in 2009-2011. We examined a control group (low income working population) that did not change their coinsurance status, and two intervention groups: pensioners who moved from full coverage to 10% coinsurance, and middle to high income working population, for whom coinsurance rose from 40% to 50% or 60%. Weekly adherence rates measured from the date of the first prescription. Days with available medication were estimated by linking prescribed and filled medications during the follow-up period.
Results. Cost-sharing change made no significant differences in adherence between intervention and control groups for essential medications with low price and low patient maximum coinsurance, such as antiplatelet and beta-blockers. For costlier ACEI/ARB and statins, it had an immediate effect in the proportion of adherence in the pensioner group as compared with the control group (6.8% and 8.3% decrease of adherence respectively, p<0 .01="" adherence="" as="" both="" compared="" control="" decreased="" effects="" for="" group="" high="" income="" increase="" middle="" non-adherence="" o:p="" of="" p="" seemed="" statins="" temporary.="" the="" these="" to="">
Conclusions. Coinsurance changes may lead to decreased adherence to proven, effective therapies, especially for higher priced agents with higher patient cost share. Consideration should be given to fully exempt high-risk patients from drug cost-sharing.