To estimate the cost-effectiveness (C-E) of pregabalin (PGB) or levetiracetam (LEV) relative to s... more To estimate the cost-effectiveness (C-E) of pregabalin (PGB) or levetiracetam (LEV) relative to standard therapy (ST) as add-on anti-epileptic therapy in patients with partial refractory epilepsy in Spain. Using stochastic simulation techniques, we estimated the C-E of PGB (300 mg/day) and LEV (2,000 mg/day) in a hypothetical cohort of 1,000 patients (vs ST). The model used data of efficacy and safety from two randomized controlled clinical trials. Direct medical costs (caused by handling of the disease and the adverse events were estimated using year-2007 prices. Model outcomes included number of additional seizure-free days (over one year), adverse events and quality adjusted life-years (QALYs). We calculated the incremental cost-effectiveness ratio (ICER) per additional seizure-free day and QALY gained. Compared with ST, treatment with PGB yielded an estimated 43.3 +/- 4.8 (mean +/- standard error) additional seizure-free days, and a gain of 0.04 +/- 0.0006 QALYs over one year. C...
Fibromyalgia (FM) patients have been regarded as great utilizers of health resources, with import... more Fibromyalgia (FM) patients have been regarded as great utilizers of health resources, with important related costs. The aim of this study is to describe health care resource utilisation and related costs of FM from the perspective of the National Health System in Spain. A cross-sectional multicenter study was conducted on FM patients based on a patient interview. Data about demographic and clinical variables, physical examination, self-perceived health, psychosocial variables and health resource utilisation, were collected. Direct and indirect costs were calculated, and a correlational study between costs and clinical variables was performed. Three-hundred and one patients were studied. During the year 2006 the mean total cost per patient per year was 9,982 Euros, of which 3,245.8 (32.5%) corresponded to health care costs and 6,736.2 (67.5%) to indirect costs attributable to productivity losses. Non-drug therapies accounted for the largest proportion of the health care costs, three ...
ABSTRACT Objetivo Evaluar la relación de coste-efectividad de la combinación beclometasona/formot... more ABSTRACT Objetivo Evaluar la relación de coste-efectividad de la combinación beclometasona/formoterol (BDP/F) frente a fluticasona/salmeterol (F/S) en el tratamiento del asma moderada a grave en pacientes adultos, desde la perspectiva de la sociedad en España. Métodos Se elaboró un modelo de Markov con un horizonte temporal de 12 semanas y cinco estados de salud según la clasificación GEMA/GINA: bien controlada, parcialmente controlada y mal controlada (con o sin hospitalización). Las probabilidades semanales de transición se obtuvieron del estudio ICAT-SE. El uso de recursos sanitarios relacionados con el tratamiento del asma y los equivalentes de días de trabajo perdidos se obtuvieron de un estudio de coste del asma en España. La efectividad se midió en años de vida ajustados por calidad (AVAC) ganados. El coste-efectividad se expresó como la razón coste-efectividad incremental (RCEI) media, estimándose su intervalo de confianza del 95% mediante remuestreo (bootstrapping). Se realizó un análisis de sensibilidad probabilístico y umbral. Resultados En comparación con F/S, BDP/F mostró una mayor ganancia de AVAC (0,0276 frente a 0,0251) a un coste diferencial menor (421 € frente a 454 €) (p
Journal of Pediatric Endocrinology and Metabolism, 2000
Several studies have analyzed the correlation between axial bone mineral density (BMD) measured b... more Several studies have analyzed the correlation between axial bone mineral density (BMD) measured by dual X-ray absorptiometry (DXA) and growth parameters. However, little is known about the growth-related changes in appendicular BMD measured by this technique. We used DXA to measure BMD in the lumbar spine (L1-L4) and distal radius in 121 normal growing children (69 boys, 52 girls), aged 3 to 18 yr. Both lumbar and radius BMD showed a steady increase with age and a steeper increment during puberty. There was a good correlation between spinal and radial BMD (r = 0.83; p < 0.001) and both were highly correlated with growth parameters; their respective correlation coefficients did not differ significantly for chronological age (r = 0.70 vs 0.80), weight (r = 0.77 vs 0.76), height (r = 0.73 vs 0.79), body surface (r = 0.78 vs 0.80), body mass index (r = 0.54 vs 0.49) and bone age (r = 0.77 vs 0.79). By multiple regression analysis the best predictors for spinal BMD were bone age, pubertal stage and weight, while for radial BMD the best predictors were chronological age and weight. We have shown that the measurement of BMD by DXA at distal radius, an easily accessible bone, has a correlation with growth parameters as good as lumbar spine BMD measurements in children.
PurposeThe purpose of this research was to analyse the effect of adding Pregabalin (PGB) on sever... more PurposeThe purpose of this research was to analyse the effect of adding Pregabalin (PGB) on severe symptoms of anxiety and depression in patients with Generalized Anxiety Disorder refractory to duloxetin in daily medical practice in Spain.MethodsThis is a post-hoc analysis of a 6-month multicentre, prospective and observational study carried out in outpatient psychiatric clinics in Spain. Men and women, above 18 years, with a diagnosis of GAD according with DSM-IV-TR criteria, pregabalin naïve and refractory to a previous course of duloxetin (3 months or more) and severe symptoms of anxiety (HAM-A ≥ 24) and depression (MADRS ≥ 35) were considered eligible for analysis.ResultsA total of twenty-five patients [76% women, mean age; 49.3 (11.8) years, 82% with a comorbid depressive disorder] fulfilled criteria for analysis, and were previously exposed to duloxetin [mean dose: 71.7 (26.7) mg/day] for an average of 6.7 (3.7) months. Adding pregabalin [mean dose: 172.8 (75.5) mg/day], durin...
1Institut de l'Envelliment, Universitat Aut`onoma de Barcelona, Barcelona, Spain 2Health Ser... more 1Institut de l'Envelliment, Universitat Aut`onoma de Barcelona, Barcelona, Spain 2Health Services Research Unit, London School of Hygiene and Tropical Medicine, London, UK 3The Institute of Psychiatry, King's College London, UK 4Health Outcomes Research Department, ...
Social Psychiatry and Psychiatric Epidemiology, 2004
■ Abstract Objective The aim of this study was to describe the length of stay, cost of drug treat... more ■ Abstract Objective The aim of this study was to describe the length of stay, cost of drug treatment, diagnostic tests and other therapeutic measures in acute psychotic patients admitted to acute in-patient psychiatric units and to analyse the factors associated with these. Methods A retrospective review was made of medical records of 200 patients admitted for acute psychosis in eight Spanish hospitals. Information was collected concerning the length of stay, cost of drug treatment and diagnostic tests; bivariate and multivariate analysis was made of factors associated with length of stay and cost of antipsychotic drug treatment. Results The average admission cost ranged between 2,830.29 and 3,624.95 euros, with a wide variability among hospitals. Of this cost, 94.3 % corresponded to fixed costs, 3.4 % to diagnostic tests and 2.4 % to drug treatment (84.2 % of this latter cost corresponded to antipsychotic drugs). Age younger than 25 years and a diagnosis of schizophrenia were associated with longer hospital stays; longer length of stay, the presence of aggressiveness/agitation, a diagnosis of schizophrenia, age younger than 25 years and the use of atypical antipsychotics were associated with higher costs in antipsychotic drug treatment. Conclusions The hospital admission cost of an acute psychotic episode is mostly dependent on the structural costs derived from in-patient treatment. The differences in costs seem to be related to the different length of stay schemes used by the various hospitals rather than to the clinical characteristics of patients or the drugs used.
In order to assess the effectiveness of sildenafil under routine conditions of use in primary car... more In order to assess the effectiveness of sildenafil under routine conditions of use in primary care settings and to evaluate its impact on patient's life satisfaction and partner's satisfaction with treatment for erectile dysfunction (ED), an open, multicentre, observational, prospective study was designed in which 2816 patients were treated with sildenafil for at least 10 weeks. Effectiveness was assessed using
Objective: The purpose of this work was to assess the health-related quality of life factors asso... more Objective: The purpose of this work was to assess the health-related quality of life factors associated with erectile dysfunction (ED). Methods: 2476 non-institutionalised Spanish males, age ranging from 25 to 70 years, were interviewed. ED was defined using two instruments: a simple self-assessment question (ED-sq) and the International Index of Erectile Function (IIEF). Health-related quality of life (HRQoL) was measured through the SF-36 questionnaire. Results: The severity of ED (measured both through the ED-sq and with the IIEF) increased as the scores of the scales of the SF-36 decreased (Mantel-Hänszel w 2 -test statistic range: ; p < 0:001). The two summary components (physical and mental) showed a downward trend, more for the physical than for the mental component. Conclusion: We found a clear pattern of negative association between self-perceived erectile dysfunction and HRQoL. This association was clearer when ED-sq (rather than IIEF) was used, and stronger for the physical summary component than for the mental one. #
patients who begin with low and high levels and regardless of final level achieved. METHODS: A co... more patients who begin with low and high levels and regardless of final level achieved. METHODS: A cohort of 27,660 patients with coronary artery disease, peripheral vascular disease, or diabetes mellitus were selected and followed retrospectively for their first myocardial infarction or revascularization recorded in the New England Veterans Affairs database. Pre-outcome low-density lipoprotein cholesterol reduction was categorized as follows: <10 mg/dl, reference; 10-39 mg/dl, small reduction; 40-69 mg/dl, moderate reduction; >70 mg/dl, large reduction. Cox proportional hazards was used to determine hazard ratios for each category of lipid reduction compared to reference and stratified by high or low initial LDL-C, adjusting for initial LDL-C, statin use, age, gender, and co morbidities. RESULTS: Among patients with initial LDL-C above the median of 133 mg/dL, hazard ratios (95% confidence intervals) for small, moderate, and large reductions compared to reference were 0.90 (0.85-0.96), 0.84 (0.79-0.90), and 0.76 (0.70-0.83) respectively. A total of 3448 or 24% of such patients achieved a final level <100 mg/dL. Among patients with initial levels below the median, hazard ratios (95% confidence intervals) for small, moderate, and large reductions were 0.90 (0.85-0.96), 0.87 (0.79-0.96), and 0.76 (0.56-1.05) respectively. A total of 5492 or 40% of such patients achieved final level <100 mg/dL. CON-CLUSION: These data suggest that magnitude of reduction in low-density lipoprotein cholesterol is proportional to degree of reduction in cardiovascular risk, and that this effect holds both for patients with initially low or high lipid levels, regardless of whether a final LDL-C of <100 mg/dL was achieved.
To estimate the cost-effectiveness (C-E) of pregabalin (PGB) or levetiracetam (LEV) relative to s... more To estimate the cost-effectiveness (C-E) of pregabalin (PGB) or levetiracetam (LEV) relative to standard therapy (ST) as add-on anti-epileptic therapy in patients with partial refractory epilepsy in Spain. Using stochastic simulation techniques, we estimated the C-E of PGB (300 mg/day) and LEV (2,000 mg/day) in a hypothetical cohort of 1,000 patients (vs ST). The model used data of efficacy and safety from two randomized controlled clinical trials. Direct medical costs (caused by handling of the disease and the adverse events were estimated using year-2007 prices. Model outcomes included number of additional seizure-free days (over one year), adverse events and quality adjusted life-years (QALYs). We calculated the incremental cost-effectiveness ratio (ICER) per additional seizure-free day and QALY gained. Compared with ST, treatment with PGB yielded an estimated 43.3 +/- 4.8 (mean +/- standard error) additional seizure-free days, and a gain of 0.04 +/- 0.0006 QALYs over one year. C...
Fibromyalgia (FM) patients have been regarded as great utilizers of health resources, with import... more Fibromyalgia (FM) patients have been regarded as great utilizers of health resources, with important related costs. The aim of this study is to describe health care resource utilisation and related costs of FM from the perspective of the National Health System in Spain. A cross-sectional multicenter study was conducted on FM patients based on a patient interview. Data about demographic and clinical variables, physical examination, self-perceived health, psychosocial variables and health resource utilisation, were collected. Direct and indirect costs were calculated, and a correlational study between costs and clinical variables was performed. Three-hundred and one patients were studied. During the year 2006 the mean total cost per patient per year was 9,982 Euros, of which 3,245.8 (32.5%) corresponded to health care costs and 6,736.2 (67.5%) to indirect costs attributable to productivity losses. Non-drug therapies accounted for the largest proportion of the health care costs, three ...
ABSTRACT Objetivo Evaluar la relación de coste-efectividad de la combinación beclometasona/formot... more ABSTRACT Objetivo Evaluar la relación de coste-efectividad de la combinación beclometasona/formoterol (BDP/F) frente a fluticasona/salmeterol (F/S) en el tratamiento del asma moderada a grave en pacientes adultos, desde la perspectiva de la sociedad en España. Métodos Se elaboró un modelo de Markov con un horizonte temporal de 12 semanas y cinco estados de salud según la clasificación GEMA/GINA: bien controlada, parcialmente controlada y mal controlada (con o sin hospitalización). Las probabilidades semanales de transición se obtuvieron del estudio ICAT-SE. El uso de recursos sanitarios relacionados con el tratamiento del asma y los equivalentes de días de trabajo perdidos se obtuvieron de un estudio de coste del asma en España. La efectividad se midió en años de vida ajustados por calidad (AVAC) ganados. El coste-efectividad se expresó como la razón coste-efectividad incremental (RCEI) media, estimándose su intervalo de confianza del 95% mediante remuestreo (bootstrapping). Se realizó un análisis de sensibilidad probabilístico y umbral. Resultados En comparación con F/S, BDP/F mostró una mayor ganancia de AVAC (0,0276 frente a 0,0251) a un coste diferencial menor (421 € frente a 454 €) (p
Journal of Pediatric Endocrinology and Metabolism, 2000
Several studies have analyzed the correlation between axial bone mineral density (BMD) measured b... more Several studies have analyzed the correlation between axial bone mineral density (BMD) measured by dual X-ray absorptiometry (DXA) and growth parameters. However, little is known about the growth-related changes in appendicular BMD measured by this technique. We used DXA to measure BMD in the lumbar spine (L1-L4) and distal radius in 121 normal growing children (69 boys, 52 girls), aged 3 to 18 yr. Both lumbar and radius BMD showed a steady increase with age and a steeper increment during puberty. There was a good correlation between spinal and radial BMD (r = 0.83; p &lt; 0.001) and both were highly correlated with growth parameters; their respective correlation coefficients did not differ significantly for chronological age (r = 0.70 vs 0.80), weight (r = 0.77 vs 0.76), height (r = 0.73 vs 0.79), body surface (r = 0.78 vs 0.80), body mass index (r = 0.54 vs 0.49) and bone age (r = 0.77 vs 0.79). By multiple regression analysis the best predictors for spinal BMD were bone age, pubertal stage and weight, while for radial BMD the best predictors were chronological age and weight. We have shown that the measurement of BMD by DXA at distal radius, an easily accessible bone, has a correlation with growth parameters as good as lumbar spine BMD measurements in children.
PurposeThe purpose of this research was to analyse the effect of adding Pregabalin (PGB) on sever... more PurposeThe purpose of this research was to analyse the effect of adding Pregabalin (PGB) on severe symptoms of anxiety and depression in patients with Generalized Anxiety Disorder refractory to duloxetin in daily medical practice in Spain.MethodsThis is a post-hoc analysis of a 6-month multicentre, prospective and observational study carried out in outpatient psychiatric clinics in Spain. Men and women, above 18 years, with a diagnosis of GAD according with DSM-IV-TR criteria, pregabalin naïve and refractory to a previous course of duloxetin (3 months or more) and severe symptoms of anxiety (HAM-A ≥ 24) and depression (MADRS ≥ 35) were considered eligible for analysis.ResultsA total of twenty-five patients [76% women, mean age; 49.3 (11.8) years, 82% with a comorbid depressive disorder] fulfilled criteria for analysis, and were previously exposed to duloxetin [mean dose: 71.7 (26.7) mg/day] for an average of 6.7 (3.7) months. Adding pregabalin [mean dose: 172.8 (75.5) mg/day], durin...
1Institut de l'Envelliment, Universitat Aut`onoma de Barcelona, Barcelona, Spain 2Health Ser... more 1Institut de l'Envelliment, Universitat Aut`onoma de Barcelona, Barcelona, Spain 2Health Services Research Unit, London School of Hygiene and Tropical Medicine, London, UK 3The Institute of Psychiatry, King's College London, UK 4Health Outcomes Research Department, ...
Social Psychiatry and Psychiatric Epidemiology, 2004
■ Abstract Objective The aim of this study was to describe the length of stay, cost of drug treat... more ■ Abstract Objective The aim of this study was to describe the length of stay, cost of drug treatment, diagnostic tests and other therapeutic measures in acute psychotic patients admitted to acute in-patient psychiatric units and to analyse the factors associated with these. Methods A retrospective review was made of medical records of 200 patients admitted for acute psychosis in eight Spanish hospitals. Information was collected concerning the length of stay, cost of drug treatment and diagnostic tests; bivariate and multivariate analysis was made of factors associated with length of stay and cost of antipsychotic drug treatment. Results The average admission cost ranged between 2,830.29 and 3,624.95 euros, with a wide variability among hospitals. Of this cost, 94.3 % corresponded to fixed costs, 3.4 % to diagnostic tests and 2.4 % to drug treatment (84.2 % of this latter cost corresponded to antipsychotic drugs). Age younger than 25 years and a diagnosis of schizophrenia were associated with longer hospital stays; longer length of stay, the presence of aggressiveness/agitation, a diagnosis of schizophrenia, age younger than 25 years and the use of atypical antipsychotics were associated with higher costs in antipsychotic drug treatment. Conclusions The hospital admission cost of an acute psychotic episode is mostly dependent on the structural costs derived from in-patient treatment. The differences in costs seem to be related to the different length of stay schemes used by the various hospitals rather than to the clinical characteristics of patients or the drugs used.
In order to assess the effectiveness of sildenafil under routine conditions of use in primary car... more In order to assess the effectiveness of sildenafil under routine conditions of use in primary care settings and to evaluate its impact on patient's life satisfaction and partner's satisfaction with treatment for erectile dysfunction (ED), an open, multicentre, observational, prospective study was designed in which 2816 patients were treated with sildenafil for at least 10 weeks. Effectiveness was assessed using
Objective: The purpose of this work was to assess the health-related quality of life factors asso... more Objective: The purpose of this work was to assess the health-related quality of life factors associated with erectile dysfunction (ED). Methods: 2476 non-institutionalised Spanish males, age ranging from 25 to 70 years, were interviewed. ED was defined using two instruments: a simple self-assessment question (ED-sq) and the International Index of Erectile Function (IIEF). Health-related quality of life (HRQoL) was measured through the SF-36 questionnaire. Results: The severity of ED (measured both through the ED-sq and with the IIEF) increased as the scores of the scales of the SF-36 decreased (Mantel-Hänszel w 2 -test statistic range: ; p < 0:001). The two summary components (physical and mental) showed a downward trend, more for the physical than for the mental component. Conclusion: We found a clear pattern of negative association between self-perceived erectile dysfunction and HRQoL. This association was clearer when ED-sq (rather than IIEF) was used, and stronger for the physical summary component than for the mental one. #
patients who begin with low and high levels and regardless of final level achieved. METHODS: A co... more patients who begin with low and high levels and regardless of final level achieved. METHODS: A cohort of 27,660 patients with coronary artery disease, peripheral vascular disease, or diabetes mellitus were selected and followed retrospectively for their first myocardial infarction or revascularization recorded in the New England Veterans Affairs database. Pre-outcome low-density lipoprotein cholesterol reduction was categorized as follows: <10 mg/dl, reference; 10-39 mg/dl, small reduction; 40-69 mg/dl, moderate reduction; >70 mg/dl, large reduction. Cox proportional hazards was used to determine hazard ratios for each category of lipid reduction compared to reference and stratified by high or low initial LDL-C, adjusting for initial LDL-C, statin use, age, gender, and co morbidities. RESULTS: Among patients with initial LDL-C above the median of 133 mg/dL, hazard ratios (95% confidence intervals) for small, moderate, and large reductions compared to reference were 0.90 (0.85-0.96), 0.84 (0.79-0.90), and 0.76 (0.70-0.83) respectively. A total of 3448 or 24% of such patients achieved a final level <100 mg/dL. Among patients with initial levels below the median, hazard ratios (95% confidence intervals) for small, moderate, and large reductions were 0.90 (0.85-0.96), 0.87 (0.79-0.96), and 0.76 (0.56-1.05) respectively. A total of 5492 or 40% of such patients achieved final level <100 mg/dL. CON-CLUSION: These data suggest that magnitude of reduction in low-density lipoprotein cholesterol is proportional to degree of reduction in cardiovascular risk, and that this effect holds both for patients with initially low or high lipid levels, regardless of whether a final LDL-C of <100 mg/dL was achieved.
Uploads
Papers by Javier Rejas