Weber

Hidradenitis suppurativa (HS) is a highly disabling chronic inflammatory disorder affecting up to 1% of the Spanish population. It is a complex disease that requires significant resources and imposes a considerable economic burden. The aim of this study was to assess the economic burden of diagnosed HS in Spain both at patient and population level. The study was conducted from a societal perspective using a bottom-up, prevalence-based approach. We evaluated publicly financed direct healthcare costs (consultations, diagnostic tests, inpatient admissions, surgery, comorbidities, treatment), direct nonhealthcare costs (formal and informal care, out-of-pocket expenses), and indirect costs (absenteeism and productivity loss) incurred by patients diagnosed with HS. A sensitivity analysis was conducted to test the uncertainty of the model. The mean annual cost of treating all severities of patients with HS in Spain was €39,535.10. The largest cost components across all categories were informal care (46.05%), treatment (18.24%), out-of-pocket expenses (12.76%), loss of work productivity (10.82%), and surgery (5.62%). Moderate and severe patients cost 64.05% (€34,221.92) and 170.53% (€56,432.77) more than mild patients (€20,860.35), respectively. Assuming a prevalence of 1% and a diagnostic rate of 10%, the total economic burden of diagnosed HS in Spain was estimated at €1587 million. HS has a significant economic impact on patients, their families, the healthcare system, and wider society. This is particularly evident among patients with moderate-to-severe HS. To reduce the economic burden and improve quality of life, efforts should be made to prevent the disease from progressing and to ensure that patients remain in the milder stages.

BackgroundSelf-report instruments are used to evaluate the effect of interventions. However, individuals adapt to adversity. This could result in individuals reporting higher levels of well-being than one would expect. It is possible to test for the influence of adapted preferences on instrument responses using measurement invariance testing. This study conducts such a test with the Wellbeing Related option-Freedom (WeRFree) and ICECAP-A instruments.MethodsA multi-group confirmatory factor analysis was conducted to iteratively test four increasingly stringent types of measurement invariance: (1) configural invariance, (2) metric invariance, (3) scalar invariance, and (4) residual invariance. Data from the Multi Instrument Comparison study were divided into subsamples that reflect groups of participants that differ by age, gender, education, or health condition. Measurement invariance was assessed with (changes in) the Comparative Fit Index (CFI), Root Mean Square Error of Approximation (RMSEA), and Root Mean Square Residual (SRMR) fit indices.ResultsFor the WeRFree instrument, full measurement invariance could be established in the gender and education subsamples. Scalar invariance, but not residual invariance, was established in the health condition and age group subsamples. For the ICECAP-A, full measurement invariance could be established in the gender, education, and age group subsamples. Scalar invariance could be established in the health group subsample.ConclusionsThis study tests the measurement invariance properties of the WeRFree and ICECAP-A instruments. The results indicate that these instruments were scalar invariant in all subsamples, which means that group means can be compared across different subpopulations. We suggest that measurement invariance of capability instruments should routinely be tested with a reference group that does not experience a disadvantage to study whether responses could be affected by adapted preferences.

Abstract Émile Durkheim remains a highly provocative theorist. He defends a particularly strong version of the claim that the social should be treated as a real object in its own right and that even many of the mental phenomena we care about are constituted by “society.” At the same time, he breaks with the dominant version of sociology that has essentially accepted the modernist self-description of contemporary societies. For a long time, this has made it difficult for Durkheimian sociology to find a receptive audience. Today, however, the individualist theories that seemed to offer good reasons for rejecting a Durkheimian approach have lost much of their plausibility. For everybody who is interested in constructing theoretical alternatives to this individualism, Durkheim’s sociology can be a highly useful inspiration—not only because of the solutions it suggests, but because of the questions it asks. Still, making use of the theoretical possibilities offered by the Durkheimian tradition requires going beyond the dominant appropriations. This applies not only to those early appropriations which saw Durkheim as a theorist of immobile consensus-based order but also to the last decades’ dominant interpretations that, while critically reacting to these earlier appropriations, often retain some of their core premises.

BackgroundIn recent years, significant advances have been made in the field of rare diseases (RDs). However, there is a large number of RDs without specific treatment and half of these treatments have public funding in Spain. The aim of the FINEERR project was to carry out a multidisciplinary strategic discussion on the challenge of funding and access to RD-targeted drugs in Spain, in order to agree on specific proposals for medium-term improvement and hence support decision-making in the Spanish National Healthcare System (SNHS).ResultsThe FINEERR Project was organized around a CORE Advisory Committee, which provided an overview, agreed on the design and scope of the project, and selected the members within each of four working groups (WG). Overall, 40 experts discussed and reached a consensus on different relevant aspects, such as conditioning factors for initial funding and access, evaluation and access to RD-targeted therapies, funding of these therapies, and implementation of a new funding and access model. From these meetings, 50 proposals were defined and classified by their level of relevance according to the experts. A descriptive analysis of responses was performed for each proposal. Thereafter, experts completed another questionnaire where they ranked the 25 most relevant proposals according to their level of feasibility of being implemented in the SNHS. The most relevant and feasible proposals were to improve: process of referral of patients with RDs, control over monitoring mechanisms, and communication between healthcare professionals and patients.ConclusionsThe FINEERR project may provide a starting point for stakeholders involved in the process of funding and access to RD-targeted therapies in Spain to provide the necessary resources and implement measures to improve both the quality of life and life expectancy of patients with RDs.

IntroductionPsoriasis is a chronic disease involving the skin, which significantly impacts the quality of life. Disease severity and treatment efficacy (i.e., response) are assessed through the Psoriasis Area and Severity Index (PASI). A PASI 75 response, i.e., an improvement of at least 75% with respect to the baseline PASI score, has traditionally been used as a therapeutic benchmark in clinical trials. Therapeutic advances have made PASI 90 or PASI 100 responses possible in most patients treated with some biologics. A greater response may generate social value beyond clinical outcomes that would benefit both patients and society.MethodsA 1-year economic model was applied to estimate the impact of having a PASI 75, PASI 90, or PASI 100 response in four areas of analysis (quality of life, activities of daily living, work productivity, and out-of-pocket expenditures) and the social value of having a PASI 90 or PASI 100 response in comparison with a PASI 75 response. A mixed-methods approach based on the scientific literature, a focus group with patient, and an advisory committee with psoriasis stakeholders was used. The model included three different scenarios: having a PASI 90 vs a PASI 75 response; a PASI 100 vs a PASI 90 response; and a PASI 100 vs a PASI 75 response. A sensitivity analysis was included.ResultsThe annual economic impact per patient with moderate-to-severe plaque psoriasis having a PASI 75 response was estimated at Ł 6,139, mainly related to labour productivity losses and quality of life reductions. Having a PASI 90 or a PASI 100 response would reduce this impact to €3,956 or €1,353, respectively. Accordingly, the social value of having a PASI 90 instead of a PASI 75 response was estimated at €2,183, and €4,786 with a PASI 100 response.DiscussionA PASI 90 or PASI 100 response would have a lower economic impact and a greater social value than a PASI 75 response for patients with moderate-to-severe plaque psoriasis.

In recent years, target therapies to specific molecular alterations in advanced non-small cell lung cancer (NSCLC) have been identified and have shown superior efficacy compared to non-targeted treatments. Anaplastic lymphoma kinase (ALK) is one of the therapeutic targets; nevertheless, ALK diagnosis is not performed in all NSCLC patients in Spain. The objective of this study is to estimate in monetary terms the benefit for the Spanish society of ALK diagnosis in advanced NSCLC patients. A cost-benefit analysis of ALK diagnosis vs. non-diagnosis in advanced NSCLC patients was carried out from the Spanish social perspective, with a time horizon of 5 years. Costs, benefits and the cost-benefit ratio were measured. The analysis has considered the overall survival in advanced NSCLC patients treated with the ALK-tyrosine kinase inhibitor (TKI) alectinib. The natural history of NSCLC was simulated using a Markov model. A 3% discount rate was applied to both costs and benefits. The result was tested using a deterministic sensitivity analysis. The cost of ALK diagnosis vs. non-diagnosis in the base case would be €10.19 million, generating benefits of €11.71 million. The cost-benefit ratio would be €1.15. In the sensitivity analysis, the cost-benefit ratio could range from €0.89 to €2.10. The results justify the universal application of ALK diagnosis in advanced NSCLC, which generates a benefit for Spanish society that outweighs its costs and allows optimal treatment with targeted therapies for these patients.