The results of this study confirm the effectiveness of the addition of omalizumab to standard therapy in patients with uncontrolled severe persistent asthma.

Taking the social perspective, the economic impact of severe asthma in Spain was estimated to be €8554/patient/year.

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IntroductionCardiovascular (CV) disease affects a high percentage of patients with type 2 diabetes mellitus (T2DM), especially in the hospital setting, impacting on mortality, complications, quality of life and use of health resources. The aim of this study was to estimate the incidence, mean length of hospital stay (LOHS) and costs attributable to hospital admissions due to CV events in patients with T2DM versus patients without diabetes mellitus (non-DM) in Spain.Research design and methodsRetrospective observational study based on the Spanish National Hospital Discharge Database for 2015. Hospital admissions for patients aged ≥35 years with a diagnosis of CV death, non-fatal acute myocardial infarction (AMI), non-fatal stroke, unstable angina, heart failure and revascularization were evaluated. The International Classification of Diseases, Ninth Revision (250.x0 or 250.x2) coding was used to classify records of patients with T2DM. For each CV complication, the hospital discharges of the two groups, T2DM and non-DM, were precisely matched and the number of hospital discharges, patients, LOHS and mean cost were quantified. Additional analyses assessed the robustness of the results.ResultsOf the 276 925 hospital discharges analyzed, 34.71% corresponded to patients with T2DM. A higher incidence was observed in all the CV complications studied in the T2DM population, with a relative risk exceeding 2 in all cases. The mean LOHS (days) was longer in the T2DM versus the non-DM group for: non-fatal AMI (7.63 vs 7.02, p<0.001), unstable angina (5.11 vs 4.78, p=0.009) and revascularization (7.96 vs 7.57, p<0.001). The mean cost per hospital discharge was higher in the T2DM versus the non-DM group for non-fatal AMI (€6891 vs €6876, p=0.029) and unstable angina (€3386 vs €3304, p<0.001).ConclusionsPatients with T2DM had a higher incidence and number of hospital admissions per patient due to CV events versus the non-DM population. This generates a significant clinical and economic burden given the longer admission stay and higher costs associated with some of these complications.

Background:The cost of chronic obstructive pulmonary disease (COPD) in Spain has been studied from different perspectives, but parameters such as the patient's phenotype have seldom been considered. Our aim was to describe the disease burden of COPD patients with frequent exacerbator phenotype, treated with triple therapy. Methods: An observational, multicenter study was carried out from December 2017 to November 2018 in pulmonology services among patients ≥40 years with COPD confirmed diagnosis receiving triple therapy (ICS/LAMA/LABA) and history of ≥2 moderate or ≥1 severe exacerbation in the 12 months prior to the inclusion visit. COPD-related healthcare resources were collected over a 12-months period prior to the inclusion visit: pharmacological and non-pharmacological treatments, medical and ER visits, hospitalizations, tests and productivity loss. Costs were updated to €2019. Patients were classified according to blood eosinophil levels: <150 cells/µL and ≥150 cells/µL. Results: A total of 306 patients were included (77.1% men), with mean age of 69.9 years. Mean COPD exacerbation rate was 2.5/patient/year and 51.3% of patients had ≥150 cells/µL eosinophil level. On average, for the total population, COPD-related visits/patients/year were 6.2. Resource use in moderate exacerbation was higher in patients with eosinophils ≥150 cells/µL, whereas in severe exacerbation was higher in patients with eosinophils <150cells/ µL. According to eosinophil levels, total annual mean (SD) costs/patient accounted for €8382 (9863) and €5144 (5444) for patients with eosinophils <150 cells/µL and ≥150 cells/µL, respectively. Conclusion:The impact of exacerbating COPD patients treated with triple therapy in Spain is large, especially among those with eosinophils <150 cells/µL.

Introduction. Clostridioides difficile infection (CDI) is associated with increased hospital stays and mortality and a high likelihood of rehospitalization, leading to increased health resource use and costs. The objective was to estimate the economic burden of recurrent CDI (rCDI). Material and methods. Observational, retrospective study carried out in six hospitals. Adults aged ≥18 years with ≥1 confirmed diagnosis (primary or secondary) of rCDI between January 2010 and May 2018 were included. rCDI-related resource use included days of hospital stay (emergency room, ward, isolation and ICU), tests and treatments. For patients with primary diagnosis of rCDI, the complete hospital stay was attributed to rCDI. When diagnosis of rCDI was secondary, hospital stay attributed to rCDI was estimated using 1:1 propensity score matching as the difference in hospital stay compared to controls. Controls were hospitalizations without CDI recorded in the Spanish National Hospital Discharge Database. The cost was calculated by multiplying the natural resource units by the unit cost. Costs (euros) were updated to 2019. Results. We included 282 rCDI episodes (188 as primary diagnosis): 66.31% of patients were aged ≥65 years and 57.80% were female. The mean hospital stay (SD) was 17.18 (23.27) days: 86.17% of rCDI episodes were isolated for a mean (SD) of 10.30 (9.97) days. The total mean cost (95%-CI) per episode was €10,877 (9,499-12,777), of which the hospital stay accounted for 92.56%. Conclusions. There is high cost and resource use associated with rCDI, highlighting the importance of preventing rCDI to the Spanish National Health System.

OBJECTIVES: Obesity is associated with elevated risks of developing major costly medical complications and impaired quality of life. The objective of this study was to create a core obesity model to compare weight management interventions, by assessing impacts on BMI and patho-physiological parameters to estimate longterm complications. METHODS: We developed a life-time Markov model with health states reflective of complications which: 1) are highly related to obesity according to the World Health Organization; 2) respond to weight loss, 3) have substantial consequences on costs, quality of life and/or life expectancy. Selected complications were: type 2 diabetes (T2D), obstructive sleep apnoea, cardiovascular disease (acute coronary syndrome [ACS], stroke), cancers (colorectal, endometrial and breast) and osteoarthritis resulting in knee replacement. Actual shortterm effects of specific interventions on BMI, blood pressure, lipids and HbA1c observed in clinical trials were translated into long-term risks of obesity complications, using published or newly developed risk-prediction equations. RESULTS: As an example, in a European cohort, mean age 45 years and BMI 37 kg/ m2, over a 10-year horizon the model predicted 5.0% mortality, 5.8% ACS and 2.1% stroke. Knee replacement occurred in 6.3% of the cohort and the proportion alive with T2D was 5.0%. Following a reduction of 3 BMI units, all other factors remaining unchanged, mortality dropped to 4.8%, with ACS and stroke incidences decreasing to 5.5% and 2.0%. The incidence of knee replacement was reduced to 4.4% and the proportion alive with T2D was 3.8%. CONCLUSIONS: The presented Core Obesity Model is novel in assessing the long-term effects of weight management interventions on such a comprehensive set of obesity medical complications. This model can therefore be used to inform cost-effectiveness analyses on the treatment of adult patients with obesity, with the usual limitations as no prospective long-term data exist on hard outcomes after intentional weight changes.

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