No abstract

Influenza is a contagious respiratory disease that causes severe illness and death, particularly in elderly populations. Two enhanced formulations of quadrivalent influenza vaccine (QIV) are available in Spain. Adjuvanted QIV (aQIV) is available for those aged 65+ and high-dose QIV (HD-QIV) for those aged 60+. In this study, we used a health economic model to assess the costs and outcomes associated with using aQIV or HD-QIV in subjects aged 65+. Using aQIV instead of HD-QIV to vaccinate an estimated 5,126,343 elderly people results in reductions of 5405 symptomatic cases, 760 primary care visits, 171 emergency room visits, 442 hospitalizations, and 26 deaths in Spain each year. Life-years (LYs) and quality-adjusted LYs (QALYs) increases by 260 and 206, respectively, each year. Savings from a direct medical payer perspective are EUR 63.6 million, driven by the lower aQIV vaccine price and a minor advantage in effectiveness. From a societal perspective, savings increase to EUR 64.2 million. Results are supported by scenario and sensitivity analyses. When vaccine prices are assumed equal, aQIV remains dominant compared to HD-QIV. Potential savings are estimated at over EUR 61 million in vaccine costs alone. Therefore, aQIV provides a highly cost-effective alternative to HD-QIV for people aged 65+ in Spain.

No abstract

Standard-dose quadrivalent influenza vaccines (QIV) are designed to provide protection against all four influenza strains. Adjuvanted QIV (aQIV), indicated for individuals aged 65+ years, combines MF59® adjuvant (an oil-in-water emulsion of squalene oil) with a standard dose of antigen, and is designed to produce stronger and longer immune response, especially in the elderly where immunosenescence reduces vaccine effectiveness. This study evaluated the cost-effectiveness of aQIV vs. egg-based standard-dose QIV (QIVe) in the elderly population, from the payer and societal perspective in Spain. A dynamic transmission model, which accounts for herd protection, was used to predict the number of medically attended infections in Spain. A decision tree structure was used to forecast influenza-related costs and benefits. Influenza-related probabilities of outpatient visit, hospitalization, work absenteeism, mortality, and associated utilities and costs were extracted from Spanish and European published literature. Relative vaccine effectiveness (rVE) was sourced from two different meta-analyses: the first meta-analysis was informed by laboratory-confirmed influenza studies only, resulting in a rVE = 34.6% (CI95% 2–66%) in favor of aQIV; the second meta-analysis included real world evidence influenza-related medical encounters outcomes, resulting in a rVE = 13.9% (CI95% 4.2–23.5%) in benefit of aQIV. All costs were expressed in 2021 euros. Results indicate that replacing QIVe with aQIV in the Spanish elderly population would prevent on average 43,664 influenza complicated cases, 1111 hospitalizations, and 569 deaths (with a rVE = 34.6%) or 19,104 influenza complicated cases, 486 hospitalizations, and 252 deaths (with a rVE = 13.9%). When the rVE of aQIV vs. QIVe is 34.6%, the incremental cost per quality adjusted life years (QALY) gained was €2240 from the payer; from the societal perspective, aQIV was cost saving compared with QIVe. If the rVE was 13.9%, the incremental cost per QALY was €6694 and €3936 from the payer and societal perspective, respectively. Sensitivity analyses validated the robustness of these findings. Results indicate that replacing QIVe with aQIV in the Spanish elderly population is a cost-effective strategy for the Spanish healthcare system.

Original-Cá ncer de pró stata Evaluació n del test PCA3 para el diagnó stico de cá ncer de pró stata: revisió n sistemá tica y metaná lisis J. Ruiz-Aragó n à y S. Má rquez-Pelá ez Agencia de Evaluació n de Tecnología Sanitaria de Andalucía (AETSA), Consejería de Salud, Junta de Andalucía, Españ a informació n del artí culo Historia del artículo: Recibido el 1 de febrero de 2010 Aceptado el 6 de febrero de 2010 On-line el 10 de abril de 2010 Palabras clave: Cá ncer de pró stata Diagnó stico PCA3 Detecció n precoz r e s u m e n Objetivos: Evaluar la eficacia de las té cnicas diagnó sticas basadas en el gen PCA3 para el diagnó stico del cá ncer de pró stata. Para ello, se ha realizado una revisió n sistemá tica de la literatura científica y posterior metaná lisis. Material y métodos: Bú squeda bibliográ fica (2000-09) en MedLine, Embase, Cochrane Library, CRD, ECRI, Hayes y en revistas especializadas de Cá ncer y Urología. Se utilizaron los descriptores)Prostatic Neoplasms*,)Prostate-Specific Antigen*,)Antigens, Neoplasm*,)Sensitivity and Specificity*,)Predictive Value of Tests* y té rminos libres)upm3*,)pca3*,)dd3*,)aptima pca3* y)prostate cancer antigen 3*. La població n eran adultos y la intervenció n consistía en la determinació n del gen PCA3, a partir de muestras de orina, para el diagnó stico de cá ncer de pró stata. La calidad de los estudios se analizó segú n los criterios QUADAS. Se calcularon los ı ´ndices de validez diagnó stica y se elaboró un metaná lisis para sintetizar los resultados. Resultados: Se incluyeron 14 estudios de pruebas diagnó sticas, de calidad moderada-alta. La sensibilidad estuvo comprendida entre 46,9-82,3%; la especificidad osciló entre 56,3-89%; el valor predictivo positivo tuvo un rango de 59,4-97,4%; y el valor predictivo negativo entre 87,8-98%. El metaná lisis detectó la existencia de efecto umbral y de heretogeneidad entre los estudios, ofreciendo valores de sensibilidad global de 0,85 (IC 0,84-0,87), especificidad de 0,96 (IC 0,96-0,97), cociente de probabilidad positivo de 22,21 (IC 15,12-32,63) y negativo de 0,15 (IC 0,13-0,18). Conclusiones: Las té cnicas de detecció n presentan aceptables ı ´ndices de validez diagnó stica para poder usarlas en el diagnó stico de cá ncer de pró stata & 2010 AEU. Publicado por Elsevier Españ a, S.L. Todos los derechos reservados. Assessment of the PCA3 test for prostate cancer diagnosis: A systematic review and meta-analysis Keywords: Prostate cancer Diagnosis a b s t r a c t Objective: To assess the efficacy of diagnostic techniques based on PCA3 gene for early detection of prostate cancer. We carried out a systematic review of scientific literature and subsequent meta-analysis.

This result should be considered with caution because of the low methodological quality of the studies included. However, the different surgical techniques assessed showed similar effects in the two types of studies included and we found that robotic surgery presented lower percentages of sexual impotence.

No abstract

No abstract