Aims We aim to agree on a set of proposals to improve the current management of heart failure (HF) within the Spanish National Health System (SNHS) and apply the social return on investment (SROI) method to measure the social impact that these proposals would generate. Methods and results A multidisciplinary working team of 16 experts was set up, with representation from the main stakeholders regarding HF: medical specialists (cardiologists, internal medicine physicians, general practitioners, and geriatric physicians), nursing professionals, health management professionals, patients, and informal caregivers. This team established a set of proposals to improve the management of HF according to the main areas of HF care: emergency and hospitalization, primary care, cardiology, and internal medicine. A forecast‐type SROI method, with a 1‐year time frame, was applied to measure the social impact resulting from the implementation of these proposals. The required investment and social return were estimated and summarized into a ratio indicating how much social return could be generated for each euro invested. Intangible returns were included and quantified through financial proxies. The approach to improve the management of HF consisted of 28 proposals, including the implementation of a case management nurse network, standardization of operational protocols, psychological support, availability of echocardiography machines at emergency departments, stationary units and primary care, early specialist visits after hospital discharge, and cardiac rehabilitation units, among others. These proposals would benefit not only patients and their informal caregivers but also the SNHS. Regarding patients, proposals would increase their autonomy in everyday activities, decrease anxiety, increase psychological and physical well‐being, improve pharmacological adherence and self‐care, enhance understanding of the disease, delay disease progression, expedite medical assessment, and prevent the decrease in work productivity associated with HF management. Regarding informal caregivers, proposals would increase their quality of life; improve their social, economic, and emotional well‐being; and reduce their care burden. The SNHS would benefit from shorter stays of HF patients at intensive care units and reduction of hospitalizations and admissions to emergency departments. The investment needed to implement these proposals would amount to €548m and yield a social return of €1932m, that is, €3.52 for each euro invested. Conclusions The current management of HF could be improved by a set of proposals that resulted in an overall positive social return, varying between areas of analysis. This may guide the allocation of healthcare resources and improve the quality of life of patients with HF.

Artificial infection of mosquitoes with the endosymbiont bacteria Wolbachia can interfere with malaria parasite development. Therefore, the release of Wolbachia-infected mosquitoes has been proposed as a malaria control strategy. However, Wolbachia effects on vector competence are only partly understood, as indicated by inconsistent effects on malaria infection reported under laboratory conditions. Studies of naturally-occurring Wolbachia infections in wild vector populations could be useful to identify the ecological and evolutionary conditions under which these endosymbionts can block malaria transmission. Here we demonstrate the occurrence of natural Wolbachia infections in three species of black fly (genus Simulium), which is a main vector of the avian malaria parasite Leucocytozoon. Prevalence of Leucocytozoon was high (25%), but the nature and magnitude of its association with Wolbachia differed between black fly species. Wolbachia infection was positively associated with avian malaria infection in S. cryophilum, negatively associated in S. aureum, and unrelated in S. vernum. These differences suggest that Wolbachia interacts with the parasite in a vector host species-specific manner. This provides a useful model system for further study of how Wolbachia influences vector competence. Such knowledge, including the possibility of undesirable positive association, is required to guide endosymbiont based control methods.

Introduction: Emicizumab is a first-in-class monoclonal antibody, recently authorized for the treatment of hemophilia A with inhibitors. This study aims to estimate the direct and indirect costs of the management of hemophilia A with inhibitors, in adult and pediatric patients, including the prophylaxis with emicizumab. Methods: We calculated the costs of the on-demand and prophylactic treatments with bypassing agents (activated prothrombin complex concentrate and recombinant activated factor VII) and the emicizumab prophylaxis, from the societal perspective, over 1 year. The study considered direct healthcare costs (drugs, visits, tests, and hospitalizations), direct non-healthcare costs (informal caregivers), and indirect costs (productivity loss). Data were obtained from a literature review and were validated by an expert group. Costs were expressed in 2019 euros. Results: Our results showed that the annual costs of the prophylactic treatment per patient varied between €543,062.99 and €821,415.77 for adults, and €182,764.43 and €319,826.59 for children, while on-demand treatment was €532,706.84 and €789,341.91 in adults, and €167,523.05 and €238,304.71 in pediatric patients. In relation to other prophylactic therapies, emicizumab showed the lowest costs, with up to a 34% and 43% reduction in the management cost of adult and pediatric patients, respectively. It reduced the bleeding events and administration costs, as this drug is less frequently administered by subcutaneous route. Emicizumab prophylaxis also decreased the cost of other healthcare resources such as visits, tests, and hospitalizations, as well as indirect costs. Conclusion: In comparison to prophylaxis with bypassing agents, emicizumab reduced direct and indirect costs, resulting in cost savings for the National Health System and society.

Impacto clínico, asistencial, económico y social del abordaje ideal de la Artritis Reumatoide en comparación con el abordaje actual-Proyecto SROI-AR] INFORME FINAL 5 [Impacto clínico, asistencial, económico y social del abordaje ideal de la Artritis Reumatoide en comparación con el abordaje actual-Proyecto SROI-AR] INFORME FINAL 9.4 Propuestas del área de AR precoz _______________________________________ 9.4.1 Propuesta 6. Estrategias Treat to Target y control estrecho. Tratamiento precoz con FAME tras diagnóstico __________________________________________________ 9.4.2 Propuesta 7. Consensuar el plan terapéutico (farmacológico y no farmacológico) con el paciente _____________________________________________________________ 9.4.3 Propuesta 8. Accesibilidad sin cita al especialista ante brotes o descompensaciones _ 9.4.4 Propuesta 9. Consultas propias de enfermería en reumatología en AR precoz ______ 9.4.5 Propuesta 10. Formación sobre adherencia y uso de los medicamentos para los pacientes con AR precoz ________________________________________________ 9.4.6 Propuesta 11. Formación y adherencia en aspectos no farmacológicos ligados a la enfermedad para los pacientes con AR precoz _______________________________ 9.4.7 Propuesta 12. Abordaje asistencial integral de otros aspectos intangibles _________ 9.4.8 Resumen de la inversión y del retorno en el área de AR precoz __________________ 9.5 Propuestas del área de AR establecida ___________________________________ 9.5.1 Propuesta 13. Estrategias Treat to Target y control estrecho ____________________ 9.5.2 Propuesta 14. Coordinación entre atención primaria y atención especializada para el tratamiento y seguimiento del paciente ____________________________________ 9.5.3 Propuesta 15. Equidad en el acceso a todos los fármacos disponibles comercializados ___________________________________________________________________ 9.5.4 Propuesta 16. Consultas propias de enfermería en reumatología en AR establecida 9.5.5 Propuesta 17. Formación sobre adherencia y uso de los medicamentos para los pacientes con AR establecida____________________________________________ 9.5.6 Propuesta 18. Formación y adherencia en aspectos no farmacológicos ligados a la enfermedad para los pacientes con AR establecida __________________________ 9.5.7 Propuesta 19. Ampliación del horario de atención especializada ________________ 9.5.8 Propuesta 20. Abordaje integral multidisciplinar e individualizado, asegurando el contacto con otros profesionales sanitarios ________________________________ 9.5.9 Propuesta 21. Fomentar el papel de las asociaciones como elemento complementario a las prestaciones del Sistema Nacional de Salud ____________________________ 9.5.10 Propuesta 22. Atención a la discapacidad: coordinación socio-sanitaria y soporte social general _____________________________________________________________ 9.5.11 Resumen de la inversión y del retorno en el área de AR establecida _____________ 9.6 Ratio SROI _________________________________________________________ 9.7 Análisis de sensibilid...

ObjectiveTo define a set of proposals that would improve the current management of patients with rheumatoid arthritis (RA) within the Spanish National Health System (SNHS), and to estimate the impact of their implementation from a social perspective. Methods A one-year forecast-type Social Return on Investment (SROI) analysis was performed on the basis of information collected from a scientific literature review, official data, and multiple stakeholders regarding RA. A sub-analysis was performed within the areas of diagnosis, early RA (<2 years from diagnosis), and established RA (≥2 years from diagnosis). Results Stakeholders agreed on a set of 22 proposals, which included incorporating specialised nursing, addressing adherence issues, providing psychological support, or promoting the role of patient associations, among others.Their implementation would require an investment of 289 million euros and yield a social return of 913 million euros, i.e. a social return of 3.16 euros per euro invested (2.92 euros in the worst-case scenario and 3.40 euros in the best-case scenario). The greatest social return relative to investment and the greatest attributed to intangible aspects were observed within the area of early RA. ConclusionEvidence-based recommendations for the management of RA are aspirational. Nevertheless, the present study estimated that the implementation of the set of proposals would result in a positive impact relative to the investment needed to implement them. The results may guide management decisions to reduce the burden associated with RA, and help bridge the gap between evidence-based recommendations and routine clinical practice.