Background and Aims: FreeStyle Libre® systems are effective and convenient glucose flash monitoring (FM) devices. This cost analysis compared FM versus self-monitoring of blood glucose (SMBG) in poorly controlled (glycated hemoglobin [HbA1c] >8%) patients with type 2 diabetes (T2D) on basal insulin in Spain. Methods: A model was used to compare the costs of FM and SMBG in a 1000-patient cohort. All model inputs were sourced from scientific literature and validated by a multidisciplinary experts’ group. Unitary costs were included in euros (2025), including value-added tax (VAT). The daily use of 2.5 strips (€0.57/strip) and 2.5 lancets (€0.14/lancet) was considered for SMBG according to Spanish recommendations. The events/person-year was 2.5 for severe hypoglycemic events (SHEs) (€1403.03/event), 17.02 for non-SHEs (NSHEs) (€3.92/event), and 0.0025 for diabetic ketoacidosis (DKA) (€2523.93/event). FM reduced the use of strips/lancets (−83.0%; sensor: €3.00/day) and acute events (NSHEs/SHEs: −58.0%; DKA: −68.0%). Sensitivity analyses were conducted to test robustness. Two additional scenarios were studied, including chronic diabetic complications (absolute reduction in HbA1c with FM: −1.1%) and absenteeism-related costs (reduction in absenteeism with FM: −58.4%). Results: The annual cost per patient was €3299.99 with SMBG and €2320.20 with FM. In 1000 patients, FM averted 2162 NSHEs (FM vs. SMBG: −€66,672), 1450 SHEs (FM vs. SMBG: −€2,579,224), and 1.5 DKA (FM vs. SMBG: −€6310), producing total cost savings of €979.706 compared with SMBG. All sensitivity analyses confirmed cost savings of FM versus SMBG, even when strips/lancets were free (−€442,117) or assuming a lower SHE frequency (1.4 events/patient-year; −€321,488). In 1000 patients, when considering chronic diabetic complications (SMBG: €3,745,869; FM: €2,886,785) and absenteeism (SMBG: €237,990; FM: €99,004), the annual cost savings of FM versus SMBG rose to €1,997,777. Conclusions: FreeStyle Libre could reduce acute events, chronic diabetic complications, and work absenteeism in poorly controlled patients with T2D on basal insulin, generating cost savings for the Spanish health system and society.

Introduction FreeStyle Libre (FSL) systems are effective and user-friendly glucose monitoring devices. This cost-effectiveness analysis compared FSL vs. self-blood glucose monitoring (SBGM) in patients with poorly controlled [hemoglobin A1c (HbA1c) > 8%] type 2 diabetes (T2DM) on basal insulin, from the Spanish National Health System perspective. Methods The DEDUCE model, which simulated 10,000 patients with T2DM over a 50 years’ time horizon (annual discount rate = 3.00%), was adapted to the Spanish setting. The population characteristics, frequency of acute and chronic diabetic complications, costs (€, 2025) and utilities/disutilities proceeded from scientific literature and were validated by national multidisciplinary experts. The annual probabilities of acute events associated with SBGM were 17.02% for non-severe hypoglycemia (SHE) (€3.92; disutility = – 0.0016), 2.50% for SHE (€1031.69; disutility = – 0.0470) and 0.25% for ketoacidosis (DKA) (€2523.93; disutility = – 0.0470). The RECODe risk engine was used to model chronic diabetic complications (myocardial infarction [€1248.44–€31,013.22; disutility = – 0.0550]; heart failure [€1523.14–6505.08; disutility = – 0.1080]; stroke [€3187.92–7849.48; disutility = – 0.1640]; blindness [€2943.37; disutility = – 0.0740]; renal failure [€4057.05–42,757.39; disutility = – 0.2040]). According to the Spanish recommendations, a patient with SBGM required 2.5 reactive strips/day and 2.5 lancets/day (€0.57/strip; €0.14/lancet; VAT included). FSL (26 sensors/year; €3.00/day; VAT included) was associated with reductions of 58% in hypoglycemia, 68% in DKA, 83% in the use of strips/lancets, and an absolute decrease of 1.1% in HbA1c. Deterministic and probabilistic sensitivity analyses (SAs) were conducted. Results While SBGM yielded 9.18 quality-adjusted life years (QALYs) and total costs of €77,092 (glucose monitoring = €17,080; diabetic complications = €68,272), FSL yielded 9.98 QALYs and total costs of €61,447 (glucose monitoring = €8820; diabetic complications = €44,367). Compared with SBGM, FSL produced total cost savings of €15,645 and 0.80 additional QALYs per patient, being a dominant alternative compared to SBGM. FSL was found to be dominant in all SAs. Conclusions This analysis suggests that FSL, which provides better clinical outcomes at a lower overall cost, is a preferable alternative to SBGM among people with poorly controlled T2DM on basal insulin.

Background: Quality-of-life (QoL) measures are key for monitoring health of patients with Parkinson’s disease (PD). Objective: This systematic review aimed to gather evidence on the psychometric properties of available patient-reported outcomes measures (PROMs) for assessing QoL in people with PD (PwPD). Methods: A search of PROMs was conducted in PubMed (MEDLINE), Embase, Scopus, Web of Science, PSICDOC, and ‘gray literature’ (April 2024, PROSPERO-ID: CRD42024526458). After screening and data extraction, in a two-phase procedure conducted by independent reviewers, a critical assessment of feasibility, validity (content, structural, known-group, and criterion) and reliability (internal consistency, test–retest, and measurement error) was conducted based on the COSMIN criteria for good psychometric properties. Results: The search identified 83 eligible studies from which 29 PROMs were gathered (15 PD-specific and 14 generic/unspecific PROMs validated for PD). All PROMs proved their feasibility and included common dimensions between them, suggesting adequate content validity. Among the 29 PROMs, 17 reported data on structural validity (58.6%), 20 on known-group validity (69.0%), 25 on criterion validity (86.2%), 23 on internal consistency (79.3%), 11 on test–retest validity (37.9%), and 4 on measurement error (13.8%). According to the COSMIN criteria, 6 PROMs have the potential to be the most suitable QoL measure for PwPD: PDQ-39, PDQ-8, PDQL, PDQUALIF, PIMS, and Neuro-QOL. Conclusions: Several PROMs are feasible, valid, and reliable for measuring QoL in PwPD. However, further research ensuring their psychometric properties and cross-cultural adaptations are needed to recommend their use.

Objective: To determine whether HIV-infected individuals versus individuals with HIV/HCV coinfection, in the era of interferon-free therapies, exhibit an increased incidence of comorbidities and non-AIDS-related events. Methods: A retrospective analysis was conducted by collecting data from clinical records of Spanish patients at a tertiary hospital involving HIV/HCV-coinfected and HIV-infected patients, all with effectively controlled HIV. Coinfected patients underwent HCV clearance using direct-acting antivirals (DAAs) and had no history of interferon treatment. The incidences of hypertension, diabetes mellitus, cardiovascular disease, kidney disease, liver disease, non-AIDS cancer, and death were compared between the groups. Multivariate adjustments for all factors potentially impacting outcomes were used to assess the risk of clinical event onset. Propensity score (PS) analyses were also conducted to support the multivariate model results. Results: Data were available from 229 HIV/HCV-coinfected patients and 229 HIV-infected patients. Both cohorts were comparable in terms of age, gender distribution, follow-up, and HIV-related characteristics. Multivariate models and PS showed that previous exposure to HCV was not associated with the onset of any clinical events studied. Significant differences between HIV/HCV-coinfected and HIV-infected were not found for survival according to the log-rank test (p = 0.402). Conclusions: Successful HCV elimination using DAAs improved the outlook regarding comorbidities and survival across HIV/HCV-coinfected cohorts. Early HCV detection and DAA therapy could enhance clinical results. These findings provide an optimistic perspective for those living with HIV/HCV coinfection and underscore the importance of continuing efforts toward early detection and DAA treatment initiation.

Several surgical treatments are available for managing lower urinary tract symptoms secondary to benign prostatic hyperplasia (LUTS/BPH). Water vapour thermal therapy (WVTT) is a new minimally inva...

Introduction: Respiratory syncytial virus (RSV) causes great morbidity and mortality among newborns. Nirsevimab represents a prophylactic alternative used in Spain for a universal prophylaxis strategy of all infants. The aim of this study was to estimate the economically justifiable price (EJP) of nirsevimab in Spain, being the price to consider nirsevimab efficient compared with the standard of practice (administration of palivizumab in eligible infants and no intervention in all other). Methods: An economic model based on a decision tree was developed to conduct a cost–utility analysis. The RSV epidemiology, RSV-related health events, clinical variables, resources consumption, costs and utilities were derived from the scientific literature and agreed by a multidisciplinary advisory board. The analyses included the universal immunisation of all infants with nirsevimab, considering both payer and societal perspectives. The EJPs were estimated considering the following willingness-to-pay (WTP) thresholds: €0/quality-adjusted life-year (QALY), €22 000/QALY and €30 000/QALY. Alternative scenarios (including immunisation strategy targeted at high-risk infants), deterministic and probabilistic sensitivity analyses were also conducted. Results: The prophylaxis with nirsevimab in all infants averted 215 878 RSV events, 9 deaths, avoided 1307 QALYs lost and reduced €48.4 and €17.3 million in direct and indirect costs. For a payer perspective, at those WTP thresholds, the EJPs resulted in €222.27, €320.52 and €356.25, raising to €281.47, €379.72 and €415.45 for a societal perspective. The robustness of the model and its results was confirmed by alternative scenarios and sensitivity analyses. Conclusions: Nirsevimab reduces RSV-related health events, leading to cost savings and avoided QALY loss associated with RSV infection in infants compared to the previous standard of practice. This study provides a range of cost-effective prices that would lead nirsevimab to be an efficient intervention, or even dominant (achieves better outcomes and produces cost savings), compared with the standard of-practice for RSV prevention, being key for decision-making in public health.