Examinando por Autor "Mar, Javier"

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    Ítem
    Cost-utility analysis of the UPRIGHT intervention promoting resilience in adolescents
    (NLM (Medline), 2023-03-17) Mar, Javier; Larrañaga, Igor; Ibarrondo, Oliver; González-Pinto, Ana; Las Hayas Rodríguez, Carlota; Fullaondo, Ane; Izco-Basurko, Irantzu; Alonso, Jordi; Zorrilla, Iñaki; Fernández Sevillano, Jessica ; de Manuel Keenoy, Esteban
    BACKGROUND: As mental health in adulthood is related to mental status during adolescence, school-based interventions have been proposed to improve resilience. The objective of this study was to build a simulation model representing the natural history of mental disorders in childhood, adolescence and youth to estimate the cost-effectiveness of the UPRIGHT school-based intervention in promoting resilience and mental health in adolescence. METHODS: We built a discrete event simulation model fed with real-world data (cumulative incidence disaggregated into eight clusters) from the Basque Health Service database (609,381 individuals) to calculate utilities (quality-adjusted life years [QALYs]) and costs for the general population in two scenarios (base case and intervention). The model translated changes in the wellbeing of adolescents into different risks of mental illnesses for a time horizon of 30 years. RESULTS: The number of cases of anxiety was estimated to fall by 5,125 or 9,592 and those of depression by 1,269 and 2,165 if the effect of the intervention lasted 2 or 5 years respectively. From a healthcare system perspective, the intervention was cost-effective for all cases considered with incremental cost-utility ratios always lower than €10,000/QALY and dominant for some subgroups. The intervention was always dominant when including indirect and non-medical costs (societal perspective). CONCLUSIONS: Although the primary analysis of the trial did not did not detect significant differences, the UPRIGHT intervention promoting positive mental health was dominant in the economic evaluation from the societal perspective. Promoting resilience was more cost-effective in the most deprived group. Despite a lack of information about the spillover effect in some sectors, the economic evaluation framework developed principally for pharmacoeconomics can be applied to interventions to promote resilience in adolescents. As prevention of mental health disorders is even more necessary in the post-coronavirus disease-19 era, such evaluation is essential to assess whether investment in mental health promotion would be good value for money by avoiding costs for healthcare providers and other stakeholders.
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    Ítem
    Healthcare inequity among people with dementia in Gipuzkoa: a retrospective cross-sectional population-based study
    (Ediciones Doyma, S.L., 2026-01-01) Mar, Javier ; Merino, Marisa; Soto Ruiz de Gordoa, Myriam; Ibarrondo, Oliver ; Zumeta Olaskoaga, Lore
    Objective: To compare the use of healthcare resources among the Gipuzkoa population with and without dementia. Method: A retrospective, cross-sectional cost study was conducted on the entire population over 60 years of age registered with the Basque Health Service. We measured the use of health services (hospital and primary care) and health needs as a function of the presence of dementia and neuropsychiatric symptoms, adjusting for age, sex and comorbidity. Generalised linear models from the Tweedie family distribution were fitted, taking into account the asymmetric distribution of costs. Results: Of the 215,859 over-60-year-olds in Gipuzkoa registered, 7553 (3.5%) had dementia. The median (interquartile range) cost was €743 (241-1682) for the total population, broken down into €722 (241-1660) for individuals without dementia and €1090 (481-2140) for those with dementia. In the Tweedie models adjusted for need, the estimated costs were €496 for the group with only neuropsychiatric symptoms, compared to €358 for the group with both conditions. Conclusions: When healthcare resource use is adjusted for need, people with dementia receive less care than those without. However, it is difficult to determine whether this is harmful, depriving people with dementia of necessary care (inverse care law), or beneficial, sparing them from unnecessary treatment (overuse).