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Article ; Online: Deliberative processes in health technology assessment of medicines: the case of Spain.

Pinilla-Dominguez, Pilar / Pinilla-Dominguez, Jaime

International journal of technology assessment in health care

2023 Volume 39, Issue 1, Page(s) e50

Abstract: Objectives: Spain incorporated in 2020 changes in its health technology assessment (HTA), pricing, and reimbursement system for medicines including publishing reports, development of networks of experts, or consultation with stakeholders. Despite these ... ...

Abstract	Objectives: Spain incorporated in 2020 changes in its health technology assessment (HTA), pricing, and reimbursement system for medicines including publishing reports, development of networks of experts, or consultation with stakeholders. Despite these changes, it is unclear how deliberative frameworks are applied and the process has been criticized for not being sufficiently transparent. This study analyses the level of implementation of deliberative processes in HTA for medicines in Spain. Methods: We review the grey literature and summarize the Spanish HTA, pricing, and reimbursement process of medicines. We apply the deliberative processes for HTA checklist, developed to assess the overall context of the deliberative process, and identify the stakeholders involved and type of involvement following the framework for evidence-informed deliberative processes, a framework for benefit package design that aims to optimize the legitimacy of decision making. Results: In the Spanish HTA, pricing, and reimbursement process deliberation takes place in order to exchange viewpoints and reach common ground, mainly during the prioritization, assessment, and appraisal steps. It is closed to the public, not clearly summarized in published documents and limited to the Ministry of Health, the regulatory agency, other Ministries, and experts with mostly clinical and/or pharmaceutical background. The views of stakeholders are only represented through consultation. Communication is the most commonly used form of stakeholder engagement. Conclusions: Despite improvements in transparency of the Spanish HTA process for evaluating medicines, aspects related to stakeholder involvement and implementation of deliberative frameworks need further attention in order to achieve further legitimacy of the process.
MeSH term(s)	Spain ; Technology Assessment, Biomedical ; Stakeholder Participation
Language	English
Publishing date	2023-07-05
Publishing country	England
Document type	Review ; Journal Article
ZDB-ID	632573-7
ISSN	1471-6348 ; 0266-4623
ISSN (online)	1471-6348
ISSN	0266-4623
DOI	10.1017/S0266462323000387
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Article ; Online: Unravelling risk selection in Spanish general government employee mutual funds: evidence from cancer hospitalizations in the public health network.

Pinilla, Jaime / López-Valcárcel, Beatriz G / Bernal-Delgado, Enrique

The European journal of health economics : HEPAC : health economics in prevention and care

2024

Abstract: Government employees in Spain are covered by public Mutual Funds that purchase a uniform basket of benefits, equal to the ones served to the general population, from private companies. Companies apply as private bidders for a fixed per capita premium ... ...

Abstract	Government employees in Spain are covered by public Mutual Funds that purchase a uniform basket of benefits, equal to the ones served to the general population, from private companies. Companies apply as private bidders for a fixed per capita premium hardly adjusted by age. Our hypothesis is that this premium does not cover risks, and companies have incentives for risk selection, which are more visible in high-cost patients. We focus on a particularly costly disease, cancer, whose prevalence is similar among government employees and the general population. We compare hospitalisations in the public hospitals of the government employees that have chosen public provision and the general population. We analysed a database of hospital discharges in the Valencian Community from 2010 to 2015 (3 million episodes). Using exact matching and logistic models, we find significant risk selection; thus, in hospitalised government employees, the likelihood for a solid metastatic carcinoma and non-metastatic cancer to appear in the registry is 31% higher than in the general population. Lymphoma shows the highest odds ratio of 2.64. We found quantitatively important effects. This research provides indirect evidence of risk selection within Spanish Mutual Funds for government employees, prompting action to reduce incentives for such a practice. More research is needed to figure out if what we have observed with cancer patients occurs in other conditions.
Language	English
Publishing date	2024-02-20
Publishing country	Germany
Document type	Journal Article
ZDB-ID	2045253-6
ISSN	1618-7601 ; 1618-7598
ISSN (online)	1618-7601
ISSN	1618-7598
DOI	10.1007/s10198-024-01671-5
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Article ; Online: Assisted reproduction in Spain, outcome and socioeconomic determinants of access.

Alon, Ido / Pinilla, Jaime

International journal for equity in health

2021 Volume 20, Issue 1, Page(s) 156

Abstract: Research question: We analyzed two questions. First, the effectiveness of public Assisted Reproductive Technologies (ART) in Spain compared with private ones, measured by the time since initiating ART treatment until achieving pregnancy, accounting for ... ...

Abstract	Research question: We analyzed two questions. First, the effectiveness of public Assisted Reproductive Technologies (ART) in Spain compared with private ones, measured by the time since initiating ART treatment until achieving pregnancy, accounting for age and socioeconomic factors. Second, socioeconomic determinants of access to ART, referring primarily to financial means derived by employment, income, and wealth. Design: We applied statistical models on data extracted from the national Spanish Fertility Survey from 2018. The first topic was analyzed by competing risk survival analysis conducted on a sample of 667 women who initiate ART treatment since 2000. The second, by a Bivariate Probit model conducted on a sample of 672 women older than 41 years who required ART services. Results: The first analysis raised that throughout the treatment, patients treated exclusively in private clinics had on average a higher cumulative incidence of becoming pregnant compared with patients who approached public clinics. The second analysis raised that both higher household equivalent income and higher education increase the likelihood of accessing ART in a private clinic and decrease the tendency of accessing public clinics or failing to access any service. Moreover, being single decreases the likelihood of accessing public clinics or ART services in general. Conclusions: Long waiting periods could be the main reason for the lower incidence of getting pregnant in public healthcare, explaining why patients choose private over public care. We develop a broader discussion over the extent of Spanish public funding of ART, the unequal medical outcome, and potential options for optimization.
MeSH term(s)	Female ; Health Services Accessibility/statistics & numerical data ; Humans ; Pregnancy ; Reproductive Techniques, Assisted/statistics & numerical data ; Socioeconomic Factors ; Spain ; Treatment Outcome
Language	English
Publishing date	2021-07-06
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	1475-9276
ISSN (online)	1475-9276
DOI	10.1186/s12939-021-01438-x
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Article ; Online: Assisted reproduction in Spain, outcome and socioeconomic determinants of access

Ido Alon / Jaime Pinilla

International Journal for Equity in Health, Vol 20, Iss 1, Pp 1-

2021 Volume 12

Abstract: Abstract Research question We analyzed two questions. First, the effectiveness of public Assisted Reproductive Technologies (ART) in Spain compared with private ones, measured by the time since initiating ART treatment until achieving pregnancy, ... ...

Abstract	Abstract Research question We analyzed two questions. First, the effectiveness of public Assisted Reproductive Technologies (ART) in Spain compared with private ones, measured by the time since initiating ART treatment until achieving pregnancy, accounting for age and socioeconomic factors. Second, socioeconomic determinants of access to ART, referring primarily to financial means derived by employment, income, and wealth. Design We applied statistical models on data extracted from the national Spanish Fertility Survey from 2018. The first topic was analyzed by competing risk survival analysis conducted on a sample of 667 women who initiate ART treatment since 2000. The second, by a Bivariate Probit model conducted on a sample of 672 women older than 41 years who required ART services. Results The first analysis raised that throughout the treatment, patients treated exclusively in private clinics had on average a higher cumulative incidence of becoming pregnant compared with patients who approached public clinics. The second analysis raised that both higher household equivalent income and higher education increase the likelihood of accessing ART in a private clinic and decrease the tendency of accessing public clinics or failing to access any service. Moreover, being single decreases the likelihood of accessing public clinics or ART services in general. Conclusions Long waiting periods could be the main reason for the lower incidence of getting pregnant in public healthcare, explaining why patients choose private over public care. We develop a broader discussion over the extent of Spanish public funding of ART, the unequal medical outcome, and potential options for optimization.
Keywords	Assisted reproductive technology ; Bivariate Probit ; Competing risk survival analysis ; Inequality ; Public coverage ; Socioeconomic determinants ; Public aspects of medicine ; RA1-1270
Subject code	336
Language	English
Publishing date	2021-07-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
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Article ; Online: Differences in acute ischaemic stroke in-hospital mortality across referral stroke hospitals in Spain: a retrospective, longitudinal observational study.

Estupiñán-Romero, Francisco / Pinilla Dominguez, Jaime / Bernal-Delgado, Enrique

BMJ open

2023 Volume 13, Issue 6, Page(s) e068183

Abstract: Objective: To assess differences in acute ischaemic stroke (AIS) in-hospital mortality between referral stroke hospitals and provide evidence on the association of those differences with the overtime adoption of effective reperfusion therapies.: ... ...

Abstract	Objective: To assess differences in acute ischaemic stroke (AIS) in-hospital mortality between referral stroke hospitals and provide evidence on the association of those differences with the overtime adoption of effective reperfusion therapies. Design: Retrospective, longitudinal observational study using administrative data for virtually all hospital admissions from 2003 to 2015. Setting: Thirty-seven referral stroke hospitals in the Spanish National Health System. Participants: Patients aged 18 years and older with a hospital episode with an admission diagnosis of AIS in any referral stroke hospital (196 099 admissions). MAIN ENDPOINTS: (1) Hospital variation in 30-day in-hospital mortality measured in terms of the intraclass correlation coefficient (ICC); and (2) the difference in mortality between the hospital of treatment and the trend of utilisation of reperfusion therapies (including intravenous fibrinolysis and endovascular mechanical thrombectomy) in terms of median OR (MOR). Results: Adjusted 30-day AIS in-hospital mortality decreased over the study period. Adjusted in-hospital mortality after AIS rates varied from 6.66% to 16.01% between hospitals. Beyond differences in patient characteristics, the relative contribution of the hospital of treatment was higher in the case of patients undergoing reperfusion therapies (ICC=0.031 (95% Bayesian credible interval (BCI)=0.017 to 0.057)) than in the case of those who did not (ICC=0.016 (95% BCI=0.010 to 0.026)). Using the MOR, the difference in risk of death was as high as 46% between the hospital with the highest risk and the hospital with the lowest risk of patients undergoing reperfusion therapy (MOR 1.46 (95% BCI 1.32 to 1.68)); in patients not undergoing any reperfusion therapy, the risk was 31% higher (MOR 1.31 (95% BCI 1.24 to 1.41)). Conclusions: In the referral stroke hospitals of the Spanish National Health System, the overall adjusted in-hospital mortality decreased between 2003 and 2015. However, between-hospital variations in mortality persisted.
MeSH term(s)	Humans ; Stroke/therapy ; Retrospective Studies ; Hospital Mortality ; Spain/epidemiology ; Bayes Theorem ; Brain Ischemia/therapy ; Ischemic Stroke ; Hospitals ; Referral and Consultation
Language	English
Publishing date	2023-06-28
Publishing country	England
Document type	Observational Study ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2022-068183
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Article ; Online: Differences in acute ischaemic stroke in-hospital mortality across referral stroke hospitals in Spain

Enrique Bernal-Delgado / Francisco Estupiñán-Romero / Jaime Pinilla Dominguez

BMJ Open, Vol 13, Iss

a retrospective, longitudinal observational study

2023 Volume 6

Abstract: Objective To assess differences in acute ischaemic stroke (AIS) in-hospital mortality between referral stroke hospitals and provide evidence on the association of those differences with the overtime adoption of effective reperfusion therapies.Design ... ...

Abstract	Objective To assess differences in acute ischaemic stroke (AIS) in-hospital mortality between referral stroke hospitals and provide evidence on the association of those differences with the overtime adoption of effective reperfusion therapies.Design Retrospective, longitudinal observational study using administrative data for virtually all hospital admissions from 2003 to 2015.Setting Thirty-seven referral stroke hospitals in the Spanish National Health System.Participants Patients aged 18 years and older with a hospital episode with an admission diagnosis of AIS in any referral stroke hospital (196 099 admissions).Main endpoints (1) Hospital variation in 30-day in-hospital mortality measured in terms of the intraclass correlation coefficient (ICC); and (2) the difference in mortality between the hospital of treatment and the trend of utilisation of reperfusion therapies (including intravenous fibrinolysis and endovascular mechanical thrombectomy) in terms of median OR (MOR).Results Adjusted 30-day AIS in-hospital mortality decreased over the study period. Adjusted in-hospital mortality after AIS rates varied from 6.66% to 16.01% between hospitals. Beyond differences in patient characteristics, the relative contribution of the hospital of treatment was higher in the case of patients undergoing reperfusion therapies (ICC=0.031 (95% Bayesian credible interval (BCI)=0.017 to 0.057)) than in the case of those who did not (ICC=0.016 (95% BCI=0.010 to 0.026)). Using the MOR, the difference in risk of death was as high as 46% between the hospital with the highest risk and the hospital with the lowest risk of patients undergoing reperfusion therapy (MOR 1.46 (95% BCI 1.32 to 1.68)); in patients not undergoing any reperfusion therapy, the risk was 31% higher (MOR 1.31 (95% BCI 1.24 to 1.41)).Conclusions In the referral stroke hospitals of the Spanish National Health System, the overall adjusted in-hospital mortality decreased between 2003 and 2015. However, between-hospital variations in mortality persisted.
Keywords	Medicine ; R
Subject code	360
Language	English
Publishing date	2023-06-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Free prescriptions for low-income pensioners? The cost of returning to free-of-charge drugs in the Spanish National Health Service.

Puig-Junoy, Jaume / Pinilla, Jaime

Health economics

2020 Volume 29, Issue 12, Page(s) 1804–1812

Abstract: This study estimated the impact of reducing a capped low coinsurance rate for outpatient medicines to nil for low-income pensioners and disabled individuals in the Valencian Community (Spain). This reduction was implemented in January 2016 as a regional ... ...

Abstract	This study estimated the impact of reducing a capped low coinsurance rate for outpatient medicines to nil for low-income pensioners and disabled individuals in the Valencian Community (Spain). This reduction was implemented in January 2016 as a regional reform which modified the national cost-sharing reform adopted in July 2012. The impact of this intervention on the number of monthly prescriptions dispensed between July 2012 and December 2018 was estimated using two different approaches of the synthetic control method, the classical method and the method based on Bayesian structural time series. The estimates from both methods were similar, showing significant overall increases of 6.34% and 6.70% [95% credible interval: 4.05, 9.47], respectively in the number of prescriptions dispensed in this region. These results are similar to those of the previous studies indicating that reducing price from a small amount to zero discontinuously boosts demand. This evidence indicates that the impact of this intervention on the budget of the regional health service is far greater than the amount of the subsidy in the public budget. These results are useful for making accurate budgetary projections for similar eliminations of charges for low-income pensioners in the Spanish National Health Service.
MeSH term(s)	Bayes Theorem ; Drug Costs ; Humans ; Pharmaceutical Preparations ; Prescriptions ; State Medicine
Chemical Substances	Pharmaceutical Preparations
Language	English
Publishing date	2020-09-15
Publishing country	England
Document type	Journal Article
ZDB-ID	1135838-5
ISSN	1099-1050 ; 1057-9230
ISSN (online)	1099-1050
ISSN	1057-9230
DOI	10.1002/hec.4161
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Article ; Online: Corrigendum

Andres Pinilla / Jan-Niklas Voigt-Antons / Jaime Garcia / William Raffe / Sebastian Möller

Frontiers in Virtual Reality, Vol

Real-time affect detection in virtual reality: A technique based on a three-dimensional model of affect and EEG signals

2023 Volume 4

Keywords	affect detection ; electroencephalography ; virtual reality ; emotion ; affective computing ; supervised leaning ; Electronic computers. Computer science ; QA75.5-76.95
Language	English
Publishing date	2023-04-01T00:00:00Z
Publisher	Frontiers Media S.A.
Document type	Article ; Online
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Article ; Online: Real-time affect detection in virtual reality

Andres Pinilla / Jan-Niklas Voigt-Antons / Jaime Garcia / William Raffe / Sebastian Möller

Frontiers in Virtual Reality, Vol

a technique based on a three-dimensional model of affect and EEG signals

2023 Volume 3

Abstract: This manuscript explores the development of a technique for detecting the affective states of Virtual Reality (VR) users in real-time. The technique was tested with data from an experiment where 18 participants observed 16 videos with emotional content ... ...

Abstract	This manuscript explores the development of a technique for detecting the affective states of Virtual Reality (VR) users in real-time. The technique was tested with data from an experiment where 18 participants observed 16 videos with emotional content inside a VR home theater, while their electroencephalography (EEG) signals were recorded. Participants evaluated their affective response toward the videos in terms of a three-dimensional model of affect. Two variants of the technique were analyzed. The difference between both variants was the method used for feature selection. In the first variant, features extracted from the EEG signals were selected using Linear Mixed-Effects (LME) models. In the second variant, features were selected using Recursive Feature Elimination with Cross Validation (RFECV). Random forest was used in both variants to build the classification models. Accuracy, precision, recall and F1 scores were obtained by cross-validation. An ANOVA was conducted to compare the accuracy of the models built in each variant. The results indicate that the feature selection method does not have a significant effect on the accuracy of the classification models. Therefore, both variations (LME and RFECV) seem equally reliable for detecting affective states of VR users. The mean accuracy of the classification models was between 87% and 93%.
Keywords	affect detection ; electroencephalography ; virtual reality ; emotion ; affective computing ; supervised learning ; Electronic computers. Computer science ; QA75.5-76.95
Subject code	150
Language	English
Publishing date	2023-01-01T00:00:00Z
Publisher	Frontiers Media S.A.
Document type	Article ; Online
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Article ; Online: The Evolution of Mental Health in the Context of Transitory Economic Changes.

Stoyanova, Alexandrina / Pinilla, Jaime

Applied health economics and health policy

2019 Volume 18, Issue 2, Page(s) 203–221

Abstract: Background: Mental health disorders are highly prevalent across countries. They increase over time and impose a severe burden on individuals and societies.: Objective: This paper examines the evolution of mental health over a period of 15 years, ... ...

Abstract	Background: Mental health disorders are highly prevalent across countries. They increase over time and impose a severe burden on individuals and societies. Objective: This paper examines the evolution of mental health over a period of 15 years, paying special attention on the impact of the most recent economic downturn and subsequent recovery, in Spain. Method: We use data coming from the National Health Surveys of 2006/2007, 2011/2012 and 2016/2017. Mental health is proxied by two measures, doctor-diagnosed mental disorder and psychological distress (based on the 12-item General Health Questionnaire). To account for the relationship between the two mental health indicators, we estimate a bivariate probit model. The potential endogeneity of unemployment status is considered. Results: We observe different patterns of the two mental health indicators over time. Psychological distress in men increased during recession years, but slightly decreased among women. Diagnosed mental disorders declined during the peak years of the crisis. Unemployment is a major risk factor for mental distress. Irrespective of the economic conditions, belonging to a higher social class acts as a buffer against psychological distress for women, but not for men. The remaining determinants acted as expected. Women declared worse psychological health than men, and were also more often diagnosed with mental disorders. Having a partner had a protective impact, while providing intensive care to a dependent relative exerted the opposite effect. Education acted as buffer against the onset of psychological distress in women. Conclusion: Even though the need for mental healthcare increased during the recession, the fact that fewer people were diagnosed suggests that barriers to accessing mental healthcare may be aggravated during the crisis. Policies aiming to tackle the challenges posed by the high prevalence of mental disorders have to be particularly attentive to changes in individuals' socioeconomic situation, including education, unemployment and social class.
MeSH term(s)	Economic Recession ; Female ; Health Surveys ; Humans ; Male ; Mental Disorders/epidemiology ; Mental Health/trends ; Spain/epidemiology ; Stress, Psychological/epidemiology ; Unemployment
Language	English
Publishing date	2019-11-25
Publishing country	New Zealand
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2171420-4
ISSN	1179-1896 ; 1175-5652
ISSN (online)	1179-1896
ISSN	1175-5652
DOI	10.1007/s40258-019-00537-9
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