BackgroundIt is well documented that obesity is strongly associated with mortality and morbidity, but less is known about its impact on functional status and health-related quality of life (HRQOL). The purpose of this study was to calculate the impact of the Body Mass Index (BMI) on the HRQOL of the Spanish adult population, with special emphasis on BMI ≥ 35.MethodsWe used the Spanish National Health Survey (SNHS) 2011–2012 to assess the statistical association between HRQOL, measured through the EuroQol-5D-5L questionnaire, and the BMI. We conducted linear regression analysis for the EuroQol-5D-5L Visual Analogue Scale (VAS) and probit regressions for each of the five dimensions of the EuroQol-5D-5L.ResultsSelf-perceived problems in the five dimensions of the EuroQol-5D-5L increased along the BMI, especially in the mobility and pain/discomfort dimensions. Having a BMI ≥ 35 reduced HRQOL even in the absence of chronic diseases. After controlling for comorbidities, severe obesity decreased the VAS score by an average of 1.9 points and increased the probability of reporting any HRQOL problem in mobility (11.8%), self-care (2.2%), usual activities (4.3%) and pain/discomfort (7.4%). No association was found between obesity and mental problems. All the parameters analysed suggest that HRQOL in women and people aged 65 years and over was significantly worse than average.ConclusionsBMI is an explanatory factor of self-perceived quality of life. Obesity is associated with a worse HRQOL, especially in women and people aged over 64 years. These results may be useful for designing prevention or treatment health policies to target obesity among the Spanish population.

ObjectiveChronic obstructive pulmonary disease (COPD) is a very prevalent and invalidating disease. The aim of this study was to analyze the burden borne by informal caregivers of patients with COPD.MethodsWe used the Survey on Disabilities, Personal Autonomy, and Dependency Situations (Encuesta sobre Discapacidad, Autonomía personal y Situaciones de Dependencia [EDAD]-2008) to obtain information on the characteristics of disabled individuals with COPD and their caregivers in Spain. Additionally, statistical multivariate analyses were performed to analyze the impact that an increase in dependence would have on the problems for which caregivers provide support, in terms of health, professional, and leisure/social dimensions.ResultsA total of 461,884 individuals with one or more disabilities and with COPD were identified, and 220,892 informal caregivers were estimated. Results showed that 35% of informal caregivers had health-related problems due to the caregiving provided; 83% had leisure/social-related problems; and among caregivers of working age, 38% recognized having profession-related problems. The probability of a problem arising was significantly associated with the degree of dependence of the patient receiving care. Caregivers of patients with great dependence showed a 39% higher probability of presenting health-related problems, 27% more professional problems, and 23% more leisure problems compared with those with nondependent patients.ConclusionThe results show the large impact on society in terms of the welfare of informal caregivers of patients with COPD. A higher level of dependence was associated with more severe problems in caregivers, in all dimensions.

BackgroundThe number of papers on the health related quality of life of patients with DM has grown in recent years but fewer studies have drawn comparisons between diabetic persons and the general population considering different risk groups. The aim of this study is to examine health related quality of life (HRQOL) in people with diabetes mellitus (DM) and to analyze the differences in HRQOL adjusting by vascular risk.MethodsThe data used in this analysis was obtained from the responses of 15,926 individuals who participated in the 2006 Catalonia Health Survey. Our analysis provides a number of multivariate statistical models designed for studying HRQOL, based on the EQ-5D questionnaire, controlling for demographic factors of survey participants and variables that identify diagnosed illnesses and health problems.ResultsOur findings suggest there is a significant, moderate negative relationship between DM and HRQOL in comparison with non diabetic people (absolute value of the coefficient ranges between −0.04 and −0.054 points on a scale of 1). A further analysis of subgroups reveals that diabetics who have not had vascular risk factors neither vascular diseases do not have a diminished HRQOL when compared to the non-diabetic population in general, when other factors are controlled for. In contrast, a comparison of diabetics and non-diabetics who exhibit vascular disease or risk factors for vascular disease reveals HRQOL is significantly diminished to a greater extent for those with diabetes (between 0.152 and 0.175 points loss when comparing a non-diabetic person with a diabetic with vascular disease). Also, HRQOL in diabetic patients who have additional risk factors or a vascular disease are lower than people non-diabetic who have additional risk factors or a vascular disease. When we focus our analysis to the EQ-5D dimensions, we observe that diabetic persons who are neither at risk for nor have a diagnosed vascular disease are no more likely than non-diabetics to report problems. However, diabetic patients who have additional risk factors for vascular disease or a diagnosed vascular disease are significantly more likely to report moderated or severe problems in 4 of the 5 dimensions of EQ-5D.ConclusionsThe HRQOL of a person who has diabetes is not necessarily lower than for a non-diabetic. Control of risk factors associated to vascular diseases is a key factor for an enhanced quality of life. Vascular disease or risk factors for vascular disease, on the other hand, are associated with a significantly diminished quality of life for diabetic persons.

For medicines with different valued indications (uses), multi-indication pricing implies charging different prices for different uses. In this article, we assess how multi-indication pricing could help achieve overall strategic objectives of pricing controls, summarise its advantages and disadvantages (vs. uniform pricing) and estimate the hypothetical impact on prices of moving towards multi-indication pricing for specific oncologic medicines in Spain. International experience shows that multi-indication pricing can be implemented in real practice, and indeed a few initiatives are currently in use, albeit mostly applied indirectly through confidential pricing agreements that offer a way to discriminate prices across countries without altering list prices. However, some more sophisticated systems are in place in Italy, and more recently in Spain, where the objective is to monitor usage per patient/indication, and ultimately pay for outcomes. Based on the existing experience, we also outline six conditions required for multi-indication pricing. Multi-indication pricing is a useful tool to determine the relative prices of a drug for multiple (different-valued) indications, but by itself will not offer the 'solution' to what the absolute price should be. That will be driven, among other things, by cost-effectiveness thresholds, if they exist. Overall, we argue multi-indication pricing is nice in theory and it could work in practice, although changes in the manner in which medicines are priced, procured and monitored in clinical practice need to be applied.