There is a need for an effective nutrition policy promoting healthy nutrition in accordance with the ongoing dietary guidelines.

(*) Tanto el desarrollo como la elaboración del modelo ha sido financiado por una beca no finalista otorgada por Medtronic Ibérica S.A. a CORE Research, quien ha llevado a cabo los análisis en todo momento y con total autonomía. RESUMENFundamento: El uso de bombas de infusión continua de insulina (BICI) para la diabetes mellitus tipo 1 (DM1) se ha relacionado con un mejor control metabólico al compararlo con las múltiples dosis de insulina (MDI). Este mejor control puede traducirse en una disminución de las complicaciones asociadas a la DM1 y por lo tanto una reducción de los costes asociados. Sin embargo el uso de esta terapia ha quedado mermado, al menos en parte, debido a su mayor coste inicial de adquisición. El objetivo del presente estudio fue estimar las consecuencias clínicas y económicas del uso de BICI frente a MDI a través de un análisis de coste-utilidad.Métodos: Se adaptó un modelo matemático de simulación que emplea datos clínicos y económicos de ámbito nacional, para simular las consecuencias clínicas y económicas a largo plazo de un paciente con DM1. El horizonte temporal fue el de toda la vida del paciente, incluyendo sólo costes directos sanitarios, y actualizando tanto costes como beneficios a una tasa del 3% anual.Resultados: En el caso base los pacientes tratados con BICI experimentaron una ganancia de vida de 0,890 años (p<0,05) y 0,852 AVACs (p<0,05). El tratamiento con BICI produce un coste medio incremental de 25.523 ? (p<0,05) por paciente tratado, lo que nos condujo a un ratio coste-utilidad incremental de 29.947 ?/AVAC [IC 95% (29.519, 30.375)].Conclusiones: La mejora en el control glucémico en pacientes con BICI se asoció a una reducción del coste global del manejo de pacientes con DM1, y resultó tener una relación coste-utilidad favorable al compararla con el tratamiento convencional MDI.Palabras clave: Diabetes mellitus Tipo 1. Coste-utilidad. Bombas de insulina. Modelo Económico. ABSTRACT Cost-Utility Analysis of Iinsulin Pumps Compared to Multiple Daily doses of Insulin in Patients with Type 1 Diabetes Mellitus in SpainBackground: The use of continuous subcutaneous insulin infusion (CSII) for treating Type I diabetes mellitus (DM1) has been related to better metabolic control compared it to daily multiple insulin injections (DMI) and thus to a lowering of the related costs. However, this therapy is now being used to a lesser extent due, at least partially, to the higher initial cost of purchase. This study is aimed at estimating the clinical and economic consequences of using CSII as compared to DMI by means of a cost-utility analysis.

BackgroundIn adults, as little as 10 minutes of moderate physical activity (PA) three times a day can help prevent non-communicable diseases and prolong life expectancy. The aim of the study was to evaluate the process and impact of scaling up a complex intervention (PAFES) implemented in Catalonia, aimed to increase the proportion of adults complying with PA recommendations (especially those with cardiovascular risk factors).MethodsThe intervention, piloted in 2005, had three elements: 1) establishing clinical guidelines for PA; 2) identifying local PA resources; 3) PA screening and advice in primary health care (PHC) settings, based on stage of change. Central and local level implementation activities included training, support to municipalities, dissemination through a web page, and promotion of World Physical Activity Day (WPAD). Evaluation followed the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance), identifying 3-6 variables for annual evaluation of each dimension. These included coverage of PA screening and advice and individuals with access to a healthy exercise route (Reach), increased PA level between 2006 and 2010-15 (Effectiveness), PAFES adoption by PHC centres and municipalities (Adoption), process evaluation data (Implementation), and cost (Maintenance).ResultsPHC screening coverage increased from 14.4% (2008) to 69.6% (2015) and advice coverage from 8.3% (2012) to 35.6% (2015). In 2015, 82.5% patients had access to a “healthy route” (Reach). The proportion of patients with at least one cardiovascular risk factor who were “sufficiently active” increased from 2006 to 2010-2013 (Effectiveness). By 2015, PAFES was applied by all PHC teams, 8.3% municipalities and 22.7% PHC centres had organized WPAD events (Adoption). The Plan showed good penetration in all health regions by 2013, with relatively low use of resources and estimated cost (Implementation). By 2013 the Plan was embedded within the health system (Maintenance).ConclusionsIn the first application of the RE-AIM framework to evaluate the scaling-up of a PA plan, PAFES showed good results for most RE-AIM indicators. Changes in priority and investment in health promotion programs affect reach, adoption, and effectiveness. It is important to maintain support until programs are strongly embedded into the health system.