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.

Severe obesity significantly increases healthcare resource utilisation in Spain. The results shed light on the real magnitude of the burden of obesity in Spain.

OBJECTIVES:The FAME Study is an international multicenter randomized clinical trial (nϭ1,005), which proved a significant improvement in health outcomes for patients undergoing multivessel percutaneous coronary intervention (PCI) guided by fractional flow reserve (FFR) measurement compared to PCI guided by angiography alone (ANGIO). The objective of this study is to estimate the impact of FFRguided PCI on public health and on healthcare budget in France and Belgium and to compare these results with those of other European countries. METHODS: We used original patient-level data of the FAME Study (Tonino et al., NEJM 2009) to estimate health effects for France and Belgium. Utilities were measured with EQ-5D using French (time trade-off based) and Belgian Torrance transformed (visual analogue scale based) weights. Costs were based on French and Belgian prices and DRG catalogues. The size of the population eligible for the intervention was taken from national PCI registries to calculate number of major adverse cardiac events (MACE) avoided, quality-adjusted life years (QALYs) gained, and cost savings during a 2-year budget period (2011-2012) from the payer's perspective. We estimated ranges based on best and worst case scenarios regarding benefits, costs and FFR uptake. RESULTS: For both countries, FFR led to more QALYs, less MACE and lower costs under different scenarios within 2-year time horizon. The public health impact of implementing FFR-guided PCI ranged from 6 to 44 QALYs gained in France and 12 to 234 in Belgium. MACEs avoided ranged from 284 to 2108 and from 23 to 467, respectively. Cost savings ranged from 4.8 to 28.9 and from 0.43 to 7.7 million EUR, respectively. CONCLUSIONS: Our impact study shows that FFR-guided PCI in patients with multivessel coronary disease is dominant and leads to considerably reduced numbers of MACE, more QALYs and substantial cost savings in the French and Belgian health care systems.

in pre-pubertal children with idiopathic GH Deficiency (GHD) and Turner Syndrome (TS). The long-term prediction of height was validated in new cohorts of pre-pubertal children with GHD (nϭ 664) or TS (nϭ607) from KIGS. RESULTS: When height was simulated from GH start in GHD, the predicted mean (SD) gain after 4 years was 30.4 (3.4) cm; the observed height gain was 30.0 (5.0) cm. In TS the corresponding predicted and observed mean gains were 27.2 (2.2) and 26.5 (3.8) cm. CONCLUSIONS: Sequential application of annual KIGS growth prediction models permits accurate simulation of height development during the first four years of GH treatment in GHD and TS and is applicable for patient groups from GH start. Long-term growth simulation helps managing patient's expectations and facilitates an individualised, cost effective growth hormone (GH) therapy in children.

patients in terms of length of stay during the GFP, intrahospital complications and follow-up outcomes (readmission and mortality). In order to standardize costing estimation, we established base cases of healthcare resource utilization for hospitalization and complications. We then estimated their costs based on drug and procedures local official sources. We then estimated the hospitalization-and complication-related costs during the GFP implementation. Results: The 2 institutions included a total of 475 patients during up to 5 year of GFP implementation. Most patients were women over 75 years of age. Both institutions evidenced increased number of patients over the years of GFP implementation. Total length of stay was consistently lower when comparing the base year to the most recent year in GFP (between-12.8 and-35.8 hours), mostly attributed to reductions in postsurgical stay. Total inpatient complications were also reduced. Follow-up outcomes showed a relative reduction tendency in total rehospitalization proportion (between-14.3% and-51.7%) and 1-year-mortality (between-55.3% to-56.9%). Estimated hospitalization-and complication-related cost-per-patient also showed potential reductions between COP-196,680 and-3,101,929. Conclusions: Both institutions showed tendencies in reductions of length of stay, complications, rehospitalization, mortality and estimated costs during the initial years of GFP implementation. These results are consistent with previously published results of another institution in Colombia, reinforcing the possibility of replicating the experience.