A J Jovell

Autonomous University of Barcelona, Cerdanyola del Vallès, Catalonia, Spain

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Publications (18)32.77 Total impact

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    ABSTRACT: Objectives: The objectives of the study were to identify the current standards of clinical practice regarding prostate cancer screening in western Europe, Canada, and the United States, and to highlight major characteristics of current prostate cancer screening programs or patterns of practice.
    International Journal of Technology Assessment in Health Care 03/2001; 17(02):215 - 221. · 1.55 Impact Factor
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    A García-Altés, A J Jovell
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    ABSTRACT: The objective of this paper is to introduce the methodology of economic analysis in health care, and its application to the measurement of the efficiency analysis of prostate cancer treatment. We presented the methodology of economic analysis. To review its application in prostate cancer treatment, we performed a bibliographic search in the main biomedical databases (February 1988-January 2001) to identify economic evaluation studies that compared both costs and effects of prostate cancer treatments. The lack of economic studies for localized prostate cancer and the diversity of treatments for advanced prostate cancer make it difficult to make comparisons across studies and to make therapeutic recommendations.Prostate Cancer and Prostatic Diseases (2001) 4, 217-220.
    Prostate cancer and prostatic diseases 02/2001; 4(4):217-220. · 2.10 Impact Factor
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    ABSTRACT: The objectives of the study were to identify the current standards of clinical practice regarding prostate cancer screening in western Europe, Canada, and the United States, and to highlight major characteristics of current prostate cancer screening programs or patterns of practice. We performed a semi-structured interview by means of a self-administered questionnaire sent by fax to 26 institutes pertaining to the International Network of Agencies for Health Technology Assessment. None of the countries surveyed had a formal national screening policy. Despite that, all the countries answering the questionnaire had discretionary, public-financed screening practices. Moreover, some scientific and professional organizations recommended population screening for prostate cancer, and few of the surveyed countries offered it as experimental practice within a randomized controlled trial. Survey results showed variation regarding screening policies, in particular test of choice, age cut-off points, and treatment prescribed for positive test results. Despite the lack of conclusive evidence on the benefits of prostate cancer screening, the availability of simple and easy-to-administer tests has lead to an enormous variation on screening policies around the world. Practice variations also affect prostate cancer therapy.
    International Journal of Technology Assessment in Health Care 02/2001; 17(2):215-21. · 1.55 Impact Factor
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    ABSTRACT: Empirical eradication therapy of H. pylori has been proposed as a therapeutic alternative for duodenal ulcer. To identify the cost-effectiveness of empirical eradication therapy vs. test-and-treatment for the management of patients already diagnosed with a duodenal ulcer. A decision analysis was performed to compare the cost-effectiveness of empirical eradication therapy of H. pylori diagnosed duodenal ulcer vs. eradication therapy after confirmatory diagnosis of Helicobacter pylori infection by means of several diagnostic tests. The empirical eradication therapy of duodenal ulcer was found to be the most effective and cost-effective strategy of all the alternatives. Amongst the alternatives, which included the previous performance of confirmatory diagnostic tests, the best cost-effectiveness ratio used a serology test. The model was robust in the face of changes in the values of therapeutic effectiveness, sensitivity and specificity of the diagnostic tests, prevalence of H. pylori infection in duodenal ulcer, duration of the antisecretory therapy, and number of medical visits. Based on our cost-effectiveness analysis, a treat approach is more effective and cost-effective than a test-and-treat approach in the clinical management of already diagnosed duodenal ulcer.
    Alimentary Pharmacology & Therapeutics 01/2001; 14(12):1631-8. · 4.55 Impact Factor
  • A García-Altés, A J Jovell
    Atención Primaria 10/2000; 26(5):333-8. · 0.96 Impact Factor
  • Pedro Gallo, Albert J. Jovell
    01/2000;
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    ABSTRACT: A review of the cost-effectiveness literature indicated that the hydroxymethylglutaryl coenzyme A-reductase inhibitor fluvastatin is more cost-effective for achieving minor-to-moderate reductions in low-density lipoprotein cholesterol (LDL-C) levels than 3 other statins: lovastatin, pravastatin, and simvastatin. The main goal of this study was to verify the applicability of these conclusions to Spanish health care costs and patterns of resource consumption related to the treatment of hypercholesterolemia. A stochastic simulation model was used to predict both the costs and effects of treating high-risk hypercholesterolemic patients with fluvastatin, lovastatin, pravastatin, or simvastatin. Epidemiologic data were used to find a suitable theoretic probability distribution model for baseline LDL-C values in high-risk hypercholesterolemic patients. The model was then used to generate 10,000 random observations of baseline LDL-C values; the corresponding LDL-C values after a 2-year treatment period were predicted as a function of the baseline value and the percentage reduction expected with a particular statin and dose, according to the results obtained in 2 meta-analyses. The probability of treatment discontinuation was also taken into account using estimates obtained in usual practice. The effects of treatment were expressed as the rate of success in achieving the goal level of LDL-C, as defined in the current Spanish recommendations for the treatment of hypercholesterolemia. The average costs of treatment were computed from both the social and public-financing perspectives, including the cost of lipid-lowering drugs, physician visits, laboratory tests, and days off work, as appropriate. The occurrence of nonscheduled visits and workdays lost because of side effects were taken into account to compute indirect costs relevant to the social perspective. The potential costs of treating side effects were ignored. A cost-effectiveness analysis was performed to compare the cost-effectiveness ratios obtained with each of the 4 statins considered in this study. Model-based predictions of the effects, total costs, and cost-effectiveness ratios were made. Cost-effectiveness ratios were interpreted as the cost per patient meeting the goal of therapy, according to current Spanish recommendations. The data showed that fluvastatin had the lowest cost-effectiveness ratios when LDL-C levels required reduction to < or =25% of baseline levels. In this situation, fluvastatin was more cost-effective than lovastatin, pravastatin, or simvastatin from public-financing and social perspectives.
    Clinical Therapeutics 12/1999; 21(11):1924-36. · 2.23 Impact Factor
  • M Serra-Prat, A J Jovell, M Aymerich
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    ABSTRACT: The role of thrombolytic agents in the treatment of pulmonary thromboembolism (PTE) remains a controversial issue. The objective of this study is to assess the efficacy and safety of thrombolytic therapy in the treatment of PTE by means of a meta-analysis of randomized controlled trials (RCT). A bibliographic search of the main biomedical bibliographic databases was carried out and eight randomized controlled trials that fulfilled the inclusion criteria were found. Two blinded and independent evaluators assessed the quality of RCT according to Jadad scale, and selected the necessary data to fulfill the objective of this study. The selected trials were heterogeneous regarding the type of thrombolytic agent, the administration schedule, and the efficacy measures used. The methodological quality was 2 points in the Jadad scale as an average. No statistically significant differences in mortality nor in risk of PTE relapse were found between the group of patients receiving thrombolytic agents and the group not receiving them. Significant differences were found, however, between these two groups as regards the risk of bleeding events (OR = 2.62; CI 95%: 1.56-4.38). The results of these meta-analyses do not suggest the use of thrombolytic therapy in PTE in everyday clinical practice since measurable risks overcome potential benefits.
    Medicina Clínica 06/1999; 112(18):685-9. · 1.40 Impact Factor
  • Medicina Clínica 05/1999; 112(14):553-5. · 1.40 Impact Factor
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    ABSTRACT: The re-emergence of bacterial diseases and their negative consequences in terms of health and economic cost, have made this issue an important public health problem. The objective of this work is to review the economic literature about antibiotic resistance, and to suggest possible solutions in our health care context aimed to reduce their negative impact. We made a bibliographic search in the main biomedical databases. Economic assessment studies published in Spanish, English, French or Italian and related to the appearance of antibiotic resistance were selected. Their main methodological characteristics and results were analysed. Two studies analysing the economic impact of the appearance of antibiotic resistance were identified. A minimum hospital cost of 1300 million dollars (in 1992), and a social cost between 100 and 30,000 million dollars (in 1989) were estimated. Economic analysis allows to quantify and assess the impact of several management strategies in relation with antibiotic administration, in terms of health and costs, and to choose the most cost-effective strategies. The identification of inappropriate consumption of antibiotics as a cause of a negative externality upon the rest of the society is basic to make health care professionals and public opinion conscious about this problem, and to develop strategies to reduce its negative impact.
    Enfermedades Infecciosas y Microbiología Clínica 02/1999; 17 Suppl 2:27-31. · 1.48 Impact Factor
  • Jovell AJ, Aymerich M
    01/1999; Acadèmia de Ciències Mèdiques de Catalunya i de Balears.
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    American Journal of Public Health 01/1999; 89(1):111-112. · 3.93 Impact Factor
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    Agència d'Avaluació de Tecnologia Mèdica. Servei Català de la Salut. Departament de Sanitat i Seguretat Social. Generalitat de Catalunya. 09/1998;
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    ABSTRACT: This paper presents the results of different screening policies for prenatal detection of Down syndrome that would allow decision makers to make informed choices. A decision analysis model was built to compare 8 screening policies with regard to a selected set of outcome measures. Probabilities used in the analysis were obtained from official administrative data reports in Spain and Catalonia and from data published in the medical literature. Sensitivity analyses were carried out to test the robustness of screening policies' results to changes in uptake rates, diagnostic accuracy, and resources consumed. Selected screening policies posed major trades-offs regarding detection rates, false-positive results, fetal loss, and costs of the programs. All outcome measures considered were found quite robust to changes in uptake rates. Sensitivity and specificity rates of screening tests were shown to be the most influential factors in the outcome measures considered. The disclosed trade-offs emphasize the need to comprehensively inform decision makers about both positive and negative consequences of adopting one screening policy or another.
    American Journal of Public Health 04/1998; 88(4):551-7. · 3.93 Impact Factor
  • Atención Primaria 10/1997; 20(5):259-62, 264-6. · 0.96 Impact Factor
  • A J Jovell, M D Navarro-Rubio
    Medicina Clínica 03/1996; 106(7):278-9. · 1.40 Impact Factor
  • A J Jovell, M D Navarro-Rubio
    Medicina Clínica 12/1995; 105(19):740-3. · 1.40 Impact Factor
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    ABSTRACT: National health systems are intended to provide equal access to health-care services to whole populations. However, they do not seem to address successfully the problem of social class differentials in access to health care, in particular access to preventive care. This study examines the relationship between the socioeconomic status (SES) of families and the use of preventive health care by children under a national health system in Spain. The study is based on weighted multivariate ordinal logistic regression analyses of data from the 1987 Spanish National Health Survey for a sample of 5,622 children, one to 10 years of age. A positive relationship was found between preventive health-care use by children and the SES of their families. Adult respondents' level of education and total family income were the most influential variables in this relationship. As these increased, children were more likely to receive visual, hearing, and dental exams. In addition, there was a gradient effect between family income and rate at which children received these preventive health-care services. Universal access to care, like that available in Spain, does not guarantee that social inequalities in children's receipt of preventive health care will not persist. In order to succeed, health-care reform must deal with social issues beyond financial access to care.
    American Journal of Preventive Medicine 01/1995; 11(4):256-62. · 3.95 Impact Factor