Original article
Consumption trends for specific drugs used to treat dementia in the region of Madrid (Spain) from 2002 to 2012
Evolución del consumo de fármacos específicos para la demencia en la comunidad autónoma de Madrid durante el periodo 2002-2012
M.C. de Hoyos-Alonsoa,
, E. Tapias-Merinob, C.M. Meseguer Barrosc, M. Sánchez-Martínezd, A. Oterod
Corresponding author
a Servicio Madrileño de Salud, Centro de Salud Pedro Laín Entralgo, Alcorcón, Madrid, Spain
b Servicio Madrileño de Salud, Centro de Salud Comillas, Área Centro, Madrid, Spain
c Servicio Madrileño de Salud, Subdirección General de Compras de Farmacia y Productos Sanitarios, Consejería de Sanidad, Comunidad de Madrid, Spain
d Departamento de Medicina Preventiva y Salud Pu¿blica, Universidad Auto¿noma de Madrid, Madrid, Spain
Read
4225
Timeswas read the article
1031
Total PDF
3194
Total HTML
Share statistics
array:25 [ "pii" => "S2173580815001042" "issn" => "21735808" "doi" => "10.1016/j.nrleng.2014.02.005" "estado" => "S300" "fechaPublicacion" => "2015-09-01" "aid" => "611" "copyright" => "Sociedad Española de Neurología" "copyrightAnyo" => "2013" "documento" => "article" "crossmark" => 1 "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Neurologia. 2015;30:416-24" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2004 "formatos" => array:3 [ "EPUB" => 69 "HTML" => 1483 "PDF" => 452 ] ] "Traduccion" => array:1 [ "es" => array:20 [ "pii" => "S0213485314000346" "issn" => "02134853" "doi" => "10.1016/j.nrl.2014.02.007" "estado" => "S300" "fechaPublicacion" => "2015-09-01" "aid" => "611" "copyright" => "Sociedad Española de Neurología" "documento" => "article" "crossmark" => 1 "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Neurologia. 2015;30:416-24" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3262 "formatos" => array:3 [ "EPUB" => 68 "HTML" => 2697 "PDF" => 497 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original</span>" "titulo" => "Evolución del consumo de fármacos específicos para la demencia en la comunidad autónoma de Madrid durante el periodo 2002-2012" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "416" "paginaFinal" => "424" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Consumption trends for specific drugs used to treat dementia in the region of Madrid (Spain) from 2002 to 2012" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 943 "Ancho" => 1657 "Tamanyo" => 101499 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Evolución del consumo de fármacos específicos para la demencia (anticolinesterásicos y memantina) en la comunidad autónoma de Madrid del 2002 al 2012, en dosis diarias definidas.</p> <p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">DDD: dosis diarias definidas.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.C. de Hoyos-Alonso, E. Tapias-Merino, C.M. Meseguer Barros, M. Sánchez-Martínez, A. Otero" "autores" => array:5 [ 0 => array:2 [ "nombre" => "M.C." "apellidos" => "de Hoyos-Alonso" ] 1 => array:2 [ "nombre" => "E." "apellidos" => "Tapias-Merino" ] 2 => array:2 [ "nombre" => "C.M." "apellidos" => "Meseguer Barros" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Sánchez-Martínez" ] 4 => array:2 [ "nombre" => "A." "apellidos" => "Otero" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173580815001042" "doi" => "10.1016/j.nrleng.2014.02.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580815001042?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213485314000346?idApp=UINPBA00004N" "url" => "/02134853/0000003000000007/v1_201509041157/S0213485314000346/v1_201509041157/es/main.assets" ] ] "itemSiguiente" => array:20 [ "pii" => "S2173580815001030" "issn" => "21735808" "doi" => "10.1016/j.nrleng.2013.12.017" "estado" => "S300" "fechaPublicacion" => "2015-09-01" "aid" => "601" "copyright" => "Sociedad Española de Neurología" "documento" => "article" "crossmark" => 1 "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Neurologia. 2015;30:425-32" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 4319 "formatos" => array:3 [ "EPUB" => 101 "HTML" => 3198 "PDF" => 1020 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Effectiveness of equine therapy in children with psychomotor impairment" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "425" "paginaFinal" => "432" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Efectividad de la terapia ecuestre en niños con retraso psicomotor" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2151 "Ancho" => 2206 "Tamanyo" => 233487 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Participants’ chronological ages vs psychomotor developmental age assessed with the Picq and Vayer test.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "O. del Rosario-Montejo, F. Molina-Rueda, S. Muñoz-Lasa, I.M. Alguacil-Diego" "autores" => array:4 [ 0 => array:2 [ "nombre" => "O." "apellidos" => "del Rosario-Montejo" ] 1 => array:2 [ "nombre" => "F." "apellidos" => "Molina-Rueda" ] 2 => array:2 [ "nombre" => "S." "apellidos" => "Muñoz-Lasa" ] 3 => array:2 [ "nombre" => "I.M." "apellidos" => "Alguacil-Diego" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0213485314000206" "doi" => "10.1016/j.nrl.2013.12.023" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213485314000206?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580815001030?idApp=UINPBA00004N" "url" => "/21735808/0000003000000007/v1_201508210125/S2173580815001030/v1_201508210125/en/main.assets" ] "itemAnterior" => array:20 [ "pii" => "S2173580815001054" "issn" => "21735808" "doi" => "10.1016/j.nrleng.2014.03.003" "estado" => "S300" "fechaPublicacion" => "2015-09-01" "aid" => "614" "copyright" => "Sociedad Española de Neurología" "documento" => "article" "crossmark" => 1 "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Neurologia. 2015;30:407-15" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2017 "formatos" => array:3 [ "EPUB" => 88 "HTML" => 1537 "PDF" => 392 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Effects on locomotion and memory in 2 models of cerebral hypoperfusion in male Wistar rats" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "407" "paginaFinal" => "415" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Efectos sobre la locomoción y la memoria de 2 modelos de hipoperfusión cerebral en ratas Wistar macho" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1083 "Ancho" => 1565 "Tamanyo" => 52056 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Percentage of correct alterations during the spontaneous alteration test by surgery type (sham <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>6, LLCC <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>6, DLCC <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>6). Values expressed as mean<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>standard error (SE) normalised to percentage change. *<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.05 vs sham and DLCC groups.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.A. Martínez-Díaz, L.I. García, M.E. Hernández, G.E. Aranda-Abreu" "autores" => array:4 [ 0 => array:2 [ "nombre" => "J.A." "apellidos" => "Martínez-Díaz" ] 1 => array:2 [ "nombre" => "L.I." "apellidos" => "García" ] 2 => array:2 [ "nombre" => "M.E." "apellidos" => "Hernández" ] 3 => array:2 [ "nombre" => "G.E." "apellidos" => "Aranda-Abreu" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0213485314000371" "doi" => "10.1016/j.nrl.2014.03.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213485314000371?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580815001054?idApp=UINPBA00004N" "url" => "/21735808/0000003000000007/v1_201508210125/S2173580815001054/v1_201508210125/en/main.assets" ] "en" => array:21 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Consumption trends for specific drugs used to treat dementia in the region of Madrid (Spain) from 2002 to 2012" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "416" "paginaFinal" => "424" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M.C. de Hoyos-Alonso, E. Tapias-Merino, C.M. Meseguer Barros, M. Sánchez-Martínez, A. Otero" "autores" => array:5 [ 0 => array:4 [ "nombre" => "M.C." "apellidos" => "de Hoyos-Alonso" "email" => array:1 [ 0 => "mcanto.hoyos@salud.madrid.org" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "E." "apellidos" => "Tapias-Merino" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "C.M." "apellidos" => "Meseguer Barros" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "M." "apellidos" => "Sánchez-Martínez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "A." "apellidos" => "Otero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Servicio Madrileño de Salud, Centro de Salud Pedro Laín Entralgo, Alcorcón, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio Madrileño de Salud, Centro de Salud Comillas, Área Centro, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio Madrileño de Salud, Subdirección General de Compras de Farmacia y Productos Sanitarios, Consejería de Sanidad, Comunidad de Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Departamento de Medicina Preventiva y Salud Pu¿blica, Universidad Auto¿noma de Madrid, Madrid, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Evolución del consumo de fármacos específicos para la demencia en la comunidad autónoma de Madrid durante el periodo 2002-2012" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1163 "Ancho" => 1567 "Tamanyo" => 107770 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Distribution of cholinesterase inhibitor and memantine consumption in the region of Madrid in 2012, by age group and sex. DDI, defined dose per 100 inhabitants per day; AChEI, cholinesterase inhibitor.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Dementia prevalence is approximately 6.4% in patients older than 65 years, and it increases with age, from 0.8% in patients aged 65 to 69, 10% in patients older than 70 years, and 25% to 54% in the group of patients aged 90 or older.<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">1–3</span></a> Alzheimer disease (AD) is the most frequent type of dementia and the main cause of disability among elderly patients. It places a significant burden on caregivers and generates social costs which increase as the disease progresses.<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">4,5</span></a> Researchers estimate that some 600,000 people have dementia and 400,000 people have AD in Spain.<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">2</span></a> According to the ECO study,<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">6</span></a> the average monthly cost per patient is 1425 euro. Almost 88% of the cost of illness corresponds to informal care, which is borne by the patient's own family. This percentage is higher than the European average, which is about 56%.<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">7</span></a> Healthcare costs include pharmacological treatments, as well as diagnostic tests, office visits, hospitalisation, and institutionalisation.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Since there is no curative treatment for dementia, treatment approach is focused on treating cognitive impairment symptoms, as well as behavioural and psychological symptoms. Its target is also to prevent complications and functional disability, and manage comorbidities. Acetylcholinesterase inhibitors (AChEI) are indicated as specific treatment for mild to moderate AD.<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">8–10</span></a> These include donepezil (marketed in Spain since 1998), rivastigmine (since 2000), and galantamine (since 2001). Memantine, a non-competitive N-methyl-<span class="elsevierStyleSmallCaps">d</span>-aspartate (NMDA)-receptor antagonist, was authorised in 2003 for use in mild to severe AD.<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">8–10</span></a> AChEI and memantine can be administered in combination, but studies yield contradictory results.<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">8,10–12</span></a> In addition to AD, both drugs can be used to treat vascular dementia, and diseases with Lewy bodies (dementia with Lewy bodies and Parkinson's disease), but they are not indicated to treat frontotemporal dementia.<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">8,9</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Their effects are modest and temporary and not all patients respond to treatment.<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">13</span></a> However, according to clinical practice guidelines,<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">8</span></a> treatment with these drugs should be started as soon as AD is diagnosed, considering that previous identification of patients who will respond to treatment is not possible.<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">14</span></a> Spanish regulations establish that every first or maintenance prescription should be authorised by the medical inspection service after a neurologist, gerontologist, or psychiatrist issues the initial report confirming the disease and the treatment indication. There is no consensus on when to suspend treatment with these drugs,<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">15–17</span></a> but some Spanish regions have established rules regarding use and continuity.<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">18</span></a> The cost-benefit ratio of these treatments is currently being debated. Although several studies indicate that starting drug treatments, especially in mild-moderate stages, can delay disease progression, institutionalisation, and associated costs, results remain uncertain.<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">19–21</span></a> Therefore, they should be interpreted considering those differences between public health systems that would influence cost distribution.<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">14</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Consumption of AChEI and memantine has increased progressively since they were introduced to the market,<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">22–26</span></a> and they are listed among the 35 most expensive active ingredients for the Spanish Health System.<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">27</span></a> This increase, which may be partly due to the increased prevalence of dementia caused by population ageing, also depends on the higher percentage of dementia patients treated since these drugs began to be indicated habitually. Thus, a study performed in a primary care setting simultaneously with our own showed that the percentage of dementia patients treated with these drugs had increased from 23% in 2002 to 41% in 2011.<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">28</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Regarding pharmacoepidemiological studies, quantitative studies of the consumption of drugs using prescription invoicing data and/or sales turnover figures show the actual consumption trends of the drugs in large populations. They also provide an overview of the actual costs of the disease and permit comparisons between different settings or populations.<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">29</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The aim of our study is to analyse time trends of consumption and costs of cholinesterase inhibitors (AChEI) and memantine (specific drugs used to treat dementia) in the region of Madrid between 2002 and 2012. Consumption profiles by age and sex were also compared to one another.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Material and methods</span><p id="par0035" class="elsevierStylePara elsevierViewall">A population-based descriptive study of the consumption of specific drugs used to treat dementia was performed between 1 January 2002 and 31 December 2012 in the region of Madrid. Our data source was the system for information and analysis on prescriptions and pharmaceutical services of the region of Madrid (Farm@drid), which serves as the database of official medical prescriptions dispensed by pharmacies in the region of Madrid and invoiced to the Spanish Health System.</p><p id="par0040" class="elsevierStylePara elsevierViewall">We selected cholinesterase inhibitors belonging to the chemical subgroup N06DA and identified the active ingredients donepezil (N06DA02), rivastigmine (N06DA03), and galantamine (N06DA04). We selected memantine (N06DX01) from the N06DX subgroup but excluded ginkgo biloba (N06DX02) as it is not used specifically to treat dementia.</p><p id="par0045" class="elsevierStylePara elsevierViewall">As variables associated with treatment, we analysed year of consumption, sex, and age group (in 9 categories: 51-55 years, 56-60 years, 61-65 years, 66-70 years, 71-75 years, 76-80 years, 81-85 years, 86-90 years, and older than 90 years).</p><p id="par0050" class="elsevierStylePara elsevierViewall">To analyse drug consumption, we used the parameters ‘defined daily dose’ (DDD) and ‘daily dose per inhabitant’ (DDI) for each active ingredient.</p><p id="par0055" class="elsevierStylePara elsevierViewall">DDD corresponds to the daily maintenance dose for a drug used for its main indication in adults and given by a specific route of administration.<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">30</span></a> We adhered to the DDDs defined by the World Health Organization: donepezil 7.5<span class="elsevierStyleHsp" style=""></span>mg, rivastigmine 9<span class="elsevierStyleHsp" style=""></span>mg (9.5<span class="elsevierStyleHsp" style=""></span>mg transdermally), galantamine 16<span class="elsevierStyleHsp" style=""></span>mg, and memantine 20<span class="elsevierStyleHsp" style=""></span>mg.<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">31</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">We assessed trends in drug consumption during the study period by calculating the total number of DDD based on the total number of packages dispensed every year. To do this, we converted commercial formats in milligrams or grams to DDD. We analysed consumption trends for the DDD of each active ingredient and therapeutic chemical subgroup, the ratio between the end and the beginning of the period, and the yearly and total increase in DDD. To calculate the percentages of total increase for 2012 compared to the beginning of the study, we used the formulaΔ<span class="elsevierStyleInf">2012–2002</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>([DDD<span class="elsevierStyleInf">2012</span><span class="elsevierStyleHsp" style=""></span>−<span class="elsevierStyleHsp" style=""></span>DDD<span class="elsevierStyleInf">2002</span>]/DDD<span class="elsevierStyleInf">2002</span>)<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>100 for AChEI, and % Δ<span class="elsevierStyleInf">2012–2003</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>([DDD<span class="elsevierStyleInf">2012</span><span class="elsevierStyleHsp" style=""></span>−<span class="elsevierStyleHsp" style=""></span>DDD<span class="elsevierStyleInf">2003</span>]/DDD<span class="elsevierStyleInf">2003</span>)<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>100 for memantine (marketed since 2003).<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">29</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Annual cost increases for each active ingredient were estimated by multiplying the number of DDD consumed each year by their sales price, calculated according to figures from the Nomenclátor Digitalis drug database.<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">32</span></a> In our cost estimation, we considered commercial formats of maintenance doses exclusively. The price per milligram for each package format was obtained to later calculate the mean price per year of the different formats. Calculated DDD prices were between 4.39 and 4.04 euro for donepezil, 3.58 and 3.24 euro for rivastagmine, 3.84 and 3.53 euro for galantamine, and 3.8 euro for memantine. We performed an additional estimation after generic forms of donepezil became available in 2011 (DDD at 1.75 euro) and rivastigmine solution in 2012 (DDD at 2.65 euro). This estimation assumed that only generic drugs were used.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Daily dose per inhabitant refers to the mean number of inhabitants receiving daily treatment with a given drug.<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">30</span></a> DDI corresponds to the DDD typically calculated for 1000 inhabitants. In our study, we decided to use a DDI per 100 inhabitants to draw comparisons with dementia prevalence in the population, and with other prevalence studies on consumption of these drugs.<a class="elsevierStyleCrossRefs" href="#bib0340"><span class="elsevierStyleSup">23,28</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">We used DDI to analyse consumption by age group and sex in 2012. We calculated DDI for both sexes and each age group, and for patients older than 60, 65, or 70 years, using the following formula: number of DDI<span class="elsevierStyleInf">2012</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>(number of DDD<span class="elsevierStyleInf">2012</span>/population<span class="elsevierStyleInf">2012</span>)<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>(1/365)<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>100. Only DDDs consumed by patients older than 50 years were considered. Populations used in calculating this rate were obtained from Farm@drid, according to health card holder records. Data were limited to patients older than 50 years since they constitute the reference population for these drugs. We calculated confidence intervals for both sexes and each age group.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Data extracted from the Farm@drid digital record did not include variables that could identify patients; therefore, our study preserves data confidentiality.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Data were analysed with the SPSS statistical software, version 19.0; Excel<span class="elsevierStyleSup">®</span> version 12.3.0 (110427); and Epidat 3.0.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0090" class="elsevierStylePara elsevierViewall">Consumption of the specific drugs used to treat dementia, cholinesterase inhibitors (AChEI) and memantine, increased by a factor of 6 between 2002 and 2012 in the region of Madrid. This meant a total increase in DDD of 507%. In this period, 76.7% of the drugs consumed to treat dementia were AChEI, with 23.3% corresponding to memantine (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Half of the AChEI prescriptions filled during the study period were for donepezil. Galantamine consumption increased progressively up to 2008, when platformed off. Beginning in 2009, rivastigmine consumption increased until it made up 30% of all AChEI prescriptions in 2012. The increasing trend in consumption was more homogeneous for donezepil and memantine throughout the 11-year study period (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">In 2012, 12.3 million DDDs of specific drugs used to treat dementia were consumed, 10.3 million more than in year 2002 (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Estimated costs increased by a factor of 5.7, from 8.2 million euro in 2002 to 47.6 million in 2012. If we consider prices for generic drugs only, the final cost amounts to 34 million, 4 times higher than at the beginning of the study period. Annual cost savings due to the use of generic drugs amounted to 12 million in 2011, and 13 million in 2013 (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Total costs during the 11-year period would be 300 million euro for brand-name drugs only or 275 million euro considering the generics that became available in 2011 and 2012.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">After adjusting 2012 consumption data by age and sex, 2.42% of patients older than 65 years (95% CI, 2.39-2.45) consumed AChEI, and 0.90% took memantine (95% CI, 0.88-0.92). Consumption increased for both drug groups in patients between 65 and 90 years old; 5.84% consumed AChEI (95% CI, 5.68-6.00), and 2.33% took memantine (95% CI, 2.23-2.43). Consumption decreased in patients older than 90 (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> and <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Consumption was higher in women than in men. In the group of patients older than 65 years, 2.82% of the women (95% CI, 2.78-2.87) consumed AChEI versus 1.83% of the men (95% CI, 1.79-1.87). Memantine was consumed by 1.10% of the women (95% CI, 1.07-1.12) versus 0.61% of the men (95% CI, 0.59-0.64). We found significant differences between sexes in patients older than 65 years regarding consumption of AChEI, and of memantine in patients older than 71 years. Increased consumption with age and decreased consumption in patients older than 90 years was observed both in men and women (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>, <a class="elsevierStyleCrossRefs" href="#fig0015">Figs. 3 and 4</a>).</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">The most widely used active ingredient in 2012 in both men and women of all ages was donezepil; the least used was galantamine. Rivastigmine was the drug with the least pronounced sex difference; differences in use by sex were only identified in patients aged 76 to 90.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0120" class="elsevierStylePara elsevierViewall">Overall consumption of specific drugs used to treat dementia in the region of Madrid increased by a mean of 50% annually between 2002 and 2012. Mean annual increase during the first 6 years (2002-2007) was 48% versus 15% for the last 6 years (2007-2012). Compared to similar periods, the consumption increase in the region of Madrid was higher than that reflected by other studies performed in Spain using the same analysis methods. For example, DDD consumption around Madrid increased by 25% annually from 2004 to 2008, while in Castille-La Mancha this increase reached 11.5% (in a study which included ginkgo biloba<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">23</span></a>). Likewise, the annual increase between 2006 and 2011 was 20% in the region of Madrid, versus 12% in the Basque country during the same period, as reported by a study in patients older than 60.<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">24</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Donepezil was the most widely used active ingredient in the region of Madrid throughout the study period, a tendency that was also observed in other Spanish studies<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">22,23,28,33,34</span></a> as well as in international studies.<a class="elsevierStyleCrossRefs" href="#bib0355"><span class="elsevierStyleSup">26,35,36</span></a> This trend has been linked to the drug's ease of use and low rate of adverse effects.<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">14</span></a> However, the literature shows considerable variability in the proportions and consumption trends for these drugs.<a class="elsevierStyleCrossRefs" href="#bib0340"><span class="elsevierStyleSup">23,24,34,37</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">The standstill in galantamine consumption in the region of Madrid coincides with the increase in the use of rivastagmine. Increased use of rivastagmine during the past few years was also observed by other consumption studies<a class="elsevierStyleCrossRefs" href="#bib0345"><span class="elsevierStyleSup">24,26</span></a> and may be explained by the marketing of rivastigmine transdermal patches in 2008.</p><p id="par0135" class="elsevierStylePara elsevierViewall">The indication of memantine for moderate to advanced dementia suggests that the prescription profile might show a use curve tending more towards advanced ages than is the case for AChEI. However, as in other studies of overall consumption,<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">28</span></a> the memantine consumption profile by age group was similar to that of AChEI in 2012. This might indicate that memantine could be used in the same progression stages of dementia, whether in combination treatment or as sole treatment in cases of moderate dementia with a contraindication of AChEI. Testing this hypothesis would require a different study design.</p><p id="par0140" class="elsevierStylePara elsevierViewall">In the last year of our study period (2012), AChEI consumption per inhabitant and day among patients older than 65 years was 2.82%, versus 1.10% in the case of memantine. Considering that combined treatment is used some patients, we have to assume that less than 3.92% of patients older than 65 consume specific anti-dementia drugs (consumption prevalence). Despite progressive increases in consumption, this percentage is lower than might be expected if we compare it to prevalences of AD (4.6%) or of dementia (5.8-7.6%)<a class="elsevierStyleCrossRefs" href="#bib0415"><span class="elsevierStyleSup">38,39</span></a> in patients older than 65, as reported by other population studies conducted in nearby settings. This difference is more pronounced if we consider only those patients older than 70, since consumption of AChEI (3.13%) and memantine (1.16%) indicate that 4.29% of all patients older than 70 consume these drugs. Meanwhile, the prevalence of dementia in that age group is much higher.<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">2</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">Women older than 65 consume more AChEI and memantine that men, which may be explained by the higher prevalence of dementia among women. Likewise, consumption increases with age, since prevalence of dementia displays the same tendency. However, consumption tapers off at more advanced ages, a trend that has also been observed in other studies in the general population<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">28,40</span></a> and in institutionalised patients.<a class="elsevierStyleCrossRefs" href="#bib0430"><span class="elsevierStyleSup">41,42</span></a> The reason may be that dementia prevalence no longer increases exponentially in patients older than 90 years; the tendency may also result from decisions to limit treatment (due to comorbidities, potential toxicity, very advanced dementia), and therefore withdrawal and/or reduced use of these drugs in this age group.<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">3,17</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">Consumption of different active ingredients varies according to sex and age, which seems to indicate a sex-related prescription profile, as also observed in other studies.<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">28,40</span></a> Confirming sex differences in how these drugs are prescribed will require further studies of consumption among patients with dementia to determine whether differences persist after adjusting by dementia subtype and stage of progression. Either one of these circumstances may determine which of the active ingredients is the most appropriate.</p><p id="par0155" class="elsevierStylePara elsevierViewall">Costs of AChEI and memantine have been increasing since they were first marketed due to the progressive increase in consumption, considering that prices have remained relatively stable. These drugs’ share of the pharmaceutical expenditure on prescriptions dispensed in the region of Madrid<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">43</span></a> also increased from 1.31% in 2003 to 3.04% in 2010 according to our results. This was in line with findings from the Basque country.<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">24</span></a> In the region of Madrid, this percentage has been increasing since 2011, despite expenditure have been contained by the appearance of generic versions of these drugs. Therefore, considering a total prescription expenditure amounting to 1.057 billion<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">43</span></a> in 2012, we estimate that 4.50% would correspond to these drugs (3.23% if we consider generic drugs). In return, appropriate use of AChEI and/or memantine could help reduce the indiscriminate use of other drugs used to treat cognitive impairment and dementia (such as ginkgo biloba, piracetam, or citicoline), which have shown no benefits for controlling symptoms in patients with dementia.</p><p id="par0160" class="elsevierStylePara elsevierViewall">This study presents some inherent limitations. Firstly, data regarding AChEI and memantine consumption refer to the total population, without mentioning patients with a confirmed diagnosis of dementia.</p><p id="par0165" class="elsevierStylePara elsevierViewall">Since we do not have data regarding combined treatment (AChEI with memantine), only an estimated prevalence of patients treated with specific anti-dementia drugs (AChEI and/or memantine) in the region of Madrid could be obtained, unlike in other studies.</p><p id="par0170" class="elsevierStylePara elsevierViewall">The study does not include prescriptions given by private practices or within the framework of special healthcare programmes such as the general Spanish civil service mutual insurance company, general mutual insurance scheme for the judiciary, and the social insurance institute of the armed forces. These groups make up such a small percentage of the population living in the region of Madrid (0.87%) and covered by the Spanish Health System that they do not impact the validity of our data whether in terms of the number of prescriptions or in population figures.<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">44</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">Using DDD in our study involves the limitations inherent to this kind of indicator, considering that it is a technical unit of measurement that does not necessarily reflect the true prescribed dose.<a class="elsevierStyleCrossRefs" href="#bib0375"><span class="elsevierStyleSup">30,31</span></a> However, since these drugs are only indicated for dementia and are used according to an established protocol, data reflect consumption quite reliably.</p><p id="par0180" class="elsevierStylePara elsevierViewall">Yearly cost estimations were performed assuming similar consumption of all available commercial formats (capsules, solution, and patches). However, there is probably a tendency towards using one type more than others. The very low variation in the price of DDDs for each active ingredient during the 11-year period, before generic drugs became available, justifies our method.</p><p id="par0185" class="elsevierStylePara elsevierViewall">Data regarding AChEI and memantine dispensed by pharmacies upon presentation of official prescriptions do not fully ensure treatment compliance among patients. However, since these drugs must be prescribed by a specialist and authorised by the medical inspection service, the statistics provide information about consumption that is quite reliable. This fact, in addition to having the consumption data for all drugs covered by the Spanish Health System and finding coherent results, lets us state that data accurately reflect consumption tendencies for specific drugs used to treat dementia in the region of Madrid.</p><p id="par0190" class="elsevierStylePara elsevierViewall">The appearance of generic formats of these drugs beginning in 2011, approval of different regulations to rationalise drug use and thus control pharmaceutical expenditure (for example, prescribing active ingredients rather than brand names under Legislative Royal Decree 9/2011<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">45</span></a>), and the changes applied to the reference price system in 2013 are all measures able to temporally reduce costs and slow the progressive increase in expenditure.</p><p id="par0195" class="elsevierStylePara elsevierViewall">However, an increase in the number of dementia patients due to population ageing is to be expected, together with gradual growth in the percentage of dementia patients receiving treatment.<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">28</span></a> Both situations lead us to believe that the trend found by our study, i.e. increasing consumption of cholinesterase inhibitors and memantine, will continue. This being the case, it is also foreseeable that expenditure on these drugs will also increase in the next few years. It is therefore important to continue performing cost-benefit studies analysing the role of AChEI and memantine in the control of symptoms in different dementia stages. These studies should assess how these drugs contribute to reducing use of neuroleptics and to delaying disease progression and institutionalisation.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Funding</span><p id="par0200" class="elsevierStylePara elsevierViewall">This study has not received funding from any sources.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflicts of interest</span><p id="par0205" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres543032" "titulo" => "Abstract" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec562344" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres543033" "titulo" => "Resumen" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec562343" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Funding" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflicts of interest" ] 10 => array:2 [ "identificador" => "xack183660" "titulo" => "Acknowledgements" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-10-16" "fechaAceptado" => "2014-02-02" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec562344" "palabras" => array:6 [ 0 => "Dementia" 1 => "Cholinesterase inhibitors" 2 => "Memantine" 3 => "Pharmacoepidemiology" 4 => "Drug utilization" 5 => "Cost" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec562343" "palabras" => array:6 [ 0 => "Demencia" 1 => "Anticolinesterásicos" 2 => "Memantina" 3 => "Farmacoepidemiología" 4 => "Uso de fármacos" 5 => "Coste" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Analysing drug consumption in large population groups lets us observe consumption trends and compare them between different settings.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To analyse the time trends for consumption and costs of specific drugs used to treat dementia in the region of Madrid (Spain) and compare trends by sex and age cohort.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Descriptive study of cholinesterase inhibitors (N06DA) and memantine (N06DX01) dispensed in Madrid between 2002 and 2012 and covered by the Spain's national health system. Consumption was calculated by analysing changes in DDD (defined daily doses) to find total and yearly increases. The cost was estimated based on DDD price. To compare consumption rates by age and sex, we calculated DDD per 100 inhabitants/day.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Between 2002 and 2012, consumption of drugs used to treat dementia increased sixfold. During this period, cholinesterase inhibitors accounted for 76.70% of the drugs consumed and memantine, 23.30%. The estimated cost rose by a factor of 5.7 over 11 years (or by a factor of 4 taking into account the use of generic drugs).</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">In 2012, 2.42% of the patients aged 65 or over consumed cholinesterase inhibitors (women 2.82%, men 1.83%) and 0.90% consumed memantine (women 1.10%, men 0.61%). Consumption increased in age cohorts up to 86 to 90 (5.84% for cholinesterase inhibitors and 2.33% for memantine) and declined thereafter.</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Consumption of cholinesterase inhibitors and memantine gradually increased, but consumption in 2012 did not reach levels equivalent to dementia prevalence figures. Pharmaceutical expenditure restraint measures may temporarily slow the cost increase temporarily but if the same trend of consumption persists, costs will rise.</p></span>" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introducción</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">El análisis del consumo de fármacos en grandes grupos poblacionales permite ver tendencias de consumo y comparar diferentes ámbitos.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Analizar la tendencia temporal de consumo y costes de fármacos específicos para la demencia en la comunidad autónoma de Madrid (CAM) y comparar por grupos de edad y sexo.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Métodos</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Estudio descriptivo, seleccionando anticolinesterásicos (N06DA) y memantina (N06DX01) dispensados en la CAM del 2002 al 2012 con cargo al Sistema Nacional de Salud. El consumo se calculó analizando la evolución de las dosis diarias definidas (DDD), con incrementos totales y anuales. El coste se estimó por precio de DDD. Para comparar el consumo por edad y sexo, se calcularon las DDD por 100 habitantes-día.</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Del 2002 al 2012 se multiplicó por 6 el consumo de fármacos para la demencia. El 76,70% de los fármacos consumidos en este periodo fueron anticolinesterásicos y el 23,30% memantina. La evolución del coste estimado se multiplicó por 5,7 en 11 años (por 4 considerando utilización de fármacos genéricos).</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">En 2012, el 2,42% de los mayores de 65 años consumió anticolinesterásicos (2,82% mujeres, 1,83% hombres) y el 0,90% memantina (1,10% mujeres, 0,61% hombres). El consumo aumentó hasta los 86-90 años (5,84% en anticolinesterásicos; 2,33% en memantina), disminuyendo posteriormente.</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">El consumo de anticolinesterásicos y memantina aumentó progresivamente, sin alcanzar en 2012 cifras equivalentes a la prevalencia poblacional de demencia. Las medidas de contención de gasto farmacéutico pueden frenar el aumento del coste, aunque este volverá a crecer si persiste la misma tendencia temporal de consumo.</p></span>" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Please cite this article as: de Hoyos-Alonso MC, Tapias-Merino E, Meseguer Barros CM, Sánchez-Martínez M, Otero A. Evolución del consumo de fármacos específicos para la demencia en la comunidad autónoma de Madrid durante el periodo 2002-2012. Neurología. 2015;30:416–424.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0030">This article has not been submitted to any other Spanish or international journals. Our results have not been published either totally or partially. Part of this study was presented at the 18th annual meeting of the Spanish Psychogeriatric Society, held in Madrid in October 2011 (partial data as of 2010). Part of this study was also presented at the 34th Congress of the Spanish Society of Primary Care Doctors (SEMERGEN) in September 2012 (partial data as of 2011).</p>" ] ] "multimedia" => array:7 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 952 "Ancho" => 1629 "Tamanyo" => 109569 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Changes in consumption of specific anti-dementia drugs (cholinesterase inhibitors and memantine) in the region of Madrid between 2002 and 2012, given as defined daily doses. DDD, defined daily dose.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1475 "Ancho" => 2158 "Tamanyo" => 174391 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Estimation of cost changes for specific drugs used to treat dementia (cholinesterase inhibitors and memantine) in the region of Madrid between 2002 and 2012. AChEI_Difference_Price brand/generic, price difference between brand name and generic drug.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1163 "Ancho" => 1567 "Tamanyo" => 107770 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Distribution of cholinesterase inhibitor and memantine consumption in the region of Madrid in 2012, by age group and sex. DDI, defined dose per 100 inhabitants per day; AChEI, cholinesterase inhibitor.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1141 "Ancho" => 1690 "Tamanyo" => 90075 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Consumption of specific drugs used to treat dementia (cholinesterase inhibitors and memantine) in patients older than 65 years in the region of Madrid in 2012. Sex distribution of dose per inhabitant and day. DDI, defined dose per 100 inhabitants per day.</p>" ] ] 4 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">DDD, defined daily dose; NM, not on the market.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col">Year \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Cholinesterase inhibitors</th><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Memantine</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">All anti-dementia drugs</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">DDD \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Δ (%)<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">%TDD<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">DDD \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Δ (%)<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">%TDD<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">DDD \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Δ (%)<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">2002 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2<span class="elsevierStyleHsp" style=""></span>037<span class="elsevierStyleHsp" style=""></span>210 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">NM \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2<span class="elsevierStyleHsp" style=""></span>037<span class="elsevierStyleHsp" style=""></span>210 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">2003 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2<span class="elsevierStyleHsp" style=""></span>656<span class="elsevierStyleHsp" style=""></span>311 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30.39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90.29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">285<span class="elsevierStyleHsp" style=""></span>712 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.71 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2<span class="elsevierStyleHsp" style=""></span>942<span class="elsevierStyleHsp" style=""></span>024 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">44.41 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">2004 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3<span class="elsevierStyleHsp" style=""></span>331<span class="elsevierStyleHsp" style=""></span>106 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25.40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">82.87 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">688<span class="elsevierStyleHsp" style=""></span>464 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">140.96 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17.13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4<span class="elsevierStyleHsp" style=""></span>019<span class="elsevierStyleHsp" style=""></span>571 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36.63 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">2005 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3<span class="elsevierStyleHsp" style=""></span>877<span class="elsevierStyleHsp" style=""></span>923 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80.17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">959<span class="elsevierStyleHsp" style=""></span>370 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39.35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19.83 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4<span class="elsevierStyleHsp" style=""></span>837<span class="elsevierStyleHsp" style=""></span>294 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20.34 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">2006 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4<span class="elsevierStyleHsp" style=""></span>449<span class="elsevierStyleHsp" style=""></span>169 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.73 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">77.36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1<span class="elsevierStyleHsp" style=""></span>302<span class="elsevierStyleHsp" style=""></span>078 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35.72 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22.64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5<span class="elsevierStyleHsp" style=""></span>751<span class="elsevierStyleHsp" style=""></span>247 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18.89 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">2007 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5<span class="elsevierStyleHsp" style=""></span>274<span class="elsevierStyleHsp" style=""></span>603 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18.55 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">76.09 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1<span class="elsevierStyleHsp" style=""></span>657<span class="elsevierStyleHsp" style=""></span>862 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27.32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23.91 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6<span class="elsevierStyleHsp" style=""></span>932<span class="elsevierStyleHsp" style=""></span>465 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20.54 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">2008 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6<span class="elsevierStyleHsp" style=""></span>170<span class="elsevierStyleHsp" style=""></span>972 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.99 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75.97 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1<span class="elsevierStyleHsp" style=""></span>952<span class="elsevierStyleHsp" style=""></span>172 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17.75 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24.03 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8<span class="elsevierStyleHsp" style=""></span>123<span class="elsevierStyleHsp" style=""></span>145 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17.18 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">2009 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7<span class="elsevierStyleHsp" style=""></span>041<span class="elsevierStyleHsp" style=""></span>935 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75.42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2<span class="elsevierStyleHsp" style=""></span>295<span class="elsevierStyleHsp" style=""></span>350 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17.58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24.58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9<span class="elsevierStyleHsp" style=""></span>337<span class="elsevierStyleHsp" style=""></span>285 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.95 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">2010 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7<span class="elsevierStyleHsp" style=""></span>766<span class="elsevierStyleHsp" style=""></span>068 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">74.80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2<span class="elsevierStyleHsp" style=""></span>616<span class="elsevierStyleHsp" style=""></span>482 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.99 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25.20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10<span class="elsevierStyleHsp" style=""></span>382<span class="elsevierStyleHsp" style=""></span>550 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.19 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">2011 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8<span class="elsevierStyleHsp" style=""></span>497<span class="elsevierStyleHsp" style=""></span>908 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">73.31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3<span class="elsevierStyleHsp" style=""></span>094<span class="elsevierStyleHsp" style=""></span>222 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18.26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26.69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11<span class="elsevierStyleHsp" style=""></span>592<span class="elsevierStyleHsp" style=""></span>130 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.65 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">2012 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8<span class="elsevierStyleHsp" style=""></span>969<span class="elsevierStyleHsp" style=""></span>820 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.55 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">72.54 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3<span class="elsevierStyleHsp" style=""></span>396<span class="elsevierStyleHsp" style=""></span>356 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.76 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27.46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12<span class="elsevierStyleHsp" style=""></span>366<span class="elsevierStyleHsp" style=""></span>176 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.68 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Total 2002-2012 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">60<span class="elsevierStyleHsp" style=""></span>073<span class="elsevierStyleHsp" style=""></span>025 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">340.30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">76.70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18<span class="elsevierStyleHsp" style=""></span>248<span class="elsevierStyleHsp" style=""></span>068 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1088.73 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23.30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">78<span class="elsevierStyleHsp" style=""></span>321<span class="elsevierStyleHsp" style=""></span>093 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">507.02 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Beginning/end ratio<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4.40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11.89 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6.07 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab872090.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Δ(%), increase in the annual percentage with regard to previous year. Total reflects cumulative increase for 2012 with regard to the initial period (2002 for cholinesterase inhibitor-TDD, and 2003 for memantine).</p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">%TDD, percentage of the total for anti-dementia drugs (cholinesterase inhibitor<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>memantine).</p>" ] 2 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "c" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">2012/2002 ratio for cholinesterase inhibitors-TDD; 2012/2003 ratio in the case of memantine.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Changes in consumption of specific drugs to treat dementia (cholinesterase inhibitors and memantine) in the region of Madrid between 2002 and 2012, in defined daily doses.</p>" ] ] 5 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">DDD, defined daily dose; DDI, defined dose per 100 inhabitants per day; AChEI, cholinesterase inhibitors.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Age group \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Population \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">DDD-AChEI \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">DDD-memantine \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">DDD-AChEI \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">DDD-memantine \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">51-55 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">400<span class="elsevierStyleHsp" style=""></span>388 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15<span class="elsevierStyleHsp" style=""></span>368 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6412 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.01 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">56-60 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">330<span class="elsevierStyleHsp" style=""></span>706 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">60<span class="elsevierStyleHsp" style=""></span>865 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">32<span class="elsevierStyleHsp" style=""></span>648 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.05 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.03 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">61-65 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">305<span class="elsevierStyleHsp" style=""></span>295 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">158<span class="elsevierStyleHsp" style=""></span>585 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66<span class="elsevierStyleHsp" style=""></span>324 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.06 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">66-70 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">258<span class="elsevierStyleHsp" style=""></span>342 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">362<span class="elsevierStyleHsp" style=""></span>895 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">145<span class="elsevierStyleHsp" style=""></span>866 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">71-75 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">203<span class="elsevierStyleHsp" style=""></span>281 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">827<span class="elsevierStyleHsp" style=""></span>404 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">306<span class="elsevierStyleHsp" style=""></span>450 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.41 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">76-80 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">192<span class="elsevierStyleHsp" style=""></span>145 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2<span class="elsevierStyleHsp" style=""></span>026<span class="elsevierStyleHsp" style=""></span>917 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">703<span class="elsevierStyleHsp" style=""></span>456 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.89 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.00 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">81-85 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">142<span class="elsevierStyleHsp" style=""></span>660 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2<span class="elsevierStyleHsp" style=""></span>697<span class="elsevierStyleHsp" style=""></span>101 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">970<span class="elsevierStyleHsp" style=""></span>434 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.86 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">86-90 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">81<span class="elsevierStyleHsp" style=""></span>317 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1<span class="elsevierStyleHsp" style=""></span>733<span class="elsevierStyleHsp" style=""></span>167 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">692<span class="elsevierStyleHsp" style=""></span>378 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.84 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.33 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">>90 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40<span class="elsevierStyleHsp" style=""></span>147 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">450<span class="elsevierStyleHsp" style=""></span>817 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">194<span class="elsevierStyleHsp" style=""></span>378 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.08 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.33 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Total >70 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">659<span class="elsevierStyleHsp" style=""></span>550 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7<span class="elsevierStyleHsp" style=""></span>735<span class="elsevierStyleHsp" style=""></span>406 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2<span class="elsevierStyleHsp" style=""></span>867<span class="elsevierStyleHsp" style=""></span>096 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.16 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Total >65 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">917<span class="elsevierStyleHsp" style=""></span>892 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8<span class="elsevierStyleHsp" style=""></span>098<span class="elsevierStyleHsp" style=""></span>301 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3<span class="elsevierStyleHsp" style=""></span>012<span class="elsevierStyleHsp" style=""></span>962 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.90 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Total >60 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1<span class="elsevierStyleHsp" style=""></span>223<span class="elsevierStyleHsp" style=""></span>188 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8<span class="elsevierStyleHsp" style=""></span>256<span class="elsevierStyleHsp" style=""></span>885 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3<span class="elsevierStyleHsp" style=""></span>079<span class="elsevierStyleHsp" style=""></span>286 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.85 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.69 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab872091.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Age distribution of consumption of cholinesterase inhibitors and memantine in the region of Madrid in 2012.</p>" ] ] 6 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "<p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">DDI, defined dose per 100 inhabitants per day.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col">Age group \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">DDI donepezil</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">DDI rivastigmine</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">DDI galantamine</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">DDI AChEI</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">DDI memantine</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Men \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Women \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Men \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Women \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Men \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Women \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Men \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Women \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Men \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Women \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">51-55 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.01 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.01 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.01 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.01 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.01 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.01 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.01 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.01 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.01 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">56-60 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.02 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.03 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.01 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.02 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.01 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.01 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.05 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.05 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.03 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.03 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">61-65 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.07 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.07 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.05 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.04 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.03 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.03 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.06 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.06 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">66-70 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.16<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.23<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.07 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.06 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.34<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.42<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.18 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">71-75 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.44<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.66<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.18<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.20<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.94<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.25<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.31<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.49<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">76-80 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.19<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.65<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.81<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.94<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.51<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.57<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.51<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.16<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.79<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.15<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">81-85 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.95<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.96<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.30<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.68<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.91<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.14<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.15<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.78<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.40<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.13<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">86-90 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.31<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.35<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.28<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.74<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.04<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.30<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.64<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.38<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.63<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.65<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">>90 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.38<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.73<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.76 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.87 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.46<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.63<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.61<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.22<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.89<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.46<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Total >70 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.21<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.90<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.78<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.05<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.53<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.70<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.52<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.65<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.84<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.41<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Total >65 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.87<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.47<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.57<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.81<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.38<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.53<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.83<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.82<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.61<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.10<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Total >60 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.65<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.15<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.43<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.63<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.29<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.42<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.37<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.20<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.4<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.86<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab872092.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Significant differences (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.05) between men and women in this section.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Age and sex distribution of consumption of specific anti-dementia drugs (cholinesterase inhibitors and memantine) in the region of Madrid in 2012.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:45 [ 0 => array:3 [ "identificador" => "bib0230" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of dementia and major subtypes in Europe: a collaborative study of population-based cohorts. Neurologic Diseases in the Elderly Research Group" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Lobo" 1 => "L.J. Launer" 2 => "L. Fratiglioni" 3 => "K. Andersen" 4 => "A. Di Carlo" 5 => "M.M. Breteler" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Neurology" "fecha" => "2000" "volumen" => "54" "numero" => "11 Suppl. 5" "paginaInicial" => "S4" "paginaFinal" => "S9" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10854354" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0235" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of dementia and major dementia subtypes in Spanish populations: a reanalysis of dementia prevalence surveys, 1990–2008" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. De Pedro-Cuesta" 1 => "J. Virués-Ortega" 2 => "S. Vega" 3 => "M. Seijo-Martínez" 4 => "P. Saz" 5 => "F. Rodríguez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1471-2377-9-55" "Revista" => array:5 [ "tituloSerie" => "BMC Neurol" "fecha" => "2009" "volumen" => "9" "paginaInicial" => "55" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19840375" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0240" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Demencia en nonagenarios. Revisión sistemática de estudios poblacionales con datos de España" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.E. Carrillo-Alcalá" 1 => "F. Bermejo-Pareja" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Neurol" "fecha" => "2008" "volumen" => "47" "paginaInicial" => "347" "paginaFinal" => "354" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18841545" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0245" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The cost of dementia in Europe: a review of the evidence, and methodological considerations" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L. Jönsson" 1 => "A. Wimo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Pharmacoeconomics" "fecha" => "2009" "volumen" => "27" "paginaInicial" => "391" "paginaFinal" => "403" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19586077" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0250" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Análisis de los costes de la enfermedad de Alzheimer en funcio¿n del deterioro cognitivo y funcional" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. López-Pousa" 1 => "J. Garre-Olmo" 2 => "A. Turon-Estrada" 3 => "F. Hernández" 4 => "I. Expósito" 5 => "M. Lozano-Gallego" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Clín (Barc)" "fecha" => "2004" "volumen" => "122" "paginaInicial" => "767" "paginaFinal" => "772" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0255" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prospective one-year cost-of-illness study in a cohort of patients with dementia of Alzheimer's disease type in Spain: the ECO study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Coduras" 1 => "I. Rabasa" 2 => "A. Frank" 3 => "F. Bermejo-Pareja" 4 => "S. López-Pousa" 5 => "J.-M. López-Arrieta" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3233/JAD-2010-1258" "Revista" => array:6 [ "tituloSerie" => "J Alzheimers Dis JAD" "fecha" => "2010" "volumen" => "19" "paginaInicial" => "601" "paginaFinal" => "615" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20110605" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0260" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The economic impact of dementia in Europe in 2008—cost estimates from the Eurocode project" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Wimo" 1 => "L. Jönsson" 2 => "A. Gustavsson" 3 => "D. McDaid" 4 => "K. Ersek" 5 => "J. Georges" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/gps.2610" "Revista" => array:6 [ "tituloSerie" => "Int J Geriatr Psychiatry" "fecha" => "2011" "volumen" => "26" "paginaInicial" => "825" "paginaFinal" => "832" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21744385" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0265" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guía de Práctica Clínica sobre la atención integral a las personas con enfermedad de Alzheimer y otras demencias. Plan de Calidad para el Sistema Nacional de Salud del Ministerio de Sanidad, Política Social e Igualdad" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Grupo de trabajo de la Guía de Práctica Clínica sobre la atención integral a las personas con enfermedad de Alzheimer y otras demencias" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:2 [ "fecha" => "2010" "editorial" => "Agència d¿Informació, Avaluació i Qualitat en Salut de Cataluña" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0270" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical practice with anti-dementia drugs: a revised (second) consensus statement from the British Association for Psychopharmacology" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "BAP Dementia Consensus Group" "etal" => false "autores" => array:2 [ 0 => "J.T. O’Brien" 1 => "A. Burns" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Psychopharmacol Oxf Engl" "fecha" => "2011" "volumen" => "25" "paginaInicial" => "997" "paginaFinal" => "1019" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0275" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "National Institute for Clinical Excellence. Technology appraisal guidance 217. Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer's disease (review of NICE technology appraisal guidance 111). Available from: <a href="http://www.nice.org.uk/guidance/TA217">www.nice.org.uk/guidance/TA217</a> [accessed 04.10.2013]." ] ] ] 10 => array:3 [ "identificador" => "bib0280" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term effects of the concomitant use of memantine with cholinesterase inhibition in Alzheimer disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "O.L. Lopez" 1 => "J.T. Becker" 2 => "A.S. Wahed" 3 => "J. Saxton" 4 => "R.A. Sweet" 5 => "D.A. Wolk" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/jnnp.2008.158964" "Revista" => array:6 [ "tituloSerie" => "J Neurol Neurosurg Psychiatry" "fecha" => "2009" "volumen" => "80" "paginaInicial" => "600" "paginaFinal" => "607" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19204022" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0285" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Donepezil and memantine for moderate-to-severe Alzheimer's disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Howard" 1 => "R. McShane" 2 => "J. Lindesay" 3 => "C. Ritchie" 4 => "A. Baldwin" 5 => "R. Barber" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1106668" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2012" "volumen" => "366" "paginaInicial" => "893" "paginaFinal" => "903" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22397651" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0290" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnosis and treatment of dementia: 5. Nonpharmacologic and pharmacologic therapy for mild to moderate dementia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D.B. Hogan" 1 => "P. Bailey" 2 => "S. Black" 3 => "A. Carswell" 4 => "H. Chertkow" 5 => "B. Clarke" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Can Med Assoc J" "fecha" => "2008" "volumen" => "179" "paginaInicial" => "1019" "paginaFinal" => "1026" ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0295" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cholinesterase inhibitors for Alzheimer's disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J. Birks" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Cochrane Database Syst Rev" "fecha" => "2006" "paginaInicial" => "CD005593" ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0300" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "EFNS guidelines for the diagnosis and management of Alzheimer's disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Hort" 1 => "J.T. O’Brien" 2 => "G. Gainotti" 3 => "T. Pirttila" 4 => "B.O. Popescu" 5 => "I. Rektorova" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Eur J Neurol Off J Eur Fed Neurol Soc" "fecha" => "2010" "volumen" => "17" "paginaInicial" => "1236" "paginaFinal" => "1248" ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0305" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "¿Cuándo suspender el tratamiento farmacológico específico en el Alzheimer?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G. Coll-de-Tuero" 1 => "S. López-Pousa" 2 => "J. Vilalta-Franch" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Aten Prim" "fecha" => "2011" "volumen" => "43" "paginaInicial" => "565" "paginaFinal" => "567" ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0310" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tratamiento farmacológico de la demencia: cuándo, cómo y hasta cuándo. Recomendaciones del Grupo de Trabajo de Demencias de la Sociedad Catalana de Geriatría y Gerontología" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "D. Rodríguez" 1 => "F. Formiga" 2 => "I. Fort" 3 => "M.J. Robles" 4 => "E. Barranco" 5 => "D. Cubí" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Esp Geriatría Gerontol" "fecha" => "2012" "volumen" => "47" "paginaInicial" => "228" "paginaFinal" => "233" ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0315" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "titulo" => "Instrucció X/2011" ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:1 [ "fecha" => "2011" ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0320" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The pharmacoeconomics of cognitive enhancers in moderate to severe Alzheimer's disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. Cappell" 1 => "N. Herrmann" 2 => "S. Cornish" 3 => "K.L. Lanctôt" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2165/11539530-000000000-00000" "Revista" => array:6 [ "tituloSerie" => "CNS Drugs" "fecha" => "2010" "volumen" => "24" "paginaInicial" => "909" "paginaFinal" => "927" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20932064" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0325" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Economic evaluation of treatment options in patients with Alzheimer's disease: a systematic review of cost-effectiveness analyses" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "L. Pouryamout" 1 => "J. Dams" 2 => "J. Wasem" 3 => "R. Dodel" 4 => "A. Neumann" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2165/11631830-000000000-00000" "Revista" => array:6 [ "tituloSerie" => "Drugs" "fecha" => "2012" "volumen" => "72" "paginaInicial" => "789" "paginaFinal" => "802" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22480339" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0330" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The effectiveness and cost-effectiveness of donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer's disease (review of Technology Appraisal No. 111): a systematic review and economic model" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Bond" 1 => "G. Rogers" 2 => "J. Peters" 3 => "R. Anderson" 4 => "M. Hoyle" 5 => "A. Miners" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Health Technol Assess Winch Engl" "fecha" => "2012" "volumen" => "16" "paginaInicial" => "1" "paginaFinal" => "470" ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0335" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Utilización de fármacos específicos para la enfermedad de Alzheimer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "I. Villar Fernández" 1 => "M.J. Rabaneque Hernández" 2 => "J. Armesto Gómez" 3 => "E. García Arilla" 4 => "M. Izuel Rami" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Neurología" "fecha" => "2007" "volumen" => "22" "paginaInicial" => "275" "paginaFinal" => "284" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17508301" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0340" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Variabilidad y tendencias en el uso de fármacos contra la demencia. Estimación de la prevalencia de la enfermedad de Alzheimer en Castilla-La Mancha" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.J. Criado-Alvarez" 1 => "C. Romo Barrientos" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Neurología" "fecha" => "2010" "volumen" => "25" "paginaInicial" => "234" "paginaFinal" => "238" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20609301" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0345" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnóstico y consumo de fármacos para la enfermedad de Alzheimer en el País Vasco, Informe de Evaluación de Tecnologías Sanitarias: No EKU 12-03" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G. Villanueva" 1 => "M. López de Argumedo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2012" "editorial" => "Departamento de Sanidad y Consumo" "editorialLocalizacion" => "Gobierno Vasco" ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0350" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Eight-year prescription trends of memantine and cholinesterase inhibitors among persons 65 years and older in Germany" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "F. Hoffmann" 1 => "H. van den Bussche" 2 => "G. Glaeske" 3 => "H. Kaduszkiewicz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/YIC.0b013e3283339496" "Revista" => array:6 [ "tituloSerie" => "Int Clin Psychopharmacol" "fecha" => "2010" "volumen" => "25" "paginaInicial" => "29" "paginaFinal" => "36" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19934763" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0355" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:1 [ "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:2 [ "titulo" => "Drug Consumption in Norway 2008–2012 (Legemiddelforbruket i Norge 2008-2012)" "serieFecha" => "2013" ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0360" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:1 [ "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "titulo" => "Subgrupos ATC y principios activos de mayor consumo en el Sistema Nacional de Salud en 2010" "tituloSerie" => "Inf Ter Sist Nac Salud" "fecha" => "2011" "volumen" => "35" "paginaInicial" => "124" "paginaFinal" => "128" ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0365" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalencia de uso de fármacos para el tratamiento de la enfermedad de Alzheimer y su evolución temporal: un estudio descriptivo con la base de datos de atención primaria BIFAP" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J. Bonis Sanz" 1 => "M.C. de Hoyos Alonso" 2 => "A. Llorente García" 3 => "M. Gil García" 4 => "D. Montero Corominas" 5 => "F. de Abajo Iglesias" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Alzheimer Real Invest Demenc" "fecha" => "2013" "volumen" => "54" "paginaInicial" => "20" "paginaFinal" => "27" ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0370" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Farmacoepidemiología. Estudios de utilización de medicamentos. Parte I: concepto y metodología" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "F. Alvarez Luna" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Seguim Farm" "fecha" => "2004" "volumen" => "23" "paginaInicial" => "129" "paginaFinal" => "136" ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0375" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Agencia Española de Medicamentos y Productos Sanitarios-Medicamentos de uso humano. Observatorio del Uso de Medicamentos de la AEMPS. Available from: <a href="http://www.aemps.gob.es/medicamentosUsoHumano/observatorio/home.htm">http://www.aemps.gob.es/medicamentosUsoHumano/observatorio/home.htm</a> [accessed 06.10.13]" ] ] ] 30 => array:3 [ "identificador" => "bib0380" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "WHO Collaborating Centre for Drug Statistics Methodology. Complete ATC/DDD Index 2012. Available from: <a href="http://www.whocc.no/atc_ddd_index/?code=N06D">http://www.whocc.no/atc_ddd_index/?code=N06D</a> [accessed 16.09.13]." ] ] ] 31 => array:3 [ "identificador" => "bib0385" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "titulo" => "Nomenclátor Digitalis" ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:2 [ "fecha" => "2011" "editorial" => "Ministerio de Sanidad, Servicios sociales e igualdad" ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0390" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Utilización de los inhibidores de la acetilcolinesterasa y la memantina para el tratamiento clínico de la demencia tipo Alzheimer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Portela Romero" 1 => "J. Pombo Romero" 2 => "R. Bugarín González" 3 => "M. Tasende Souto" 4 => "S. Represa Veiga" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Esp Salud Pública" "fecha" => "2005" "volumen" => "79" "paginaInicial" => "665" "paginaFinal" => "672" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16457058" "web" => "Medline" ] ] ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0395" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Atención a los pacientes con demencia en Atención Primaria de Salud" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E. Tapias Merino" 1 => "M.C. De Hoyos Alonso" 2 => "A. Garrido Barral" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:7 [ "edicion" => "1st ed." "titulo" => "Libro Blanco sobre la demencia y enfermedad de Alzheimer en la Comunidad de Madrid" "fecha" => "2005" "paginaInicial" => "27" "paginaFinal" => "43" "editorial" => "Siglo SL" "editorialLocalizacion" => "Madrid" ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0400" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison of cholinesterase inhibitor utilization patterns and associated health care costs in Alzheimer's disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "L. Mucha" 1 => "S. Shaohung" 2 => "B. Cuffel" 3 => "T. McRae" 4 => "T.L. Mark" 5 => "M. Del Valle" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.18553/jmcp.2008.14.5.451" "Revista" => array:6 [ "tituloSerie" => "J Manag Care Pharm JMCP" "fecha" => "2008" "volumen" => "14" "paginaInicial" => "451" "paginaFinal" => "461" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18597574" "web" => "Medline" ] ] ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0405" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prescribing of drugs for Alzheimer's disease: a South African database analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "I. Truter" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Int Psychogeriatr IPA" "fecha" => "2010" "volumen" => "22" "paginaInicial" => "264" "paginaFinal" => "269" ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0410" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Variability in the prescription of cholinesterase inhibitors and memantine" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "I. Villar-Fernández" 1 => "L. Bjerrum" 2 => "C. Feja" 3 => "M.J. Rabanaque" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000253845" "Revista" => array:6 [ "tituloSerie" => "Dement Geriatr Cogn Disord" "fecha" => "2009" "volumen" => "28" "paginaInicial" => "373" "paginaFinal" => "379" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19887800" "web" => "Medline" ] ] ] ] ] ] ] ] 37 => array:3 [ "identificador" => "bib0415" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalencia de demencia y de sus subtipos principales en sujetos mayores de 65 años: efecto de la educación y ocupación. Estudio Toledo" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F.J. García García" 1 => "M.I. Sánchez Ayala" 2 => "A. Pérez Martín" 3 => "E. Martín Correa" 4 => "C. Marsal Alonso" 5 => "G. Rodríguez Ferrer" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2001" "volumen" => "116" "paginaInicial" => "401" "paginaFinal" => "407" ] ] ] ] ] ] 38 => array:3 [ "identificador" => "bib0420" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Consistency of clinical diagnosis of dementia in NEDICES: a population-based longitudinal study in Spain" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Bermejo-Pareja" 1 => "J. Benito-León" 2 => "S. Vega" 3 => "J. Olazarán" 4 => "M. de Toledo" 5 => "J. Díaz-Guzmán" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/0891988709335794" "Revista" => array:6 [ "tituloSerie" => "J Geriatr Psychiatry Neurol" "fecha" => "2009" "volumen" => "22" "paginaInicial" => "246" "paginaFinal" => "255" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19417217" "web" => "Medline" ] ] ] ] ] ] ] ] 39 => array:3 [ "identificador" => "bib0425" "etiqueta" => "40" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Análisis de la utilización de fármacos específicos para la enfermedad de Alzheimer en Aragón" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "I. Villar Fernández" 1 => "M.J. Rabanaque Hernández" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:1 [ "fecha" => "2008" ] ] ] ] ] ] 40 => array:3 [ "identificador" => "bib0430" "etiqueta" => "41" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalencia de demencia en pacientes institucionalizados: estudio RESYDEM" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R. López Mongil" 1 => "J.A. López Trigo" 2 => "F.J. Castrodeza Sanz" 3 => "S. Tamames Gómez" 4 => "T. León Colombo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Esp Geriatría Gerontol" "fecha" => "2009" "volumen" => "44" "paginaInicial" => "5" "paginaFinal" => "11" ] ] ] ] ] ] 41 => array:3 [ "identificador" => "bib0435" "etiqueta" => "42" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cholinesterase inhibitor and memantine use in newly admitted nursing home residents with dementia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C. Parsons" 1 => "B.A. Briesacher" 2 => "J.L. Givens" 3 => "Y. Chen" 4 => "J. Tjia" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1532-5415.2011.03478.x" "Revista" => array:6 [ "tituloSerie" => "J Am Geriatr Soc" "fecha" => "2011" "volumen" => "59" "paginaInicial" => "1253" "paginaFinal" => "1259" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21668913" "web" => "Medline" ] ] ] ] ] ] ] ] 42 => array:3 [ "identificador" => "bib0440" "etiqueta" => "43" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Ministerio de Sanidad, Servicios Sociales e Igualdad. Datos de Facturación de Recetas Médicas del Sistema Nacional de Salud (CC.AA. e Ingesa). Available from: <a href="http://www.msssi.gob.es/profesionales/farmacia/datos/home.htm">http://www.msssi.gob.es/profesionales/farmacia/datos/home.htm</a> [accessed 06.10.13]." ] ] ] 43 => array:3 [ "identificador" => "bib0445" "etiqueta" => "44" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Consulta interactiva del Sistema Nacional de Salud. Available from: <a href="http://pestadistico.inteligenciadegestion.msssi.es/">http://pestadistico.inteligenciadegestion.msssi.es/</a> [accessed 22.09.13]." ] ] ] 44 => array:3 [ "identificador" => "bib0450" "etiqueta" => "45" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Disposición 14021 del BOE n.° 200 del 2011-BOE-A-2011-14021.pdf. Available from: <a href="http://www.boe.es/boe/dias/2011/08/20/pdfs/BOE-A-2011-14021.pdf">http://www.boe.es/boe/dias/2011/08/20/pdfs/BOE-A-2011-14021.pdf</a> [accessed 27.09.13]." ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack183660" "titulo" => "Acknowledgements" "texto" => "<p id="par0210" class="elsevierStylePara elsevierViewall">Directorate General for Pharmacy and Healthcare Products, Region of Madrid.</p> <p id="par0215" class="elsevierStylePara elsevierViewall">Juan José de la Cruz Troca, Universidad Autónoma de Madrid.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/21735808/0000003000000007/v1_201508210125/S2173580815001042/v1_201508210125/en/main.assets" "Apartado" => array:4 [ "identificador" => "9491" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original Articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735808/0000003000000007/v1_201508210125/S2173580815001042/v1_201508210125/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580815001042?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 22 | 13 | 35 |
| 2024 September | 63 | 9 | 72 |
| 2024 August | 47 | 5 | 52 |
| 2024 July | 34 | 4 | 38 |
| 2024 June | 28 | 8 | 36 |
| 2024 May | 33 | 3 | 36 |
| 2024 April | 42 | 7 | 49 |
| 2024 March | 23 | 8 | 31 |
| 2024 February | 36 | 15 | 51 |
| 2024 January | 40 | 10 | 50 |
| 2023 December | 32 | 9 | 41 |
| 2023 November | 14 | 7 | 21 |
| 2023 October | 28 | 13 | 41 |
| 2023 September | 11 | 7 | 18 |
| 2023 August | 14 | 7 | 21 |
| 2023 July | 15 | 11 | 26 |
| 2023 June | 33 | 6 | 39 |
| 2023 May | 44 | 4 | 48 |
| 2023 April | 45 | 5 | 50 |
| 2023 March | 34 | 2 | 36 |
| 2023 February | 28 | 5 | 33 |
| 2023 January | 36 | 5 | 41 |
| 2022 December | 17 | 9 | 26 |
| 2022 November | 20 | 13 | 33 |
| 2022 October | 26 | 13 | 39 |
| 2022 September | 21 | 11 | 32 |
| 2022 August | 21 | 14 | 35 |
| 2022 July | 18 | 13 | 31 |
| 2022 June | 18 | 8 | 26 |
| 2022 May | 30 | 11 | 41 |
| 2022 April | 36 | 11 | 47 |
| 2022 March | 26 | 11 | 37 |
| 2022 February | 15 | 12 | 27 |
| 2022 January | 21 | 17 | 38 |
| 2021 December | 21 | 12 | 33 |
| 2021 November | 40 | 12 | 52 |
| 2021 October | 31 | 14 | 45 |
| 2021 September | 31 | 23 | 54 |
| 2021 August | 30 | 23 | 53 |
| 2021 July | 30 | 10 | 40 |
| 2021 June | 27 | 10 | 37 |
| 2021 May | 22 | 21 | 43 |
| 2021 April | 57 | 32 | 89 |
| 2021 March | 45 | 10 | 55 |
| 2021 February | 20 | 15 | 35 |
| 2021 January | 19 | 8 | 27 |
| 2020 December | 42 | 7 | 49 |
| 2020 November | 64 | 5 | 69 |
| 2020 October | 41 | 6 | 47 |
| 2020 September | 34 | 12 | 46 |
| 2020 August | 37 | 6 | 43 |
| 2020 July | 31 | 8 | 39 |
| 2020 June | 24 | 12 | 36 |
| 2020 May | 32 | 14 | 46 |
| 2020 April | 28 | 4 | 32 |
| 2020 March | 21 | 4 | 25 |
| 2020 February | 28 | 8 | 36 |
| 2020 January | 23 | 8 | 31 |
| 2019 December | 54 | 11 | 65 |
| 2019 November | 32 | 10 | 42 |
| 2019 October | 31 | 8 | 39 |
| 2019 September | 22 | 7 | 29 |
| 2019 August | 19 | 4 | 23 |
| 2019 July | 27 | 10 | 37 |
| 2019 June | 36 | 31 | 67 |
| 2019 May | 96 | 59 | 155 |
| 2019 April | 58 | 14 | 72 |
| 2019 March | 22 | 12 | 34 |
| 2019 February | 42 | 15 | 57 |
| 2019 January | 26 | 2 | 28 |
| 2018 December | 44 | 4 | 48 |
| 2018 November | 47 | 1 | 48 |
| 2018 October | 69 | 6 | 75 |
| 2018 September | 45 | 9 | 54 |
| 2018 August | 14 | 1 | 15 |
| 2018 July | 9 | 7 | 16 |
| 2018 June | 9 | 1 | 10 |
| 2018 May | 7 | 8 | 15 |
| 2018 April | 9 | 8 | 17 |
| 2018 March | 9 | 2 | 11 |
| 2018 February | 22 | 3 | 25 |
| 2018 January | 15 | 4 | 19 |
| 2017 December | 23 | 3 | 26 |
| 2017 November | 19 | 5 | 24 |
| 2017 October | 14 | 5 | 19 |
| 2017 September | 19 | 6 | 25 |
| 2017 August | 16 | 3 | 19 |
| 2017 July | 11 | 1 | 12 |
| 2017 June | 16 | 4 | 20 |
| 2017 May | 25 | 3 | 28 |
| 2017 April | 21 | 7 | 28 |
| 2017 March | 18 | 12 | 30 |
| 2017 February | 35 | 3 | 38 |
| 2017 January | 12 | 3 | 15 |
| 2016 December | 30 | 4 | 34 |
| 2016 November | 25 | 4 | 29 |
| 2016 October | 36 | 8 | 44 |
| 2016 September | 37 | 8 | 45 |
| 2016 August | 45 | 3 | 48 |
| 2016 July | 19 | 1 | 20 |
| 2016 June | 22 | 7 | 29 |
| 2016 May | 29 | 24 | 53 |
| 2016 April | 12 | 9 | 21 |
| 2016 March | 41 | 15 | 56 |
| 2016 February | 44 | 12 | 56 |
| 2016 January | 38 | 12 | 50 |
| 2015 December | 29 | 12 | 41 |
| 2015 November | 20 | 13 | 33 |
| 2015 October | 16 | 13 | 29 |
| 2015 September | 9 | 4 | 13 |
Show all
