Contributions from the systematic review of economic evaluations: the case of childhood hepatitis A vaccination in Brazil

The aim of this study was to present the contributions of the systematic review of economic evaluations to the development of a national study on childhood hepatitis A vaccination. A literature review was performed in EMBASE, MEDLINE, WOPEC, HealthSTAR, SciELO and LILACS from 1995 to 2010. Most of the studies (8 of 10) showed favorable cost-effectiveness results. Sensitivity analysis indicated that the most important parameters for the results were cost of the vaccine, hepatitis A incidence, and medical costs of the disease. Variability was observed in methodological characteristics and estimates of key variables among the 10 studies reviewed. It is not possible to generalize results or transfer epidemiological estimates of resource utilization and costs associated with hepatitis A to the local context. Systematic review of economic evaluation studies of hepatitis A vaccine demonstrated the need for a national analysis and provided input for the development of a new decision-making model for Brazil.

Identificazione dei fenotipi clinici dell’insufficienza renale cronica che predicono la progressione della malattia. Un’applicazione della tecnica degli alberi decisionali

The primary aim of this dissertation to identify subgroups of patients with chronic kidney disease (CKD) who have a differential risk of progression of illness and the secondary aim is compare 2 equations to estimate the glomerular filtration rate (GFR). To this purpose, the PIRP (Prevention of Progressive Kidney Disease) registry was linked with the dialysis and mortality registries. The outcome of interest is the mean annual variation of GFR, estimated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. A decision tree model was used to subtype CKD patients, based on the non-parametric procedure CHAID (Chi-squared Automatic Interaction Detector). The independent variables of the model include gender, age, diabetes, hypertension, cardiac diseases, body mass index, baseline serum creatinine, haemoglobin, proteinuria, LDL cholesterol, tryglycerides, serum phoshates, glycemia, parathyroid hormone and uricemia. The decision tree model classified patients into 10 terminal nodes using 6 variables (gender, age, proteinuria, diabetes, serum phosphates and ischemic cardiac disease) that predict a differential progression of kidney disease. Specifically, age <=53 year, male gender, proteinuria, diabetes and serum phosphates >3.70 mg/dl predict a faster decrease of GFR, while ischemic cardiac disease predicts a slower decrease. The comparison between GFR estimates obtained using MDRD4 and CKD-EPI equations shows a high percentage agreement (>90%), with modest discrepancies for high and low age and serum creatinine levels. The study results underscore the need for a tight follow-up schedule in patients with age <53, and of patients aged 54 to 67 with diabetes, to try to slow down the progression of the disease. The result also emphasize the effective management of patients aged>67, in whom the estimated decrease in glomerular filtration rate corresponds with the physiological decrease observed in the absence of kidney disease, except for the subgroup of patients with proteinuria, in whom the GFR decline is more pronounced.

Inducible nitric oxide synthase and the effect of aminoguanidine in experimental neonatal meningitis

This study explored the role of inducible nitric oxide (NO) synthase (iNOS) in an infant rat model of group B streptococcal meningitis. Brain iNOS activity increased during meningitis (P < .001), and iNOS was detected by immunocytochemistry in the walls of meningeal vessels and cells of the cerebrospinal fluid (CSF) inflammation. Animals treated with iNOS inhibitor aminoguanidine (AG; 130 mg/kg every 8 h) had reduced NO production (P < .05), higher CSF bacterial titers (P < .05), and increased incidence of seizures (P < .01) compared with untreated infected animals. AG also increased areas of severe hypoperfusion in the cortex (31% +/- 14% in controls vs. 56% +/- 16% in AG; P < .01) and the extent of cortical neuronal injury, both when administered at the time of infection (P < .05) and in established meningitis (P < .02). Thus, NO produced by iNOS may be beneficial in this model of experimental meningitis by reducing cerebral ischemia.

Evaluating the usefulness of soil moisture (forecasts) in streamflow prediction for central Texas

The past decade has brought significant advancements in seasonal climate forecasting. However, water resources decision support and management continues to be based almost entirely on historical observations and does not take advantage of climate forecasts. This study builds on previous work that conditioned streamflow ensemble forecasts on observable climate indicators, such as the El Niño-Southern Oscillation (ENSO) and the Pacific Decadal Oscillation (PDO) for use in a decision support model for the Highland Lakes multi-reservoir system in central Texas operated by the Lower Colorado River Authority (LCRA). In the current study, seasonal soil moisture is explored as a climate indicator and predictor of annual streamflow for the LCRA region. The main purpose of this study is to evaluate the correlation of fractional soil moisture with streamflow using the 1950-2000 Variable Infiltration Capacity (VIC) Retrospective Land Surface Data Set over the LCRA region. Correlations were determined by examining different annual and seasonal combinations of VIC modeled fractional soil moisture and observed streamflow. The applicability of the VIC Retrospective Land Surface Data Set as a data source for this study is tested along with establishing and analyzing patterns of climatology for the watershed study area using the selected data source (VIC model) and historical data. Correlation results showed potential for the use of soil moisture as a predictor of streamflow over the LCRA region. This was evident by the good correlations found between seasonal soil moisture and seasonal streamflow during coincident seasons as well as between seasonal and annual soil moisture with annual streamflow during coincident years. With the findings of good correlation between seasonal soil moisture from the VIC Retrospective Land Surface Data Set with observed annual streamflow presented in this study, future research would evaluate the application of NOAA Climate Prediction Center (CPC) forecasts of soil moisture in predicting annual streamflow for use in the decision support model for the LCRA.

Cost-effectiveness of ticagrelor and generic clopidogrel in patients with acute coronary syndrome in Switzerland

QUESTION UNDER STUDY The aim of this study was to evaluate the cost-effectiveness of ticagrelor and generic clopidogrel as add-on therapy to acetylsalicylic acid (ASA) in patients with acute coronary syndrome (ACS), from a Swiss perspective. METHODS Based on the PLATelet inhibition and patient Outcomes (PLATO) trial, one-year mean healthcare costs per patient treated with ticagrelor or generic clopidogrel were analysed from a payer perspective in 2011. A two-part decision-analytic model estimated treatment costs, quality-adjusted life years (QALYs), life years and the cost-effectiveness of ticagrelor and generic clopidogrel in patients with ACS up to a lifetime at a discount of 2.5% per annum. Sensitivity analyses were performed. RESULTS Over a patient's lifetime, treatment with ticagrelor generates an additional 0.1694 QALYs and 0.1999 life years at a cost of CHF 260 compared with generic clopidogrel. This results in an Incremental Cost Effectiveness Ratio (ICER) of CHF 1,536 per QALY and CHF 1,301 per life year gained. Ticagrelor dominated generic clopidogrel over the five-year and one-year periods with treatment generating cost savings of CHF 224 and 372 while gaining 0.0461 and 0.0051 QALYs and moreover 0.0517 and 0.0062 life years, respectively. Univariate sensitivity analyses confirmed the dominant position of ticagrelor in the first five years and probabilistic sensitivity analyses showed a high probability of cost-effectiveness over a lifetime. CONCLUSION During the first five years after ACS, treatment with ticagrelor dominates generic clopidogrel in Switzerland. Over a patient's lifetime, ticagrelor is highly cost-effective compared with generic clopidogrel, proven by ICERs significantly below commonly accepted willingness-to-pay thresholds.

Cost-effectiveness analysis of paclitaxel-coated balloons for endovascular therapy of femoropopliteal arterial obstructions.

PURPOSE To explore the cost-effectiveness of using drug-eluting balloon (DEB) angioplasty for the treatment of femoropopliteal arterial lesions, which has been shown to significantly lower the rates of target lesion revascularization (TLR) compared with standard balloon angioplasty (BA). METHODS A simplified decision-analytic model based on TLR rates reported in the literature was applied to baseline and follow-up costs associated with in-hospital patient treatment during 1 year of follow-up. Costs were expressed in Swiss Francs (sFr) and calculated per 100 patients treated. Budgets were analyzed in the context of current SwissDRG reimbursement figures and calculated from two different perspectives: a general budget on total treatment costs (third-party healthcare payer) as well as a budget focusing on the physician/facility provider perspective. RESULTS After 1 year, use of DEB was associated with substantially lower total inpatient treatment costs when compared with BA (sFr 861,916 vs. sFr 951,877) despite the need for a greater investment at baseline related to higher prices for DEBs. In the absence of dedicated reimbursement incentives, however, use of DEB was shown to be the financially less favorable treatment approach from the physician/facility provider perspective (12-month total earnings: sFr 179,238 vs. sFr 333,678). CONCLUSION Use of DEBs may be cost-effective through prevention of TLR at 1 year of follow-up. The introduction of dedicated financial incentives aimed at improving DEB reimbursements may help lower total healthcare costs.

Next-to-Minimal SOFTSUSY

We describe an extension to the SOFTSUSY program that provides for the calculation of the sparticle spectrum in the Next-to-Minimal Supersymmetric Standard Model (NMSSM), where a chiral superfield that is a singlet of the Standard Model gauge group is added to the Minimal Supersymmetric Standard Model (MSSM) fields. Often, a Z3 symmetry is imposed upon the model. SOFTSUSY can calculate the spectrum in this case as well as the case where general Z3 violating (denoted as ) terms are added to the soft supersymmetry breaking terms and the superpotential. The user provides a theoretical boundary condition for the couplings and mass terms of the singlet. Radiative electroweak symmetry breaking data along with electroweak and CKM matrix data are used as weak-scale boundary conditions. The renormalisation group equations are solved numerically between the weak scale and a high energy scale using a nested iterative algorithm. This paper serves as a manual to the NMSSM mode of the program, detailing the approximations and conventions used.

Reliability of operational data from pig herds and performance ratings by veterinarians and pig farmers collected during telephone interviews for the evaluation of a PCV2 piglet vaccination

BackgroundThe aim of the present study was to evaluate the feasibility of using a telephone survey in gaining an understanding of the possible herd and management factors influencing the performance (i.e. safety and efficacy) of a vaccine against porcine circovirus type 2 (PCV2) in a large number of herds and to estimate customers¿ satisfaction.ResultsDatasets from 227 pig herds that currently applied or have applied a PCV2 vaccine were analysed. Since 1-, 2- and 3-site production systems were surveyed, the herds were allocated in one of two subsets, where only applicable variables out of 180 were analysed. Group 1 was comprised of herds with sows, suckling pigs and nursery pigs, whereas herds in Group 2 in all cases kept fattening pigs. Overall 14 variables evaluating the subjective satisfaction with one particular PCV2 vaccine were comingled to an abstract dependent variable for further models, which was characterized by a binary outcome from a cluster analysis: good/excellent satisfaction (green cluster) and moderate satisfaction (red cluster). The other 166 variables comprised information about diagnostics, vaccination, housing, management, were considered as independent variables. In Group 1, herds using the vaccine due to recognised PCV2 related health problems (wasting, mortality or porcine dermatitis and nephropathy syndrome) had a 2.4-fold increased chance (1/OR) of belonging to the green cluster. In the final model for Group 1, the diagnosis of diseases other than PCV2, the reason for vaccine administration being other than PCV2-associated diseases and using a single injection of iron had significant influence on allocating into the green cluster (P¿<¿0.05). In Group 2, only unchanged time or delay of time of vaccination influenced the satisfaction (P¿<¿0.05).ConclusionThe methodology and statistical approach used in this study were feasible to scientifically assess ¿satisfaction¿, and to determine factors influencing farmers¿ and vets¿ opinion about the safety and efficacy of a new vaccine.

Beyond sexist beliefs: How do people decide to use gender-inclusive language?

When people use generic masculine language instead of more gender-inclusive forms, they communicate gender stereotypes and sometimes exclusion of women from certain social roles. Past research related gender-inclusive language use to sexist beliefs and attitudes. Given that this aspect of language use may be transparent to users, it is unclear whether people explicitly act on these beliefs when using gender-exclusive language forms or whether these are more implicit, habitual patterns. In two studies with German-speaking participants, we showed that spontaneous use of gender-inclusive personal nouns is guided by explicitly favorable intentions as well as habitual processes involving past use of such language. Further indicating the joint influence of deliberate and habitual processes, Study 2 revealed that language-use intentions are embedded in explicit sexist ideologies. As anticipated in our decision-making model, the effects of sexist beliefs on language emerged through deliberate mechanisms involving attitudes and intentions.

Transfer Pricing in the Decentralized Multinational Corporation

This paper considers how the multinational corporation's transfer price responds to changes in international corporate effective tax rates. It extends the decentralized decision-making analysis of transfer pricing in the context of different tax rates. It adopts and extends Bond's (1980) model of the decentralized multinational corporation that assumes centralized transfer pricing. The direction of transfer price change is as expected, while the magnitude of change is likely to be less than predicted by the Horst (1971), centralized decision-making model. The paper extends the model further by assuming negotiated transfer pricing, where the analysis is partitioned into perfect and imperfect information cases. The negotiated transfer pricing result reverts to the Horst (1971), or centralized decision-making, result, under perfect information. Under imperfect information, the centralized decision-making result obtains when top management successfully informs division general managers or it successfully implements a non-monetary reward scheme to encourage division general managers to cooperate. Under simplifying assumptions, centralized decision-making dominates decentralized decision-making, while negotiated transfer pricing weakly dominates centralized transfer pricing.

The high cost of inappropriate empiric treatment of presumed Clostridium difficile-associated diarrhea

The Center for Disease Control and Prevention (CDC) estimates that more than 2 million patients annually acquire an infection while hospitalized in U.S. hospitals for other health problems, and that 88,000 die as a direct or indirect result of these infections. Infection with Clostridium difficile is the most important common cause of health care associated infectious diarrhea in industrialized countries. The purpose of this study was to explore the cost of current treatment practice of beginning empiric metronidazole treatment for hospitalized patients with diarrhea prior to identification of an infectious agent. The records of 70 hospitalized patients were retrospectively analyzed to determine the pharmacologic treatment, laboratory testing, and radiographic studies ordered and the median cost for each of these was determined. All patients in the study were tested for C. difficile and concurrently started on empiric metronidazole. The median direct cost for metronidazole was $7.25 per patient (95% CI 5.00, 12.721). The median direct cost for laboratory charges was $468.00 (95% CI 339.26, 552.58) and for radiology the median direct cost was $970.00 (95% CI 738.00, 3406.91). Indirect costs, which are far greater than direct costs, were not studied. At St. Luke's, if every hospitalized patient with diarrhea was empirically treated with metronidazole at a median cost of $7.25, the annual direct cost is estimated to be over $9,000.00 plus uncalculated indirect costs. In the U.S., the estimated annual direct cost may be as much as $21,750,000.00, plus indirect costs. ^ An unexpected and significant finding of this study was the inconsistency in testing and treatment of patients with health care associated diarrhea. A best-practice model for C. difficile testing and treatment was not found in the literature review. In addition to the cost savings gained by not routinely beginning empiric treatment with metronidazole, significant savings and improvement in patient care may result from a more consistent approach to the diagnosis and treatment of all patients with health care associated diarrhea. A decision tree model for C. difficile testing and treatment is proposed, but further research is needed to evaluate the decision arms before a validated best practice model can be proposed. ^

Folate pathway polymorphisms and neuropsychological impairment after leukemia therapy

Neuropsychological impairment occurs in 20%-40% of childhood acute lymphoblastic leukemia (ALL) survivors, possibly mediated by folate depletion following methotrexate chemotherapy. We evaluated the relationship between two folate pathway polymorphisms and neuropsychological impairment after childhood ALL chemotherapy. Eighty-six childhood ALL survivors were recruited between 2004-2007 at Texas Children's Hospital after exclusion for central nervous system leukemia, cranial irradiation, and age<1 year at diagnosis. Neuropsychological evaluation at a median of 5.3 years off therapy included a parental questionnaire and the following child performance measures: Trail Making Tests A and B, Grooved Pegboard Test Dominant-Hand and Nondominant-Hand, and Digit Span subtest. We performed genotyping for polymorphisms in two folate pathway genes: reduced folate carrier (RFC1 80G>A, rs1051266) and dihydrofolate reductase (DHFR Intron-1 19bp deletion). Fisher exact test, logistic regression, Student's t-test, and ANOVA were used to compare neuropsychological test scores by genotype, using a dominant model to group genotypes. In univariate analysis, survivors with cumulative methotrexate exposure ≥9000 mg/m2 had an increased risk of attention disorder (OR=6.2, 95% CI 1.2 – 31.3), compared to survivors with methotrexate exposure <9000 mg/m2. On average, female survivors scored 8.5 points higher than males on the Digit Span subtest, a test of working memory (p=0.02). The RFC1 80G>A and DHFR Intron-1 deletion polymorphisms were not related to attention disorder or impairment on tests of attention, processing speed, fine motor speed, or memory. These data imply a strong relationship between methotrexate dose intensity and impairment in attention after childhood ALL therapy. We did not find an association between the RFC1 80G>A or DHFR Intron-1 deletion polymorphisms and long-term neuropsychological impairment in childhood ALL survivors.^

Contribution of re-regulation reservoirs considering pumping capability to environmentally friendly hydropower operation

Environmental constraints imposed on hydropoweroperation are usually given in the form of minimum environmental flows and maximum and minimum rates of change of flows, or ramp rates. One solution proposed to mitigate the environmental impact caused by the flows discharged by a hydropower plant while reducing the economic impact of the above-mentioned constraints consists in building a re-regulationreservoir, or afterbay, downstream of the power plant. Adding pumpingcapability between the re-regulationreservoir and the main one could contribute both to reducing the size of the re-regulationreservoir, with the consequent environmental improvement, and to improving the economic feasibility of the project, always fulfilling the environmental constraints imposed to hydropoweroperation. The objective of this paper is studying the contribution of a re-regulationreservoir to fulfilling the environmental constraints while reducing the economic impact of said constraints. For that purpose, a revenue-driven optimization model based on mixed integer linear programming is used. Additionally, the advantages of adding pumpingcapability are analysed. In order to illustrate the applicability of the methodology, a case study based on a real hydropower plant is presented

Balancing groundwater conservation and rural livelihoods under water and climate uncertainties: An integrated hydro-economic modeling framework

In arid countries worldwide, social conflicts between irrigation-based human development and the conservation of aquatic ecosystems are widespread and attract many public debates. This research focuses on the analysis of water and agricultural policies aimed at conserving groundwater resources and maintaining rurallivelihoods in a basin in Spain's central arid region. Intensive groundwater mining for irrigation has caused overexploitation of the basin's large aquifer, the degradation of reputed wetlands and has given rise to notable social conflicts over the years. With the aim of tackling the multifaceted socio-ecological interactions of complex water systems, the methodology used in this study consists in a novel integration into a common platform of an economic optimization model and a hydrology model WEAP (Water Evaluation And Planning system). This robust tool is used to analyze the spatial and temporal effects of different water and agricultural policies under different climate scenarios. It permits the prediction of different climate and policy outcomes across farm types (water stress impacts and adaptation), at basin's level (aquifer recovery), and along the policies’ implementation horizon (short and long run). Results show that the region's current quota-based water policies may contribute to reduce water consumption in the farms but will not be able to recover the aquifer and will inflict income losses to the rural communities. This situation would worsen in case of drought. Economies of scale and technology are evidenced as larger farms with cropping diversification and those equipped with modern irrigation will better adapt to water stress conditions. However, the long-term sustainability of the aquifer and the maintenance of rurallivelihoods will be attained only if additional policy measures are put in place such as the control of illegal abstractions and the establishing of a water bank. Within the policy domain, the research contributes to the new sustainable development strategy of the EU by concluding that, in water-scarce regions, effective integration of water and agricultural policies is essential for achieving the water protection objectives of the EU policies. Therefore, the design and enforcement of well-balanced region-specific polices is a major task faced by policy makers for achieving successful water management that will ensure nature protection and human development at tolerable social costs. From a methodological perspective, this research initiative contributes to better address hydrological questions as well as economic and social issues in complex water and human systems. Its integrated vision provides a valuable illustration to inform water policy and management decisions within contexts of water-related conflicts worldwide.

Propuesta metodológica para la identificación de medidas de adaptación al cambio climático en sistemas de recursos hídricos

Esta tesis realiza una contribución metodológica en el estudio de medidas de adaptación potencialmente adecuadas a largo plazo, donde los sistemas de recursos hídricos experimentan fuertes presiones debido a los efectos del cambio climático. Esta metodología integra el análisis físico del sistema, basándose en el uso de indicadores que valoran el comportamiento de éste, y el análisis económico mediante el uso del valor del agua. El procedimiento metodológico inicia con la construcción de un conjunto de escenarios futuros, que capturan por un lado las características de variabilidad de las aportaciones de diversos modelos climáticos y, por otro, las características hidrológicas de la zona de estudio. Las zonas de estudio seleccionadas fueron las cuencas del Guadalquivir, Duero y Ebro y se utilizaron como datos observados las series de escorrentía en régimen natural estimadas por el modelo SIMPA que está calibrado en la totalidad del territorio español. Estas series observadas corresponden al periodo 1961-1990. Los escenarios futuros construidos representan el periodo 2071-2100. La identificación de medidas de adaptación se apoyó en el uso de indicadores que sean capaces de caracterizar el comportamiento de un sistema de recursos hídricos frente a los efectos del cambio climático. Para ello se seleccionaron los indicadores de calidad de servicio (I1) y de confiabilidad de la demanda (I2) propuestos por Martin-Carrasco et al. (2012). Estos indicadores valoran el comportamiento de un sistema mediante la identificación de los problemas de escasez de agua que presente, y requieren para su cuantificación el uso de un modelo de optimización. Para este estudio se ha trabajado con el modelo de optimización OPTIGES. La determinación de estos indicadores fue realizada para análisis a corto plazo donde los efectos del cambio climático no son de relevancia, por lo que fue necesario analizar su capacidad para ser usados en sistemas afectados por dichos efectos. Para este análisis se seleccionaron tres cuencas españolas: Guadalquivir, Duero y Ebro, determinándose que I2 no es adecuado para este tipo de escenarios. Por ello se propuso un nuevo indicador “Indicador de calidad de servicio bajo cambio climático” (I2p) que mantiene los mismos criterios de valoración que I2 pero que responde mejor bajo fuertes reducciones de aportaciones producto del cambio climático. La metodología propuesta para la identificación de medidas de adaptación se basa en un proceso iterativo en el cual se van afectando diversos elementos que conforman el esquema del sistema bajo acciones de gestión previamente identificadas, hasta llegar a un comportamiento óptimo dado por el gestor. Las mejoras de estas afectaciones son cuantificadas mediante los indicadores I1 e I2p, y de este conjunto de valores se selecciona la que se acerca más al comportamiento óptimo. Debido a la extensa cantidad de información manejada en este análisis, se desarrolló una herramienta de cálculo automatizada en Matlab. El proceso seguido por esta herramienta es: (i) Ejecución del modelo OPTIGES para las diferentes modificaciones por acciones de gestión; (ii) Cálculo de los valores de I1 e I2p para cada una de estas afectaciones; y (iii) Selección de la mejor opción. Este proceso se repite hasta llegar al comportamiento óptimo buscado, permitiendo la identificación de las medidas de adaptación mas adecuadas. La aplicación de la metodología para la identificación de medidas de adaptación se realizó en la cuenca del Guadalquivir, por ser de las tres cuencas analizadas bajo los indicadores I1 e I2p la que presenta los problemas más serios de escasez de agua. Para la identificación de medidas de adaptación se analizaron dos acciones de gestión: 1) incremento de los volúmenes de regulación y 2) reducción de las demandas de riego, primero bajo la valoración del comportamiento físico del sistema (análisis de sensibilidad) permitiendo identificar que la primera acción de gestión no genera cambios importantes en el comportamiento del sistema, que si se presentan bajo la segunda acción. Posteriormente, con la acción que genera cambios importantes en el comportamiento del sistema (segunda acción) se identificaron las medidas de adaptación más adecuadas, mediante el análisis físico y económico del sistema. Se concluyó que en la cuenca del Guadalquivir, la acción de reducción de las demandas de riego permite minimizar e incluso eliminar los problemas de escasez de agua que se presentarían a futuro bajo diferentes proyecciones hidrológicas, aunque estas mejoras implicarían fuertes reducciones en dichas demandas. Siendo las demandas más afectadas aquellas ubicadas en cabecera de cuenca. Los criterios para la reducción de las demandas se encuentran en función de las productividades y garantías con las que son atendidas dichas demandas. This thesis makes a methodological contribution to the study of potentially suitable adaptation measures in the long term, where water resource systems undergo strong pressure due to the effects of climate change. This methodology integrates the physical analysis of the system, by the use of indicators which assess its behavior, and the economic analysis by the use of the value of water. The methodological procedure begins with the building of a set of future scenarios that capture, by one hand, the characteristics and variability of the streamflow of various climate models and, on the other hand, the hydrological characteristics of the study area. The study areas chosen were the Guadalquivir, Ebro and Duero basins, and as observed data where used runoff series in natural regimen estimated by the SIMPA model, which is calibrated in the whole Spanish territory. The observed series are for the 1961-1990 period. The future scenarios built represent the 2071-2100 periods. The identification of adaptation measures relied on the use of indicators that were able of characterize the behavior of one water resource system facing the effects of climate change. Because of that, the Demand Satisfaction Index (I1) and the Demand Reliability Index (I2) proposed by Martin-Carrasco et al. (2012) were selected. These indicators assess the behavior of a system by identifying the water scarcity problems that it presents, and require in order to be quantified the use of one optimization model. For this study the OPTIGES optimization model has been used. The determination of the indicators was made for the short-term analysis where the climates change effect are not relevant, so it was necessary to analyze their capability to be used in systems affected by those these. For this analysis three Spanish basins were selected: Guadalquivir, Duero and Ebro. It was determined that the indicator I2 is not suitable for this type of scenario. It was proposed a new indicator called “Demand Reliability Index under climate change” (I2p), which keeps the same assessment criteria than I2, but responsive under heavy reductions of streamflow due to climate change. The proposed methodology for identifying adaptation measures is based on an iterative process, in which the different elements of the system´s schema are affected by previously defined management actions, until reach an optimal behavior given by the manager. The improvements of affectations are measured by indicators I1 e I2p, and from this set of values it is selected the affectation that is closer to the optimal behavior. Due to the large amount of information managed in this analysis, it was developed an automatic calculation tool in Matlab. The process followed by this tool is: Firstly, it executes the OPTIGES model for the different modifications by management actions; secondly, it calculates the values of I1 e I2p for each of these affectations; and finally it chooses the best option. This process is performed for the different iterations that are required until reach the optimal behavior, allowing to identify the most appropriate adaptation measured. The application of the methodology for the identification of adaptation measures was conducted in the Guadalquivir basin, due to this was from the three basins analyzed under the indicators I1 e I2p, which presents the most serious problems of water scarcity. For the identification of adaptation measures there were analyzed two management actions: 1) To increase the regulation volumes, and 2) to reduce the irrigation demands, first under the assessment of the physical behavior of the system (sensibility analysis), allowing to identify that the first management action does not generate significant changes in the system´s behavior, which there are present under the second management action. Afterwards, with the management action that generates significant changes in the system´s behavior (second management action), there were identified the most adequate adaptation measures, through the physical and economic analysis of the system. It was concluded that in the Guadalquivir basin, the action of reduction of irrigation demands allows to minimize or even eliminate the water scarcity problems that could exist in the future under different hydrologic projections, although this improvements should involve strong reductions of the irrigation demands. Being the most affected demands those located in basins head. The criteria for reducing the demands are based on the productivities and reliabilities with which such demands are meet.