bluuebunny/crossref_metadata_2025 huggingface dataset:
Valsartan: come versatilità e tollerabilità possono contribuireal contenimento della spesa sanitaria
Authors: Costa Francesco Vittorio
Published: June 2016

The search for a more specific and complete blockade of the hypertensive effects of angiotensin and of better tolerability than ACE-inhibitors has led to the development of angiotensin II receptor blockers (ARBs). ARBs have been evaluated in several large studies in terms of efficacy and safety in reducing blood pressure, as well as for cardiovascular and renal protection. Among angiotensin II receptor blockers, valsartan and losartan have the greatest number of therapeutic indications. In light of the costs related to cardiovascular disorder valsartan represents a potential long-term health cost saving strategy. Furthermore valsartan shows one of the lowest costs for patient achieving blood pressure goals and the higher level of persistence in its class.
Adherence to treatment and anticoagulation control in vitamin K antagonists-treated patients: an administrative databases analysis in a large Italian population
Authors: Degli Esposti Luca , Sangiorgi Diego , Di Pasquale Giuseppe , Gensini Gian Franco , Iori Ido , Buda Stefano , Degli Esposti Ezio
Published: June 2016

Oral anticoagulant therapy is essential for the treatment and prevention of many thromboembolic disorders. The aim of the present study is to evaluate the level of anticoagulation intensity in patients treated with vitamin K antagonists (VKAs) in a clinical practice setting and to explore the relationship between anticoagulation intensity and adherence to VKA treatment. We conducted a retrospective cohort study using the administrative databases of three Italian Local Health Units. Patients were enrolled if they had filled at least one prescription for VKAs (ATC code B01AA) between January 1st, 2007 and June 30th, 2008. In the same period all determinations of the international normalised ratio (INR) were collected. The parameters evaluated were anticoagulation control and adherence to VKA treatment.The survey showed that only 47.9% and 56.3% of INR determinations, in VKA naïve and established patients respectively, were into the recommended range (2.0-3.0). Moreover, the percentage of INR determination below the recommended range was higher than the percentage of INR determination above the recommended range for both naïve and established patients. Moreover, adherence to VKA treatment was poor both in naïve and established patients and, consequently, anticoagulation control is poor. Also in patients with the highest adherence to VKA treatment, only about 60% of INR determinations were into the recommended range. Our findings evidence that the anticoagulation control in clinical practice settings is still unsatisfactory and it is necessary to evaluate interventions to increase the amount of time at which patients’ INR are within the recommended range.
Cost-effectiveness evaluations of spinal neuromodulation with ziconotide continuous infusion in cancer pain in a real clinical practice
Authors: Zaniolo Orietta , Iannazzo Sergio , Patrucco Gian Piero , Bellini Roberto
Published: June 2016

Introduction and objective: ziconotide is the first-in-class drug of selective N-type voltage-sensitive calcium-channel blockers used to control severe chronic pain. The present study is developed in order to analyze clinical and economical outcomes of spinal neuromodulation with ziconotide continuous infusion in cancer pain in a real clinical practice.Methods: costs and effects of ziconotide are compared with those of traditional neuromodulation with morphine and adjuvant drugs, administered by intrathecal infusion.Effectiveness and resources consumption data were retrospectively collected in 22 patients with severe complex cancer pain followed by one Italian centre from the day of port implantation to drop-out , due to death or consent withdrawal. 11 patients received morphine regimens and the other 11 were treated with ziconotide. The evaluation of the number of days with controlled pain (i.e., with an at least 30% reduction on the Numeric Rating Scale-Pain Intensity, NRSPI) is the primary outcome of the analysis. The evaluated consumed health resources include drugs, visits, port maintenance, and pump recharge and amortization. Current Italian prices, real practice acquisition and remuneration costs borne by the third payer are applied.Results: patients receiving ziconotide lived significantly more days with controlled pain (78% vs 40%; p < 0.05). Average weekly cost is about 232 € for ziconotide and 120 € for morphine; the main driver being the pharmaceutical cost (respectively 81% and 65% of the total). Higher ziconotide acquisition costs are partially offset by minor expenses for adjuvant therapies, as ziconotide-treated patients on average receive a lower number of drugs than those receiving a traditional regimen. The incremental cost for one further day with controlled pain resulted of 42,30 €.Conclusions: ziconotide permits effective treatment of extremely difficult-to-manage pain, with a mild increment of cost, as compared to intrathecal morphine-based therapy.
Valutazione economica dello studio CARDS: un aggiornamento
Authors: De Portu Simona , Montella Sabato , Cortesi Paolo , Menditto Enrica , Mantovani Lorenzo G.
Published: June 2016

Introduction: in the last decades, prevalence and incidence of type II diabetes mellitus have been rapidly growing worldwide. Most recent projections estimate that the number of people affected by diabetes is destined to double in 2030, producing a significant increase of the healthcare expenditure for the management of complications. Prevention of cardiovascular events in diabetes population represents a priority for decision makers, who have to evaluate the cost-effectiveness of therapeutic interventions. Objective: to provide an updated cost-effectiveness evaluation of treating type II diabetes patients with atorvastatin versus placebo, in the light of the imminent price reduction of atorvastatin due to loss of exclusivity and of other therapeutic and hospital costs.
Material and Methods: we derived clinical information from the CARDS study, a randomized, multicenter
clinical trial evaluating efficacy of atorvastatin versus placebo in preventing the occurrence of cardiovascular events in a cohort of type II diabetes patients without previous history of coronary events. A cost-effectiveness analysis in the perspective of the National Healthcare System (SSN) has been performed, under the hypothesis of the imminent price reduction of atorvastatin, due to the loss of exclusivity. Results: after a median follow up of 3.9 years, the number of patients with at least a major cardiovascular event requiring hospitalization was lower in the atorvastatin arm (5.8%) compared to the placebo arm (9.0%; p=0.001). Based on a cohort of 1,000 patients, treatment with atorvastatin permitted to gain 29.28 life years. The incremental cost of adding atorvastatin to the standard therapy amounted to €305,682, and was partially balanced by a cost reduction due to fewer hospitalizations, compared to the placebo arm (€ 168,313). Total direct costs were of €602.186 in the atorvastatin group and of € 464,818 in the placebo group, resulting into an incremental cost-effectiveness ratio of € 4,692 for Life Year Gained (LYG). Conclusion: the present study is an update of a previous economic analysis of the CARDS trial. Under the assumed new cost scenario, the cost-effectiveness profile of treating diabetic patients with atorvastatin becomes highly favourable, and leads to a significant reduction of the cost for Life Year Gained compared to the previous findings.
Cost of osteoporosis-related fracture in Italy. Results of the BLOCK study
Authors: Degli Esposti Luca , Adami Silvano , Iolascon Giovanni , Nardi Alfredo , Pietrogrande Luca , Resmini Giuseppina , Rossini Maurizio , Tarantino Umberto , Tranquilli Leali Paolo , Trevisan Carlo , Cheli Alessandra , Veronesi Chiara , Buda Stefano
Published: June 2016

The objectives of the present study were to calculate the cost of illness of osteoporosis and to assess drug utilization patterns in postmenopausal women after a fracture-related hospitalization. The study subjects were enrolled from a large population-based administrative database. Female patients (age ≥ 65 years) who were hospitalized for a typical osteoporotic fracture between 1/1/2000 and 31/12/2005 were included. Patients were classified as exposed/unexposed to treatment according to the presence/absence of at least one prescription for an osteoporosis-related medication in the 6 months following the discharge date. Treatment adherence was calculated for patients who were exposed to bisphosphonate therapy and was defined as at least 80% of treatment coverage during the follow-up period of 18 months after the discharge date. Hospitalizations, medications, diagnostic tests, laboratory tests and specialist visits during the 18-month follow-up period were collected and classified as osteoporosis-related or non-related to osteoporosis. A total of 12,376 patients were included in the study (mean age ± SD, 79.1 ± 7.5 years), out of which 97.9% (n = 12,110) were hospitalized due to an osteoporosis-related fracture and only 2.1% (n = 266) had general osteoporosis diagnosis. Among the 12,110 women with a fracture, 15.2% (n = 1,845) had a subsequent fracture-related hospitalization (63.8% of the patients had hip fracture). Only 32.3% (n = 4,001) of all included patients was exposed to osteoporosis-related medications and out of those patients exposed to bisphosphonates (n = 860) only 34.2% (n = 294) was adherent to therapy. The average cost per patient was € 4,481, of which € 1,089 was for osteoporosis-related and € 3,392 for non-osteoporosis-related items. The average cost of a matching cohort of patients without hospitalizations for fracture was € 2,339. Among osteoporosis-related costs, 87.0% was due to hospitalizations for subsequent fractures, 1.5% was due to subsquent hospitalizations for osteoporosis, 9.0% was due to medications, 2.5% was due to laboratory or diagnostic/ instrumental tests. Osteoporosis costs after a first hospitalization for fracture were relevant (twice the costs for patients without hospitalizations for fracture), evident in the short run (within the first 24 months following the index fracture) and mostly due to re-hospitalizations for a new typical osteoporotic fracture. This is in mainly relatedto a low exposure to pharmacological therapy and to insufficient treatment adherence. This study and publication were supported by Amgen Dompe and GlaxoSmithKline.
Could the choice of patient versus proxy ratings for assessing quality of life in dementia affect resource allocation in health care?
Authors: Alwin Jenny , Brodtkorb Thor-Henrik
Published: June 2016

OBJECTIVE: The aim of this paper is to demonstrate how the choice of patient versus proxy ratings of patient health-related quality of life (HRQoL) in dementia, for use in cost-effectiveness analyses (CEAs), could potentially affect resource allocation in health care.METHODS:A model of Alzheimer’s disease (AD) based on cognitive ability was used to assess the consequences of using HRQoL ratings from either patients themselves or proxies if a new treatment was to be introduced. The model was based on previously published data on costs related to AD stages as well as HRQoL ratings from AD patients and from their caregivers as proxy raters.RESULTS:The results show that there can be large differences in the results of the CEAs depending on whether the ratings of patients’ HRQoL were made by the patients themselves or by the proxy. When patient self-ratings of HRQoL were used, the cost/quality-adjusted life year (QALY) gained was much higher as compared to the scenario when proxy ratings were used for the same analysis.CONCLUSIONS: The choice of patient self-ratings compared to proxy ratings of patients’ HRQoL can have a substantial effect on the results of CEAs. These differences in results may have an important impact on decision making and, ultimately, on resource allocation. In order to critically appraise the results of CEA studies in dementia we advise that both patient and proxy ratings are used in the CEA. To decide on methodology it is of great importance that focus is directed towards determining the most valid way to measure HRQoL in AD.
Adherence to therapeutic guidelines among patients treated with statins. Results from STAR study
Authors: Degli Esposti Luca , Sangiorgi Diego , Lazzeri Gabriele , Buda Stefano
Published: June 2016

INTRODUCTION: the objective of this study was to analyze adherence to therapeutic guidelines among patients treated with lipid lowering drugs (statins).MATERIAL AND METHODS: a retrospective observational study including 5 Local Health Units (LHUs) was conducted using administrative databases. Patients who received at least one prescription for statins between January 1st, 2007 and June 30th, 2008 were selected and followed for 12 months. Patients were classified according to their level of absolute cardiovascular risk (moderate, high, very high according to Nota 13 AIFA).RESULTS: a total of 71,855 patients were included (14,133 newly treated patients with statins, representing 19.4% of total sample), (age 68.8±10.7, male 51%). Level of absolute cardiovascular risk were: moderate risk (45.4%), high risk (33.4%), very high risk (16.3%), familial hypercholesterolemia (4.9%). Statins assumed by patients in analysis were stratified in two groups (first or second choice), accordingly to their efficacy (level of LDL cholesterol reduction) in relation to the patient’s cardiovascular risk (coherently with new Nota 13 AIFA, 2011). Among patients with a very high cardiovascular risk, only 52.8% used statins indicated by Nota13 as a first choice while 2.9% used a second choice statin and 44.3% used an inadequate statin and/or dosage; among familial hypercholesterolemia patients, those percentages were, respectively: 53.8%, 21.1% and 25.1%. When only patients naïve to statins treatment were analyzed, similar percentages were found. Only few patients in very high risk group used adequate dosages: among patients treated with rosuvastatin and atorvastatin, 11.2% used atorvastatin 40 mg, and 0.2% used atorvastatin 80 mg (this population was not analyzed for events because of low numerosity) while 4.1% used rosuvastatin 20 mg and 0.2% used rosuvastatin 40 mg; overall, 84.3% of patients in this group used inadequate dosages. Cardiovascular events at one year of follow up were 1.6% for patients treated with rosuvastatin 20 mg, 1.6% for rosuvastatin 40 mg and 6.1% for atorvastatin 40 mg; death rates (any cause) were 0.9%, 0.0%, 2.6% respectively. The analysis of the sub-population of patients treated with rosuvastatin 20 mg with previous CV event showed a percentage of patients with a CV event during the observational period of 3.4%, a percentage of patients with cerebrovascular event of 0.9% and a mortality percentage of 0.9%.Conclusions: in real practice setting, the percentage of patients prescribed for recommended statins and dosages is low.
Cetuximab in first line treatment of metastatic colorectal cancer
Authors: Barone Carlo , Belisari Andrea , Ciardiello Fortunato , Mantovani Lorenzo , D’Angiolella Lucia , Furneri Gianluca , Normanno Nicola , Piacentini Patrizio , Pinto Carmine
Published: June 2016

The present health technology assessment report evaluates the clinical and economic profile of cetuximab in first-line metastatic colorectal cancer (mCRC) in Italy. The first part of the report addresses the epidemiological, clinical, social and economic impact of mCRC. In the second part, evidence of efficacy, safety and cost-effectiveness of cetuximab and its available alternatives is shown. Finally, a model-based economic evaluation aimed at comparing cetuximab-based re­gimens vs. alternative therapeutic strategies indicated in mCRC in Italy is presented. The model estimates the incremental cost-effectiveness of adding cetuximab to FOLFOX-4 or FOLFIRI based on KRAS status, vs. adding bevacizumab to FOLFOX-4 or vs. FOLFOX-4 or FOLFIRI alone. A theoretical analysis vs. panitumumab has also been performed, despite panitumumab is not yet reimbursed in Italy in first-line mCRC. Survival outcomes, quality of life and costs of patient ma­nagement are estimated through a Markov model, using the Italian National Healthcare Service (NHS) perspective, over a 10 year period, taking into account KRAS status of patients. The results of the pharmaco-economic analysis show that cetuximab + FOLFOX-4 and cetuximab + FOLFIRI are associated with increased survival, increased cost and increased quality adjusted survival, compared to all other treatments currently indicated and reimbursed in Italy. Adding cetuximab to FOLFOX-4 or FOLFIRI, based on KRAS status shows favorable incremental cost-effectiveness ratio (ICER) vs. adding bevacizumab to FOLFIRI or vs. FOLFOX-4 or FOLFIRI alone. ICER of cetuximab (in combination with FOLFOX-4 or FOLFIRI), compared to currently reimbursed alternatives, is estimated between 6 and 13 thousand Euros per QALY gai­ned, depending on alternative treatment. These estimates are robust in extensive sensitivity analyses. As a final result, both clinical and economic evidence analyzed in this health technology assessment leads to recommend cetuximab as preferred option for the first-line treatment of mCRC KRAS wild-type patients in Italy.
Basilicata
Authors: Gasparini Roberto , Panatto Donatella , Dirodi Bruna , Prato Rosa , Amunni Gianni , Turello Valter , Sudano Luigi , Cristoforoni Paolo , Boccalini Sara , Bonanni Paolo
Published: June 2016

In Basilicata region 75% of women (aged 24-64) are screened regularly, meaning every 3 years. The analysis on cross-protective activity exercised by bivalent and quadrivalent vaccines shows that the bivalent vaccine could prevent more pre-cancerous lesions and cases of cervicocarcinoma than quadrivalent, and that the latter could prevent genital warts that are not prevented by bivalent. The major number of cases avoided by the bivalent make it possible to fully offset the cost savings related to warts associated with the quadrivalent vaccine. Furthermore, a cost-effectiveness analysis shows that, considering regional tariffs, the multiple cohort (12-year-old + 25-year-old women) vaccination strategy with a 90% coverage could prevent 7 cases of cervicocarcinoma and 3 related deaths more than the vaccination of only 12-year-old girls, and thus proves to be cost-effective (10,933 €/QALY).
Bolzano
Authors: Gasparini Roberto , Panatto Donatella , Dirodi Bruna , Prato Rosa , Amunni Gianni , Turello Valter , Sudano Luigi , Cristoforoni Paolo , Boccalini Sara , Bonanni Paolo
Published: June 2016

In the province of Bolzano 86% of women (aged 24-64) are screened regularly, meaning every 3 years. The analysis on cross-protective activity exercised by bivalent and quadrivalent vaccines shows that the bivalent vaccine could prevent more pre-cancerous lesions and cases of cervicocarcinoma than quadrivalent, and that the latter could prevent genital warts that are not prevented by bivalent. The major number of cases avoided by the bivalent make it possible to fully offset the cost savings related to warts associated with the quadrivalent vaccine. Furthermore, a cost-effectiveness analysis shows that, considering regional tariffs, the multiple cohort (12-year-old + 25-year-old women) vaccination strategy with a 90% coverage could prevent 4 cases of cervicocarcinoma and 2 related deaths more than the vaccination of only 12-year-old girls, and thus proves to be cost-effective (11,035 €/QALY).
Calabria
Authors: Gasparini Roberto , Panatto Donatella , Dirodi Bruna , Prato Rosa , Amunni Gianni , Turello Valter , Sudano Luigi , Cristoforoni Paolo , Boccalini Sara , Bonanni Paolo
Published: June 2016

In Calabria region 56% of women (aged 24-64) are screened regularly, meaning every 3 years. The analysis on cross-protective activity exercised by bivalent and quadrivalent vaccines shows that the bivalent vaccine could prevent more pre-cancerous lesions and cases of cervicocarcinoma than quadrivalent, and that the latter could prevent genital warts that are not prevented by bivalent. The major number of cases avoided by the bivalent make it possible to fully offset the cost savings related to warts associated with the quadrivalent vaccine. Furthermore, a cost-effectiveness analysis shows that, considering regional tariffs, the multiple cohort (12-year-old + 25-year-old women) vaccination strategy with a 90% coverage could prevent 37 cases of cervicocarcinoma and 17 related deaths more than the vaccination of only 12-year-old girls, and thus proves to be cost-effective (9,767 €/QALY).
Emilia Romagna
Authors: Gasparini Roberto , Panatto Donatella , Dirodi Bruna , Prato Rosa , Amunni Gianni , Turello Valter , Sudano Luigi , Cristoforoni Paolo , Boccalini Sara , Bonanni Paolo
Published: June 2016

In Emilia Romagna region 84% of women (aged 24-64) are screened regularly, meaning every 3 years. The analysis on cross-protective activity exercised by bivalent and quadrivalent vaccines shows that the bivalent vaccine could prevent more pre-cancerous lesions and cases of cervicocarcinoma than quadrivalent, and that the latter could prevent genital warts that are not prevented by bivalent. The major number of cases avoided by the bivalent make it possible to fully offset the cost savings related to warts associated with the quadrivalent vaccine. Furthermore, a cost-effectiveness analysis shows that, considering regional tariffs, the multiple cohort (12-year-old + 25-year-old women) vaccination strategy with a 90% coverage could prevent 29 cases of cervicocarcinoma and 14 related deaths more than the vaccination of only 12-year-old girls, and thus proves to be cost-effective (13,352 €/QALY).
Friuli-Venezia Giulia
Authors: Gasparini Roberto , Panatto Donatella , Dirodi Bruna , Prato Rosa , Amunni Gianni , Turello Valter , Sudano Luigi , Cristoforoni Paolo , Boccalini Sara , Bonanni Paolo
Published: June 2016

In Friuli-Venezia Giulia region 86% of women (aged 24-64) are screened regularly, meaning every 3 years. The analysis on cross-protective activity exercised by bivalent and quadrivalent vaccines shows that the bivalent vaccine could prevent more pre-cancerous lesions and cases of cervicocarcinoma than quadrivalent, and that the latter could prevent genital warts that are not prevented by bivalent. The major number of cases avoided by the bivalent make it possible to fully offset the cost savings related to warts associated with the quadrivalent vaccine. Furthermore, a cost-effectiveness analysis shows that, considering regional tariffs, the multiple cohort (12-year-old + 25-year-old women) vaccination strategy with a 90% coverage could prevent 8 cases of cervicocarcinoma and 3 related deaths more than the vaccination of only 12-year-old girls, and thus proves to be cost-effective (11,960 €/QALY).
Lazio
Authors: Gasparini Roberto , Panatto Donatella , Dirodi Bruna , Prato Rosa , Amunni Gianni , Turello Valter , Sudano Luigi , Cristoforoni Paolo , Boccalini Sara , Bonanni Paolo
Published: June 2016

In Lazio region 79% of women (aged 24-64) are screened regularly, meaning every 3 years. The analysis on cross-protective activity exercised by bivalent and quadrivalent vaccines shows that the bivalent vaccine could prevent more pre-cancerous lesions and cases of cervicocarcinoma than quadrivalent, and that the latter could prevent genital warts that are not prevented by bivalent. The major number of cases avoided by the bivalent make it possible to fully offset the cost savings related to warts associated with the quadrivalent vaccine. Furthermore, a cost-effectiveness analysis shows that, considering regional tariffs, the multiple cohort (12-year-old + 25-year-old women) vaccination strategy with a 90% coverage could prevent 51 cases of cervicocarcinoma and 23 related deaths more than the vaccination of only 12-year-old girls, and thus proves to be cost-effective (8,555 €/QALY).
Piemonte
Authors: Gasparini Roberto , Panatto Donatella , Dirodi Bruna , Prato Rosa , Amunni Gianni , Turello Valter , Sudano Luigi , Cristoforoni Paolo , Boccalini Sara , Bonanni Paolo
Published: June 2016

In Piemonte region 82% of women (aged 24-64) are screened regularly, meaning every 3 years. The analysis on cross-protective activity exercised by bivalent and quadrivalent vaccines shows that the bivalent vaccine could prevent more pre-cancerous lesions and cases of cervicocarcinoma than quadrivalent, and that the latter could prevent genital warts that are not prevented by bivalent. The major number of cases avoided by the bivalent make it possible to fully offset the cost savings related to warts associated with the quadrivalent vaccine. Furthermore, a cost-effectiveness analysis shows that, considering regional tariffs, the multiple cohort (12-year-old + 25-year-old women) vaccination strategy with a 90% coverage could prevent 33 cases of cervicocarcinoma and 15 related deaths more than the vaccination of only 12-year-old girls, and thus proves to be cost-effective (11,974 €/QALY).
Sardegna
Authors: Gasparini Roberto , Panatto Donatella , Dirodi Bruna , Prato Rosa , Amunni Gianni , Turello Valter , Sudano Luigi , Cristoforoni Paolo , Boccalini Sara , Bonanni Paolo
Published: June 2016

In Sardegna region 75% of women (aged 24-64) are screened regularly, meaning every 3 years. The analysis on cross-protective activity exercised by bivalent and quadrivalent vaccines shows that the bivalent vaccine could prevent more pre-cancerous lesions and cases of cervicocarcinoma than quadrivalent, and that the latter could prevent genital warts that are not prevented by bivalent. The major number of cases avoided by the bivalent make it possible to fully offset the cost savings related to warts associated with the quadrivalent vaccine. Furthermore, a cost-effectiveness analysis shows that, considering regional tariffs, the multiple cohort (12-year-old + 25-year-old women) vaccination strategy with a 90% coverage could prevent 17 cases of cervicocarcinoma and 8 related deaths more than the vaccination of only 12-year-old girls, and thus proves to be cost-effective (10,841 €/QALY).
Regione “Test”
Authors: Gasparini Roberto , Panatto Donatella , Dirodi Bruna , Prato Rosa , Amunni Gianni , Turello Valter , Sudano Luigi , Cristoforoni Paolo , Boccalini Sara , Bonanni Paolo
Published: June 2016

In “Test” region 75% of women (aged 24-64) are screened regularly, meaning every 3 years. A cost-effectiveness analysis shows that, considering regional tariffs, the multiple cohort (12-year-old + 25-year-old women) vaccination strategy with a 50% coverage, even if the coverage is much lower than 90%, could prevent 8 cases of cervicocarcinoma and 4 related deaths more than the vaccination of only 12-year-old girls, and thus proves to be cost-effective (8,721 €/QALY).
Incentives of Health Care Expenditure
Authors: Siljander Eero
Published: June 2016

The incentives of health care expenditure (HCE) have been a topic of discussion in the USA (Obama reforms) and in Europe (adjustment to debt crisis). There are competing views of institutional versus GDP (unit income elasticity) and productivity related factors of growth of expenditure. However ageing of populations, technology change and economic incentives related to institutions are also key drivers of growth according to the OECD and EU’s AWG committee. Simulation models have been developed to forecast the growth of social expenditure (including HCEs) to 2050. In this article we take a historical perspective to look at the institutional structures and their relationship to HCE growth. When controlling for age structure, price developments, doctor density and in-patient and public shares of expenditures, we find that fee-for-service in primary care, is according to the results, in at least 20 percent more costly than capitation or salary remuneration. Capitation and salary (or wage) remuneration are at same cost levels in primary care. However we did not find the cost lowering effect for gatekeeping which could have been expected based on previous literature. Global budgeting 30 (partly DRG based) percent less costly in specialized care than other reimbursement schemes like open contracting or volume based reimbursement. However the public integration of purchaser and provider cost seems to result to about 20 higher than public reimbursement or public contracting. Increasing the number of doctors or public financing share results in increased HCEs. Therefore expanding public reimbursement share of health services seems to lead to higher HCE. On the contrary, the in-patient share reduced expenditures. Compared to the previous literature, the finding on institutional dummies is in line with similar modeling papers. However the results for public expansion of services is a contrary one to previous works on the subject. The median lag length of adjustment is 6.6 years or 26 quarters for countries to move half way to the eventual equilibrium in HCE/GDP-ratios in response to a shock in demand factors which indicates “hysteresis” in demand.
Le analisi costo della malattia e costo efficacia in farmacoeconomia. Ambiti di applicabilità, problemi, prospettive
Authors: Bondonio Piervincenzo
Published: June 2016

Aim of the paper is to compare and evaluate some of the main features of two different tecniques of economic analyses: cost of illness e and cost-effectiveness. The former is not so widely used in pharmacoeconomics, while the latter is dominant. Although their theory has recently much progressed, their practice is still hindered by some unresolved questions, to which the paper also addressess.
Percorsi diagnostico-terapeutici nella gestione dei pazienti affetti da polmonite acquisita in comunità
Authors: Eandi Mario
Published: June 2016

Community-Acquired Pneumonia (CAP) is one of the major cause of death due to infectious diseases in developed countries. In Italy, about 18% of the patients with CAP are hospitalized, accounting for an annual health-care cost of more than 1.000 billion Lire. Overall, CAP represents an heavy burden to the society and the National Health-Care System. The managed-care of patients with CAP should be committed to find a balance between the individual health-care needs and the more general claims of a fair utilization and an overall efficiency of the healthcare system. The comprehensive strategy of care should consider many decision nodes and the outcomes related with each different options. The diagnostic procedures (physical examination, chest radiography, microbiology, laboratory) should be oriented to obtain a robust differential diagnosis and to estimate the risk of mortality. Prediction rule are now available that help physicians to make more rational decisions about hospitalization for patients with pneumonia. The selection of antibiotic in the absence of an etiologic diagnosis is based on the epidemiological settings, the severity of the illness and other clinical conditions of the patients. Non concordant therapeutic recommendations are provided by the published guidelines. Decisions to be taken during the follow-up concern the switch therapy and the early discharge options, as soon as the patient stabilizes, or the admission to ICU in case of worsening. The length of hospital stay depends on the time to stability and the risk of mortality. However, socio-cultural factors and availability of outpatient care programs could facilitate the early discharge of patients and help to decrease the health-care costs of CAP patients. The results of the present review can be used as a background to implement a general decision model suitable to performe pharmacoeconomic analysis of the CAP therapy.
Analisi comparativa del mercato dei dispositivi per incontinenza in cinque paesi europei
Authors: Cornago Dante , Garattini Livio
Published: June 2016

The aim of the paper is to compare and valutate the market of the incontinence devices in five European countries: Italy, France, Germany, U.K. and Denmark. We chose incontinence devices because they are strictly connected with the development of the home delivery. France, Germany and U.K. has been analysed for their politic and territorial importance, while Denmark has been considered for its home assistance system. A common pattern has been applied in every country: first of all there is a general outline of the legislative aspect of the incontinence devices, then the study presents prescription procedure and the different models of distribution. Finally, it shows the competitive systems of the pharmaceuticals industry in every single country. The necessary information has been gathered through relevant literature and interviews with the area operators. The incontinence devices are repayable in all the studied countries, except from France. Every country has different health system (Italy, U.K and Denmark had a public health system; France and Germany has a mutualist health system). There isn’t an evident correlation between the type of the health system and the market of the incontinence devices.
Una checklist per la gestione dei costi nel trattamento dell’HIV
Authors: Sazonov Vasilisa , Urleb Uros , Wertheimer Albert L.
Published: June 2016

The human immunodeficiency virus (HIV) infection is currently one of the major health problems in the world. Since the first occurrence of the infection 17 years ago until today, many people have died of its devastating consequences and an enormous amount of health-related funds have been spent on the problem. The pandemic is still growing in some areas, and its negative impact on society is in-creasing. This is the main reason why scientists are trying to find the best way to reduce costs and still keep the same level of management or, in some ways, even improve it (e.g., new combination of drugs in one pill—fewer pills to be taken per day). Since HIV infection has been. a fatal, severe, and widespread disease, a so-called global problem, very early in the course of the pandemic the idea of economic evaluation was raised. Published studies mostly presented the antiretroviral drugs in the frames of pharmacoeconomic models or costs of HIV/AIDS according to development of the disease through longer time periods. The cost sections that have to be considered in any pharmacoeconomic study of HIV management are briefly presented. Often the presented costs are confusing and could be misleading. Direct, indirect, and intangible costs are described.
Creazione di valore sanitario e sistemi di finanziamento: il caso del dipartimento di salute mentale
Authors: Munizza Carmine , Nieddu Salvatore
Published: June 2016

Health-value adding is the new priority and a watchword for all clinicians and health service workers. The creation of health-value requires a team work involving different actors: A. the clinical staff, whose task consists in the creation of treatment models and in their formalization into guidelines and protocols; B. the managers, since effective clinical and therapeutic practices must go along with coherent organizational models and valuable control instruments; C. the public institutions responsible for the definition of health policy guidelines: among these, a prioritary role is played by funding methods, which can affect significantly the results of health-value adding initiatives. This work aims at studying the relationships between funding methods and health-value creation, with particular reference to mental health services. Particular relevance is given to the funding of mental health departments, with a view to putting aside the shortcomings of the current models and proposing the DRG as an alternative funding method for mental health services. The procedures for patients classification and evaluation envisaged in the psychiatric DRG can assist health service managers in evaluating the outcomes and the patients’ health conditions. In other words, the issues concerning funding and management evaluation will be articulated in the same language: this, in turn, will eliminate the lack of integration which can be presently identified as the main fault of most funding methods, and improve the degree of coherence among resource allocation, activities and results. The case of mental health services can therefore be taken as an example of successful and effective cooperation among management, health policy and clinical staff.
La valutazione dei costi: uno studio applicato all’unità operativa di diagnostica per immagini
Authors: Nieddu Salvatore , Bianco Maurizio
Published: June 2016

The aim of the analysis was to evaluate the reasons that caused the poor economic results and performances of a Radiology Department located in a public hospital. The models of Decision Support System were utilized in order to conduct the studies. These models represent clearly a current economic situation and allow simulations in order to estimate in a preventive way the economic results of different alternative actions. The economic analysis was conducted according to the extended direct costing method utilizing a single performance (product) as a calculation unit. The simulations were carried out in accordance to the “price-cost-volume analysis” method that identifies the break even point for the families of products. These analysis resulted in a significant improvement of the awareness relative to the economic actions of the operative managerial decisions: the main factor in the process of the decision making for the public healthcare structure is to respond to the needs of the potential users and therefore to satisfy the demand, the increase of which is immediately signalised by the lengthening of the awaiting list. For the structure which is incorporated in the hospital frame there is the necessity to provide the service towards inside the hospital both relative to the patients and to the performances of first aid supported by the emergency department. It is important to stress that, even if limited or conditional, there is a space for improvement: the first step in this direction is to analyse in order to recognize and to measure, if not able to improve that what is unknown and not measured before.
Modello di analisi decisionale della gestione terapeutica della polmonite acquisita in comunità e creazione di valore
Authors: Donna Giorgio , Nieddu Salvatore , Allara Daniele
Published: June 2016

The pharmacoeconomical analysis of the strategies in the disease management of the Community-Acquired Pneumonia (CAP) is a very good starting point for considering the value creation utility. The value creation represents a basic target for the health area, both in short term management and in strategic management: in fact, creating value means to satisfy people health interests and needs. The cost-benefit analysis (CBA) is the more functional economic valuation method, fitting the value creation model in the best possible way. In fact it examines the greatest number of variables that generates costs and benefits, having an influence on the value creation. In the CAP specific case, the question is if it’s possibile to reduce the average days of stay and/or to reduce the admissions to hospital, considering if this changes can generate a health value creation by causing more benefits than costs. This study presents data and values related to infectious disease hospitalization to analyse the resources economy from days of stay cutback and admission to hospital number.
Ketorolac vs. morfina nel trattamento del dolore acuto in pazienti traumatizzati: un’analisi di minimizzazione dei costi
Authors: Colombo G.L. , Borghi B. , Caruggi M. , De Nicola A.
Published: June 2016

Aim of this study is to develop an economic valuation comparing ketorolac vs. morphine for the treatment of sharp pain caused by heavy limb injury, in traumatology ward and in first aid ward. As cost minimization analysis, this economic valuation has been based on clinical results of Rainer et al. (2000). Ketorolac and morphine have the same efficacy in calming the pain; the greatest difference in the clinical outcomes is about the morphine side effects (nausea, vomiting and phlebitis). Assuming the hospital point of view with a differential costs perspective, the ketorolac patients showed two consequences than could generate lower resources consumption: less side effects and the reduction of time permanence in first aid ward. Considering the drug cost, the administration cost and the side effects treatment costs, the expenditure for every single morphine patient is L. 23.385, vs L. 4.875 for a ketorolac patient, with a difference of L. 18.510.
I costi delle Terapie Intensive italiane
Authors: Arrighi Enrico , Rossi Franco
Published: June 2016

In the 1995 the (GiViTI started a programme for the research about the economic features of the Intensive unit in Italy. After a preliminary check on available data, the GiViTI research considered 30 multipurpose ICUs during the period between 1996 and 1998. Every selected units received a questionnaire to fill up with information about staff, drugs and blood derivatives, other medical products, diagnostic and therapeutic services. The studied departments held on average 8 beds and their overall annual costs came to £ 3,4 billion. The single patient costs was £ 9,9 million and one day of stay in hospital amounted £ 1,3 million. These expenditures were allocated according to this percentage: 62% far the staff; 12% far drugs and blood derivatives, 12,7 for other medical products, 7% for laboratory services and 6,3% for different diagnostic and non sanitary services. Besides, the research showed the presence of scale economies production in the Italian multipurpose ICUs, even if only for the work costs. The GiViTI programme now is tackling the next phase, that studies the relations between treatment costs clinical characteristics of patients.
L’effetto delle operazioni di fusione e acquisizione sui profitti degli azionisti nell’industria farmaceutica
Authors: Skrepnek Grant H. , Lawson Kenneth A.
Published: June 2016

The purpose of this study was to quantify the excess return in shareholder security prices following initial announcements of successful horizontal pharmaceutical mergers which occurred between 1985 and 1996. An event study methodology was used to study a sample of26 fim1s involved in 14 mergers wherein transaction costs exceeded $500 million. Overall, results of the study were consistent with prior research, indicating that target-firm shareholders received a majority oft he short-term merger-related wealth effects in comparison to those received by bidder- firm shareholders.
La day surgery centralizzata: l’appropriatezza clinica e organizzativa come leva di creazione di valore sanitario
Authors: Vogliolo Bruno , Nieddu Salvatore , Bianco Maurizio
Published: June 2016

In the last years Public Health Service has been trying to find out solutions in order to improve its health value added creation capacity. The implementation of the Day-surgery division mainly aims to follow that direction, since it enables the improvement of the ratio between efficacy, quality and healthcare suitability and on the other hand efficiency, costs and modality of better resources utilization. The centralization of Day-surgery activities proposes some innovative characteristics, concerning that it introduces an organizational model focused on needs and it performs the separation of the clinic and therapeutic activities from the ones involving the assistance. Both economic and qualitative advantages deriving from the changes stand out in term of: - high possibility of activities’ scheduling; - improved customer satisfaction; - rationalisation of day-hospital recovery, with positive effects on the inpatients; - improved hospital economic stability. This study was carried out with the support of the multiple-skill group composed of doctors, nurses, administrative staff as well as experts in the field of organisation with an aim to provide the full outline of the necessary competences. The proposed discussion reflects the multidisciplinary view of the problem and different perspectives. Each of them regards particular aspects and implications indicated as following: - clinical perspective, related to the possibility of day-surgery interventions both from the medical and the anaesthetic point of view; - organisational perspective, which refers to the possible day-surgery models in conjunction with the organisational model and their peculiarities; - operative perspective, which consist of the analysis of the ideal structural dimension, flows of activities among all services involved and the analysis of the productive capability; (number of necessary beds, staff dimension and a relapse of the operation activities needs); - economic perspective, focused mainly to provide the final valuation on the capacity of the project to contribute to the improvement of the hospital.
Le conseguenze sulla spesa farmaceutica pubblica di un nuovo inibitore di pompa protonica: esomeprazolo
Authors: Lucioni C. , Mazzi S. , Negrini C.
Published: June 2016

Aim of the present study is to check the economic advantage of esomeprazole, a new proton pump inhibitor that suppresses gastric acid secretion. The efficacy and tolerability of esomeprazole have been already demonstrated, now the pharmacoeconomic studies must investigate the possible savings for the SSN in case of esomeprazole immission on the Italian market. In this paper the authors present two pharmacoeconomic evaluations, the first based on cost/efficacy analysis, the second based on cost minimization analysis. For both analyses, the term of comparison is omeprazole, “gold standard” in the treatment of acid reflux-related pathologies. The effect in terms of volumes (DDD) and costs of the introduction of esomeprazole in the italian market has also been simulated.
Costi del trattamento con oloprazina nelle fasi iniziali della schizofrenia
Authors: Berardi Domenico , Dell’Atti Maddalena , Russo Francesca , Vagnini Virginia , Guidi Luca , Edgell Eric T.
Published: June 2016

Objective: In Italy, use of olanzapine in the public sector was limited by law to patients that had failed treatment with conventional antipsychotics, due to the higher purchase price of the drug. This restriction prevented first-episode patients and patients early in the course of their illness from being treated with olanzapine. The present study investigates economic consequences of this policy. Design: The present study retrospectively outlines treatment costs of patients switched to olanzapine during the early stages of schizophrenia as compared to the costs of patients switched during a later stage of the illness. Setting: The study was conducted within Italian Community Mental Health Services. Patients: The cost of pharmacological and non-pharmacological treatment was retrospectively calculated in 25 out-patients with schizophrenia and related disorders over a one-year span. Thirteen patients were switched to olanzapine in the early stage of their illness, prior to drug approval under a compassionate use regimen. Twelve patients started olanzapine under the restriction in a later stage of illness following failed treatment with a conventional antipsychotic. Results: While total treatment costs between the two groups was similar, cost distribution was different. Early Switch patients had higher drug costs and higher rehabilitation costs, while Late Switch patients had higher hospitalisation costs. Conclusions: Small patient numbers and design limitations prevent conclusions being drawn regarding the ultimate impact on outcome and total treatment cost of restriction of olanzapine to second-line use. Despite this, our findings demonstrate that within the context of the Italian CMHS, patients treated with olanzapine while still in the early stages of schizophrenia do not necessarily cost more overall compared to patients who receive olanzapine after failing treatment with a conventional antipsychotic.