bluuebunny/crossref_metadata_2025 huggingface dataset:
Dabigatran in the prevention of venous thromboembolism after major orthopedic surgery
Authors: Zaniolo Orietta
Published: June 2016

Venous thromboembolism (VTE) is a very frequent surgical complication, especially in major orthopedic procedures. Prophylaxis with pharmacological agents, including warfarin and subcutaneous injection of either low-molecular weight heparin (LMWH) or low-dose unfractionated heparin, and/or with mechanical methods has been shown to be effective and safe. Despite recommendations on the routine implementation of these prophylaxis methods, some surveys demonstrate that many patients currently don’t receive any prophylaxis. The recent introduction of dabigatran etexilate, a novel oral direct thrombin inhibitor approved for VTE prophylaxis in total knee and hip substitution, represents a major advance in the provision of efficient anticoagulation therapy. Two pivotal randomized controlled multicenter trials assessed non-inferiority of dabigatran 150/220 mg/day versus enoxaparin 40 mg/day in the prevention of VTE after hip and knee replacement. From an economical point of view, an English modeling study on dabigatran cost/effectiveness showed it to be associated with lower cost and slightly higher gain in Quality Adjusted Life Years, thus dominating enoxaparin. Other analyses obtained results consistent with these, estimating inferior costs related to the use of dabigatran with respect to low weight heparin; this difference was mainly due to health personnel work for heparins subcutaneous administration. In Italy, acquisition costs for a 28-35 days therapeutic cycle of main antithrombotic drugs vary between 70 and 170 €, according to different distribution policy. Dabigatran, with a cost of 117 €, holds a medial position. Cost savings related to oral administration may partially offset the price difference between dabigatran and the less expensive options among LMWHs or, compared with the more expensive ones, add to pharmaceutical cost savings. In order to increase the effectiveness of VTE prophylaxis, the improvement of patient adherence to the prescribed strategy is needed. On this plane, dabigatran may be associated to some advantages, like the lack of drug and food interactions, the need for less frequent coagulation monitoring compared to vitamin K antagonists, and obviation of daily injections of parenteral agents. In conclusion, these considerations suggest that dabigatran may prove an interesting alternative in VTE prevention in orthopedic surgery.
Trends in prescribing and persistence with antihypertensive therapy: results of the study PAPEETE (Population-based Analysis of Persistence and Economics of treatment with telmisartan) study
Authors: Costa Francesco Vittorio
Published: June 2016

This paper summarizes the results of the PAPEETE study (Population-based Analysis of PErsistence with treatment and Economics of TElmisartan) that assessed trends in prescriptions, determinants and timing of treatment discontinuation and/or changes in antihypertensive drug therapy in a cohort of hypertensive patients living in Pavia. In the study were included all new users 18 years old or over receiving a first prescription for diuretics, beta-blockers, calcium channel-blockers, ACE inhibitors (ACEi) or angiotensin receptor blockers (ARBs) between 1 January 2003 and 31 December 2006. The follow-up period for each patient was 12 months starting from enrolment date. Based in the presence of continuous therapy, patients were defined as persistent and non-persistent users. A total of 61,493 patients was included in the study of whom 11.2% were persistent. Persistence with the treatment seems to be associated with patient-related factors and with the class of anti-hypertensive drug initially prescribed with the lowest persistence to antihypertensive treatment with diuretics (3.0%) and the highest with ARBs (18.8%).
Revisiting the role of a service-Day Hospital in infectious diseases, based on the natural history of HIV infection in the era of potent antiretroviral combination therapy
Authors: Manfredi Roberto
Published: June 2016

On the ground of the analysis of health care assistance performed by an Infectious Diseases Day-Hospital outpatient service operating in a metropolitan area during a 15-year-old time, we assess the evolution of referred disorders, in order to plan eventual future remodeling of the service and structure organization and performances, based one the present and evolving epidemiology of infectious diseases.
Fungal infections today: size of the problem and focus on the initial cost of therapy with echinocandin
Authors: Venditti Mario
Published: June 2016

Three candins had been approved for the treatment of invasive candidiasis (IC): caspofungin, micafungin, and anidulafungin. Different drugs are associated with different needs for dose adjustment which might affect the total cost. A Spanish economic analysis estimated the budget impact of caspofungin, micafungin and anidulafungin in the treatment of 100 patients with invasive candidiasis from the perspective of the Spanish hospital pharmacy setting. It has demonstrated that patients treated with anidulafungin did not required dose adjustment unlike caspofungin and micafungin, and the use of anidulafungin in the treatment of adult non-neutropenic patients with invasive candidiasis is a cost saving treatment option, from the pharmacy department perspective in Spain. The aim of this study was to estimate the initial costs of therapy with caspofungin, micafungin, and anidulafungin in the perspective of the Italian hospital setting.
Cost/effectiveness model of dabigatran in the prevention of venous thromboembolism in major orthopedic surgery: Adaptation for Italy
Authors: Zaniolo Orietta , Wolowacz Sorrel E. , Pradelli Lorenzo
Published: June 2016

Venous thromboembolic events (VTE) represent a dangerous complication of major orthopedic surgery, especially in total hip replacement (THR) and total knee replacement (TKR) procedures. Dabigatran etexilate (DBG), a direct and reversible thrombin inhibitor, has proven its non-inferiority with respect to enoxaparin 40mg once-daily, a low molecular weight heparin (LMWH), in the prevention of VTE in patients undergoing THR and TKR, in the RE-NOVATE and RE-MODEL trials, respectively. The objective of this analysis was to estimate cost/effectiveness and cost/utility of DBG compared to standard care for the prevention of VTE in Italy. A decision analytic, Markov-chain based model, originally developed for the UK, was adapted to the Italian context. The adaptation involved cost and demographic characteristics, clinical and utility data were not altered. Costs were taken from national observational studies, where available. Otherwise, current prices and tariffs were applied. Resource consumption was derived from practice guidelines or taken from the UK model. According to the prevalent national practice, extended prophylaxis is considered for both surgical procedures. The time horizon of the analysis was patients’ lifetimes. In order to consider different alternatives for drug dispensation and, consequently, National Health Service acquisition costs, alternative scenarios were developed. A further scenario, excluding LMWHs administration costs (“worst-case” scenario), was considered. Compared to LMWHs, DBG was associated with an expected increase of 0.019 life-years (LYs) and 0.014 quality-adjusted life-years (QALYs) per THR patient and of 0.024 LYs and 0.019 QALYs per TKR patient. DBG-related costs were lower than LMWH in both procedures, with a mean difference ranging from 89 to 116 € for THR, and 107 to 142 for TKR, depending on the LMWH product. Higher acquisition costs for DBG were completely offset and inverted by avoided administration expenses and, to a lesser extent, by savings in VTE management. The results of alternative scenarios confirm the dominance of DBG, with a net saving ranging between 119 €, when both drugs were obtained by auction, and 32 €, when the auction price was applied but DBG was dispensed through territorial pharmacies. The corresponding estimates for TKR were 148 and 54 €. In the “worst-case” scenario, DBG was no longer dominant, with a cost per LYs of 2,788 and 4,514 € and a cost per QALY gained of 3,619 and 5,926 €, for TKR and THR respectively. In conclusion, DBG dominated LMWHs, and was cost-saving and non-inferior in terms of efficacy and safety, except for in the “worst-case” scenario, in which the incremental cost/effectiveness ratio estimate was lower than commonly accepted thresholds in health economics.
Cost/effectiveness analysis of atorvastatin in patients with acute coronary syndromes
Authors: Cammarota Simona , Menditto Enrica , Putignano Daria , Citarella Anna
Published: June 2016

Introduction: recent clinical trials found that high-dose statin therapy, compared with conventional-dose statin therapy, reduces the risk of cardiovascular events in patients with acute coronary syndromes (ACS) and stable coronary artery disease (CAD). With the introduction of simvastatin and pravastatin generics and the next patent expiration of atorvastatin, projected for 2011 in Italy, it is natural to ask: what is the most cost-effective treatment for a rational use of resources?Aim: the aim of this study was to estimate the cost-effectiveness of high-dose atorvastatin versus conventional standard-dose statins based on the scenario of atovastatin price evolution.Methods: a cost-effectiveness analysis was conducted in the perspective of the Italian National Health Service over the 4.9 years time horizon. Clinical data were obtained from a pooled analyses of the 3 clinical trials that directly compared high-dose atorvastatin with conventional standard-dose statins in patients with either ACS or CAD. Hospitalizations were quantified based on the Italian National Health Service tariffs and drug costs according to the Italian National Therapeutic Formulary (2009). Assuming the cost of atorvastatin reduces in line with that observed for simvastatin when the patent expires, 3 scenarios were constructed: atorvastatin current price (scenario 1); 55% price discount (scenario 2); 65% price discount (scenario 3). Effects were measured in terms of primary composite endpoint (coronary death or any adverse cardiovascular event). All costs were discounted at 3% per annum. Sensitivity analyses were performed to assess the robustness of findings. Results: intensive therapy with atorvastatin provided a hospitalization cost saving of 245,519.36 € per 1,000 patients. Under the assumptions established for scenario 1 and scenario 2, the incremental cost-effectiveness of treatment with atorvastatin 80 mg was estimated to be 20,289.72 € and 917.05 € for patient free from event, respectively; it was cost-saving for the scenario 3. Conclusions: high-dose atorvastatin represented a cost-effective use of healthcare resources in Italy. If the cost of atorvastatin reduces by 65% when the patent expires, for every million patient with SCA or CAD stable, treated for 5 years, the high-dose atorvastatin strategy potentially yields a cost-saving of ~2,4 billion € for the NHS.
The health and social costs of chronic kidney disease in Italy
Authors: Cicchetti Americo , Ruggeri Matteo , Codella Paola , Ridolfi Alessandro
Published: June 2016

Chronic kidney disease is growing as a global public health problem throughout the world. In Italy, CKD is becoming increasingly common with 52,777 patients treated with dialysis in 2010, about 10,000 new patients/years in dialysis from 2010.  The impact on the health care system includes € 2.1 billion/year for dialysis plus € 338 million for indirect costs. Aim of the present analysis was to explore socio-economical variables in the management of CKD, and assess direct and indirect health costs and NHS resources consumption. The overall cost for patients in dialysis is about 44,000 €/years for hemodialysis and 30,000 €/years for peritoneal dialysis with different resources consumption over the different stage disease. The possibility of reducing the progression of renal damaging and beginning of dialysis may induce a low expenditure for the Italian NHS.
Ipertensione arteriosa, continuum cardiovascolare e ruolo clinico dei sartanii
Authors: Destro Maurizio
Published: June 2016

The cardiovascular and cardiorenal continuum comprises the transition from cardiovascular risk factors to endothelial dysfunction and atherosclerosis, to chronic congestive heart failure, and-stage renal disease or premature death. RAAS (renin-angiotensin-aldosterone system) is involved in all steps along this pathway. Data from clinical studies involving valsartan and other ARBs provide evidence of the reduction of risk of cardiovascular events, and end-organ damage in the heart, kidneys and brain. This paper summarizes the status on research of ARBs based on clinical trials and regulatory approval.
Clinical and economic profile of entecavir in the treatment of chronic hepatitis b virus infection
Authors: Eandi Mario
Published: June 2016

HBV infection in Italy is frequently underestimated, raising the risk of important complications, such as cirrhosis and hepatocellular carcinoma, and thus increasing mortality. In infections phases requiring treatment, it’s possible to choose among the currently available drugs: interferons, nucleoside and nucleotide analogues. Entecavir is a nucleoside analogue able to maintain a high genetic barrier, and to reduce the viral load < 300 copies/ml in 67% of HBeAg-positive patients and in 90% of HBeAg-negative patients after 48-weeks treatment, improving also necroinflammatory grade and fibrosis degree. In spite of the high cost of the confection, entecavir induces a saving in health costs because of the decrease in the disease progression. If compared, through pharmacoeconomic models and analysis, to tenofovir, a nucleotide acid considered equivalent in the first-line monotherapy of HBeAg-positive patients and in the long-term treatment of HBeAg-negative patients by the current international and Italian guidelines, it seems favourable in terms of safety and consequently in terms of costs of adverse events spared. However further studies are required: in particular direct comparative studies are still lacking.
Gefitinib: a pharmacoeconomic profile of its use in patients with Non Small Cell Lung Cancer EGFR+
Authors: Sacchi Viola
Published: June 2016

Lung cancer is the most common form of cancer with the highest incidence worldwide. The mortality rates are highest in males and second highest in females, after breast cancer. The genetic predisposition to Non Small Cell Lung Cancer (NSCLC) is still under investigation, however, studies have shown that the Epidermal Growth Factor Receptor (EGFR), a receptor tyrosine kinase is frequently over-expressed and activated to a phosphorylated state in NSCLC. The activity of EGFR in cancer cells results in the phosphorylation of downstream proteins that promote cell proliferation, invasion, metastasis, and inhibition of apoptosis. Targeting the EGFR pathway therefore constitutes a relevant strategy for cancer therapy. Gefitinib is a selective inhibitor of the EGFR tyrosine kinase and is indicated for the treatment of adult patients with locally advanced or metastatic NSCLC with activating mutations of EGFR-TK. From the pharmacoeconomic point of view gefitinib is dominant (more effective and less expensive) compared to the alternatives. In conclusion, gefitinib is a treatment option for NSCLC tumors with a high clinical and economic value in the Italian setting.
Valutazione dei processi assistenziali e del carico economico dei soggetti con ospedalizzazione incidente di infarto acuto del miocardio mediante il Data Warehouse DENALI
Authors: Mantovani Lorenzo G. , Fornari Carla , Madotto Fabiana , Riva Michele A. , Merlino Luca , Chiodini Virginio , Cesana Giancarlo
Published: June 2016

Aims: this study wants to estimate the economic burden of incident Acute Myocardial Infarction (AMI) registered in Lombardy (about 9.2 million residents). Method and results: a longitudinal study was conducted using a Data Warehouse (DENALI) that organised Healthcare Administrative databases of Lombardy related to eligibility criteria, hospital discharges (HDs), pharmaceutical and outpatient claims of citizens. All individuals with a HD for a first event of AMI during 2003 were identified and followed for 12 months. During 2003 12,049 individuals (64% males, mean age 70 +/-13 y.o.) had a HD for incident AMI. The total cost during the first year was € 163 million, corresponding to the 1% of the healthca re budget of Lombardy. The monthly cost in the first year was € 1,249 per person (77% attributable to HDs, 15% to pharmaceuticals and 8% to outpatient care). While most of the uptake of drugs used in secondary prevention was quick and happened in the first 3 months after the index event, the phenomenon of non persistence at 12 months was relevant. Conclusion: this large study on the burden of AMI shows the epidemiologic, economic and clinical impact of the disease. DENALI, with its large population followed over time, is a powerful and dynamic tool for epidemiologic and health economic research.
Pharmacoeconomic aspects of poor adherence to treatment in multiple sclerosis management
Authors: Eandi Mario
Published: June 2016

Multiple sclerosis (MS) is a chronic autoimmune disease, which affects the central nervous system and is the leading cause of chronic disability in young adults. Especially in the most common form characterized by relapses and remissions (RRMS), MS is a major burden on the NHS and society at a cost of illness per year for Italy estimated at 1.5 billion euros. The DMT (Disease-Modifying Therapies) when used continuously since the diagnosis of the disease have proved effective in reducing the risk of relapses, slowing the progression of the disease, reducing the consumption of health resources, especially hospitalizations, with a significant savings on healthcare costs. High rates of adherence have been associated with DMT not only to improved clinical performance, but also to a significant reduction in costs associated with the consumption of health resources. Because some recent studies have shown that the use of IFNβ-1a IM leads to better adherence to therapy and a significant savings in hospitalizations, outpatient visits, and also on the access to the PS, it is desirable that in Italy the use of IFNβ-1a IM will become ever greater. In this way, we can assume that we can achieve a significant saving in direct health care costs that affect the NHS, as has been observed in some foreign studies in which adherence to treatment was associated with a reduction in the average annual cost per patient between 33 and 65%.
Palivizumab nella profilassi del virus respiratorio sinciziale: analisi di impatto sul budget del SSN italiano
Authors: Roggeri Daniela
Published: June 2016

Palivizumab is a monoclonal antibody to RSV that has been shown to significantly reduce the frequency of hospitalisations for RSV infection, in at-risk populations. However, payers are concerned about the budgetary impact of adopting palivizumab. A budget impact model was developed to estimate the financial impact of palivizumab for the prevention of severe RSV infection in at-risk populations in the Netherlands. These analyses were adapted to Italy, after a brief review of the literature on the health care system and epidemiology of RSV infection in our country. The report below outlines the methodology and analysis of the costs associated with palivizumab prophylaxis of premature infants of 33 to 35 weeks gestational age which are the at-risk subgroup eligible for prophylaxis according to Italian guidelines.
Campania
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 Campania 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 114 cases of cervicocarcinoma and 50 related deaths more than the vaccination of only 12-year-old girls, and thus proves to be cost-effective (9,841 €/QALY).
Liguria
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 Liguria region 80% 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 11 cases of cervicocarcinoma and 5 related deaths more than the vaccination of only 12-year-old girls, and thus proves to be cost-effective (11,122 €/QALY).
Lombardia
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 Lombardia 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 92 cases of cervicocarcinoma and 42 related deaths more than the vaccination of only 12-year-old girls, and thus proves to be cost-effective (10,919 €/QALY).
Marche
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 Marche region 68% 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 18 cases of cervicocarcinoma and 8 related deaths more than the vaccination of only 12-year-old girls, and thus proves to be cost-effective (10,700 €/QALY).
Sicilia
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 Sicilia region 64% 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 82 cases of cervicocarcinoma and 37 related deaths more than the vaccination of only 12-year-old girls, and thus proves to be cost-effective (10,534 €/QALY).
Trento
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 Trento 80% 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 5 cases of cervicocarcinoma and 2 related deaths more than the vaccination of only 12-year-old girls, and thus proves to be cost-effective (11,029 €/QALY).
Valle d’Aosta
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 Valle d’Aosta region 89% 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 1 case of cervicocarcinoma more than the vaccination of only 12-year-old girls, and thus proves to be cost-effective (11,365 €/QALY).
Clinical and economic profile of prucalopride in the treatment of chronic constipation in women
Authors: Stanghellini Vincenzo , Eandi Mario
Published: June 2016

Chronic constipation is a common disorder, especially in women. Options available for different subgroups of constipation are limited and in most cases unsatisfactory. The most severe forms of chronic constipation often require the use of laxatives in high doses or the use of invasive therapies. The introduction of a new drug, such as prucalopride, active in promoting intestinal transit, can help to improve the therapy of patients with chronic idiopathic constipation who have not found relief from previous treatment with laxatives. In this review, after a brief discussion of pathophysiology and pharmacotherapy of chronic constipation, we evaluate the pharmacological profile, therapeutic and cost of prucalopride, recently authorized in the EU countries and also available in Italy for the treatment of chronic constipation in women who did not benefit from the use of laxatives
Job satisfaction, workplace stress, unhealthy lifestyle choices, and productivity among Canadian nurses: an empirical study
Authors: Buhr Karen J.
Published: June 2016

BACKGROUND: Nurses’ occupational stress and job satisfaction can have an affect on lifestyle choices and productivity. OBJECTIVES: The objective of this study is to provide a detailed examination of the relationship between job satisfaction, job stress, unhealthy lifestyle choices, and productivity among Canadian nurses. METHODS: This study uses data from the confidential master data files of the 2005 National Survey of the Work and Health of Nurses (NSWHN). Ordinary least squares regressions and binary probit regression models were used to estimate the relationships between job satisfaction and job stress on productivity and unhealthy lifestyle choices. RESULTS: Workplace stress variables have a small effect on lifestyle choices. Job satisfaction has an effect on the probability of smoking, but not on drinking. Workplace stress and job satisfaction do not have statistically significant effects on productivity. DISCUSSION: The study found weak relationships among the work related stress variables and productivity. These findings can allow policy makers to consider efforts to reduce workplace stress which can be beneficial to productivity.
Creare Valore Sanitario: nuove prospettive per il management delle aziende sanitarie
Authors: Donna Giorgio , Nieddu Salvatore
Published: June 2016

The value creation is the primary target of a firm and to this pattern is inspired each managerial instrument, behaviour and action. For particular firms as health companies, the pattern of value creation can be well – grounded, provided that it takes care of their particular attributes. Therefore this article is structured on the following methodology of analysis: first of all the pattern of value creation for private firms is shown making clear the meaning of value creation compared with firm’s strategic targets. Then the particular attributes of health companies and the meaning that value creation can undertake in these circumstances are analysed. If the creation of health value can become the strategic target of a health company, it is essential a valuation of the “key variables” marking out the way to create value. At last the change of classical instruments of management and administration control are described. To create health value is the real strategic target of health companies. After years of prevailing or exclusive orientation to efficiency, now managerial instruments rediscover the efficacy and the quality of medical treatments as “key variables” to program and control. Old management tools, such as the budget or the reporting, can become an excellent support for every operator, first of all the medical class that, because of various motives, was (and is) particularly refractory to these instruments. The pattern of value creation can become the philosophy which has to inspire all the health management instruments, and the common language for all the cultures and the professions inside the health companies. Concluding, the pattern of value creation can be an interesting proposal to innovate control systems of health companies and to put an end to the impasse of most of the health management’s applications, but, it required a new co-operation between managers and medical class. Only if the medical class will accept valuation and measurement systems of activity, the value creation will stop to be just a theory and will become a reality.
Stato di salute degli italiani e prospettive di spesa sanitaria e farmaceutica
Authors: Eandi Mario
Published: June 2016

In december 2000 the Italian National Institute of Statistics (INSTAT) published some extracts from the latest statistical survey about the state of health and the resort to medical services in Italy. The research is based on a sample of 52.300 italian families. Since 1980 the average lifetime in Italy grew five years longer: today the average expectancy for a man is 76 years old, and for a woman is 82 years old. All these deep demographic transformations involve an important increase in the chronic-degenerative pathologies. This rise will take up a great deal of public and private health resources. The most frequent chronic-degenerative pathologies are arthrosis or arthritis (18% of italian people) and the high blood pressure (11,5%). After the age of 45, the chronic-degenerative pathologies show a clear growth: some diseases are prevalent in women (e.g. osteoporosis), other prevail in men (e.g. chronic brochitis and stomach ulcer). To better understand the intensity of the resort to medical services, the statistical survey also consider the perception of the health state in Italy. The overall analysis show that the drug consumption (and the health resources consumption generally) is based on a complexity of social and cultural elements; therefore in some particular areas the control of the medical expenditure is more diffucult then in others.
La profilassi antibiotica in chirurgia e la sua valutazione economica
Authors: Lucioni Carlo , Mazzi Silvio
Published: June 2016

Surgical wound infections (SWIs) are a subset of hospital acquired infections (HAIs), associated – though not to the highest frequency – to the highest cost share within HAIs. On these grounds, an economic approach to their entity (incidence and costs) and to the clinical means (surgical prophylaxis) for their containment is attempted in this article. In particular, a simple model is reported to evaluate the best effectiveness of alternative regimens, based on the following equation: Diff Cost = Cost SWI x Diff WIR. Where Diff Cost = difference in the costs of the prophylactic regimens in comparison. Cost SWI = cost per wound infection. Diff Wir = difference in the efficacy of regimens, measured as the difference in Wound Infection Rate. Such equation computes points of indifference, that is points where the difference in efficacy is balanced by the difference in cost between two treatments. At a bit more sophisticated level, this model can be used by adding some stochastic components (confidence intervals). This article collects a group of case-studies, relative to which the model is applied and discussed.
I costi diretti dei servizi psichiatrici in un dipartimento di salute mentale
Authors: Roggeri Daniela , Covelli Giampiero , Garattini Livio
Published: June 2016

The present study aimed to evaluate the mean unit cost of psychiatric services, broken down by type of output. The analysis concerned a psychiatric service (with a Psychiatric Ward in General Hospital (PWGH), a Day-Care Center, a Community Residential Facilitie (CRF) and a NHS Mental Center (NHSMC), located in the North of Italy, selected among the 14 participants of the SCORE (Schizophrenia COsts and REsources) project. The most important result of this study was to estimate a baseline unit cost which can be used for assessing the total cost of a psychiatric disease. The study was conducted according to the full cost method. However, drugs and examinations were not included in this analysis, assuming that these costs are tightly related to the specific psychiatric pathology considered. Personnel was the most relevant component of total cost, accounting for 65% in PWGH, 61% for NHSMC and 65% for CRF. The estimated unit cost was L.536.000 for a day of stay in PWGH, L.590.000 for a day hospital day in PWGH, L.110.000 for an outpatient consultation in PWGH, L.59.000 for a day in a Day-Care Center and L.375.000 for a day in CRF.
I costi dell’influenza in Italia
Authors: Lucioni C. , Costa B. , Sessa A.
Published: June 2016

The influenza is an acute viral infection that strikes respiratory tract and its diffusion is characteristic of epidemic and pandemic reoccurence. Globally the influenza represents, for the entity of its social impact (measurable in terms of morbility, hospitalization and mortality), a heavy healt care problem. In Italy the estimated incidence is 10-15%: the influenza is the third death cause for infectiuos disease, after AIDS and tubercolosis. This study is based on the Studio 606, the first italian study that allow us to pass from the presumptive phase to the observational one. The Studio 606 has been projected and realized by the Società Italiana di Medicina Generale (SIMG), involving about 200 general practitioners (MMG) in two sample region, Lombardia and Puglia. The study has been developed between December the 15th, 1998 and March the 15th, 1999. The influenza causes especially indirect costs: most of people affected with influenza doesn’t go to work for about five days and these absences create an average cost per capita of £558.000. This indirect cost represents 87% of total average cost of one single influenza event.
Traiettorie tecniche e Metodologia QWERTY: come si applicano alle innovazioni farmaceutiche
Authors: Altagracia Marina , Cimoli Mario , Kravzov Jaime , Castillo Rafael , Espejo Ofelia , Wertheimer Albert I.
Published: June 2016

Hypertension is a problem that has a social component and a biological one. The history of the biological solutions has been an increase in research activities and an increase in the number of new products introduced in the pharmaceutical market and adopted as usual therapies. This article analyzes each of the main innovations in the treatment of moderate arterial hypertension and their competitive inter-relationships using a conceptual frame based on the recent theory of innovation. These innovations compete with each other for a market, similar to what happens with other areas and products. The concept of trajectories and the analysis of the competition process among them has not previously been applied to a pharmaceutical market and offers an exciting new avenue for insurance organizations, government health agencies, provider groups, and manufacturers to analyze trends and events in an organized and consistent framework. Learning by using, pharmacological interrelatedness, and pharma-institutional networks are the main analytical tools used to explain the competing processes among the different trajectories considered.
Costruzione di un modello decisionale per valutare la costo/efficacia delle strategie alternative nella terapia della polmonite acquisita in comunità
Authors: Eandi Mario
Published: June 2016

Aim of this paper was to analyse the cost effectiveness of the main alternative (and complementary) strategies in the disease menagement of the Community-Acquired Pneumonia (CAP): hospital admission vs home-care, antibiotic parental vs oral therapy, switch vs no-switch therapy, and early discarge vs conventional hospitalization. The cost effectivenessanalysis (CEA) has been performed by implementing a general decision tree model wich describes all the main decisional and change nodes encountered in the clinical course from the firm sign and symptoms of CAP (root) to the final aoutcomes: full recovery or death (terminal nodes). We assumed the perspectives of three main institutional decision-makers: the society, the italian national healthcare system (NACS), and the hospital. In the perspective of society both the direct (health and non-health) costs and the indirect costs have been included, while in the perspective of the NACS only the health-direct costs were considered. In the perspective of the hospital we considered the overall mean expences sustained for each day of staying in the general and in the intensive care unit. Separately, the antibiotic treatement costs to hospital have been accounted. As effectiveness we considered the percentage of recovery for each class of mortality aqccording to fine. Most of the probability data used in the model were obtained or derived from the published literature. The cost were valued according to the Italian NACS charges and prices in use during the year 2000. According to the model structure, the main expenditure factor for the SSN is the hospitalization cost, while the home care is less expensive. The antibiotic parentenal therapy, during hospedalization or home care, is more expensive than the antibiotic oral therapy; but the cost difference between one therapy and the other is clearly lower than the cost difference between the hospitalization and the home care. The optimum expenditure situation for the SSN, the Society and also for the Hospital coul be obtained by decreasing the days of hospital stay in and by choosing to hospitalize the patients according to the death risk. The sensitivity analysies performed confirmed the robusteness of the results obtained with the model. However the model and its usefulness in decision-making will be definitely confirmed when clinical and epidemiological robust data on CAP in Italy will be available.
Il mercato dei dispositivi per stomia in cinque paesi europei: lezioni per l’Italia
Authors: Cornago Dante , Garattini Livio
Published: June 2016

Aim of the present study is to analyze the international market of the ostomy devices in Italy, France, Germany, U.K. and Denmark. The ostomy systems are technologically mature devices, and the more interesting market developments are about innovative modality of distribution and patients technical support, like home distribution. For every country it has been applied a common pattern, based on four aspect of the ostomy devices market: 1. the legislative aspect; 2. the prescription procedure; 3. the different models of distribution; 4. the competitive systems of pharmaceutical industry. All the data in this study has been galthered through relevant literature and interviews with the area operators. The ostomy devices are repayable against medical prescription in all the studied countries; significant legislative differences are registered in the repayment prices determination. For all the studied countries, in the decisional process related to the choice of one or another device, the essential role is played by the ostomy hospital nurse, that advises the patient immediately after the surgery. Finally, the more significant examples to innovate purchase and distribution process of ostomy devices in Italy comes from Denmark and U.K., where the home distribution is already available and it is working.
Valutazione dell’impatto delle politiche del prezzo di riferimento sul mercato degli H2-antagonisti nella British Columbia, Canada
Authors: Narine Lutchmie , Senathirajah Mahil , Smith Tina , Wertheimer Albert I.
Published: June 2016

In this study we assess the implementation and impact of reference-based pricing (RBP) in British Columbia (BC), Canada, and other OECD (Organization for Economic Cooperation and Development) jurisdictions within an evaluative framework. This was accomplished by conducting a review of prior studies and an analysis of secondary utilization and cost data. Our review of previous work found the introduction of RBP in other OECD jurisdictions was followed by a temporary reduction in pharmaceutical expenditure growth but the rate of growth soon returned to those of previous years. Early results from the BC experience show similar declines in expenditures within reference drug categories, but it remains to be seen if this will continue in the long term. Although early results suggest RBP in BC may be achieving its goals, more work is needed before it can be declared a success. A more balanced evaluation will need to address nonmonetary issues such as impact on the quality of patient care or extent of cost shifting to other areas of the health system. The policy questions raised in this study indicate decision makers should be cautious when thinking of any wider application of referencebased pricing.
Valutazione farmacoeconomica di una casistica di pazienti con riacutizzazione di bronchite cronica
Authors: Liconti M. , Polimeni M. , Filloramo C. , Reale F.
Published: June 2016

Aim of this study is to operate a pharmaeconomical evaluation on case histories of patients affected by chronic bronchitis relapse, comparing the effectiveness of different molecules with antibiotic activity and the total cost far each considered drogo. The observational retrospective study has been conducted at the Bronchopncumology Depaliment of the E. Morelli Hospital (Reggio Calabria) on 344 patients aftècted by acute infective or chronic relapsed bronchopneumopaties between January, the 1st, 1997 and December, the 31th 1999. To avoid excessive data dispersal, the study considered only the active principles prescribed to at least 50 persons: ceftazidime, ceftriaxone, cefepime and piperacilline + tazobactam. AlI the patients have responded positively to the treatment, so the cost minimization analysis has been carried out far every dosage regimen, considering different parameters: nursing staff costs, consumable material and drug costs. The Prescribed Daily Dose (PDD) has been taken as unit of measurement for drug costs. The single adminstration cost is based on nursing costs and consumable material costs. To get the total therapy cost, it’s necessary to add the single administration drug costo. In this study, the lowest total cost is guaranteed by treatment with ceftriaxone.
Le valutazioni economiche in Italia: una revisione sistematica della letteratura esistente
Authors: Garattini L. , Clemente R. , De Compadri P. , Denti C.
Published: June 2016

Aim of this paper is to provide some systematic information about Economic Evaluation studies published on national and international journals by Italian authors. All studies are in Italian or English language and published between 1994 and 2000. The main source is the CESAV database, according to these keywords: “Economic Evaluation”, “Cost-Benefit Analysis”, “Cost-Efficacy Analysis”, “Cost-Utility Analysis”, Cost of Illness” and “Italy”. The study investigated the following variables: methods of analysis, illness, kind of therapy, source of data on efficacy, modelling, source of data on health resources, source of data on unit cost, type of costs, sensitivity analysis. A comparison with the main international reviews (“The U .K. NHS Economic Evaluation Database” and “The Health Economic Evaluation Database”) showed that the approach to the Economic Evaluation in Italy is consistent to the European model, even though the number of studies is still less than in other States.
Farmaci orfani e malattie rare: un confronto internazionale delle normative di riferimento
Authors: Martina S. , Denti C. , Garattini L.
Published: June 2016

Orphan drugs are defined as medicines with low economic returns, so that their production is not a profitable business far pharmaceutical companies. The present study analyses the main characteristics and the role of orphan drugs in four countries (United States of America, .Japan, Australia and European Union), by considering the regulation and the market situation of each State. All countries have introduced a specific legislation on orphan drugs to stimulate the research activity of pharmaceutical industry. The first law was the Orphan Drug Act of the United States of America in 1982. A common limit of all regulations is the strict correlation between “orphan drugs” and “rare diseases”. In fact, the term “orphan” does not refer only to rare disease, but also to other elements that can determine low economic returns for the industry (e.g. drugs with high cost of research and development, drugs that cannot be patented).
L’uso ospedaliero di ciprofloxacina nella terapia parenterale ed orale delle infezioni gravi: profilo farmacoeconomico
Authors: Eandi Mario , Della Pepa Carlo
Published: June 2016

The study focuses on the microbiological and economic aspects of the treatment of hospital infections. The following topics are presented and discussed: I) principal microbiological features of infections acquired during hospital stays; II) data on the use of fluoroquinolones in hospital patients; III) cost-analysis of hospital infection treatment; IV) impact of different antibiotics on the selection of resistant strains of Pseudomonas aeruginosa; V) review of pharmacoeconomic data of different antibacterial regimens.