bluuebunny/crossref_metadata_2025 huggingface dataset:
Economic and clinical value of levofloxacin
Authors: Eandi Mario , Zaniolo Orietta
Published: June 2016

Levofloxacin is a newer fluoroquinolone, with broad spectrum of antibacterial activity and good tolerability. This drug has a pharmacokinetic and pharmacodynamic profile that allows a once-a-day administration and offers the potential for intravenous-to-oral switch therapy. Due to these characteristics, the principal guidelines recommend it, as an option for the empirical therapy of patients with mild or more severe community acquired pneumonia (CAP), acute exacerbation of chronic bronchitis (AECB), complicated urinary tract infection (cUTI) and skin and soft tissue infection (SSTI). These pathologies are common causes of morbidity and mortality and place a large burden on medical and economic resources, specially if hospitalization is required. The implementation of a critical pathway, based on levofloxacin use and on a risk prediction rule to establish the need for hospitalization, has the potential to decrease healthcare resource consumption without impairment of clinical outcomes, with respect to conventional management. The possibility of switch therapy allows to reduce length of hospital stay, with a saving in both direct and indirect costs, and an increase in patient satisfaction. In summary, when used according to appropriateness criteria and for approved indications, levofloxacin offers favorable economic features for the healthcare provider, whilst guaranteeing a positive impact on patient functioning and quality of life.
Bayesian statistic methods and theri application in probabilistic simulation models
Authors: Iannazzo Sergio
Published: June 2016

Bayesian statistic methods are facing a rapidly growing level of interest and acceptance in the field of health economics. The reasons of this success are probably to be found on the theoretical fundaments of the discipline that make these techniques more appealing to decision analysis. To this point should be added the modern IT progress that has developed different flexible and powerful statistical software framework. Among them probably one of the most noticeably is the BUGS language project and its standalone application for MS Windows WinBUGS. Scope of this paper is to introduce the subject and to show some interesting applications of WinBUGS in developing complex economical models based on Markov chains. The advantages of this approach reside on the elegance of the code produced and in its capability to easily develop probabilistic simulations. Moreover an example of the integration of bayesian inference models in a Markov model is shown. This last feature let the analyst conduce statistical analyses on the available sources of evidence and exploit them directly as inputs in the economic model.
Simvastatin: between clinics and health economics
Authors: Costa Francesco Vittorio , Zaniolo Orietta
Published: June 2016

Statins reduce the incidence of cardiovascular events, one of the most important public health problems and among the main leading causes of death. Their use has been increasing in the last decade and today they represent the first drug class in terms of public expenditure. In view of the introduction of generic simvastatin in the Italian market, this paper outlines a pharmacological and economic profile of this compound. Despite two decades of life, simvastatin remains competitive with other HMG-CoA inhibitors, inducing a dose-dependent, up to 43% cLDL reduction. In clinical trials evaluating hard endpoints, simvastatin treatment achieved a strong reduction of cardiovascular events, revascularization procedures and mortality. Review of the main published pharmacoeconomic studies on simvastatin consistently indicated good cost/effectiveness ratios in most geographic contexts; convenience of this therapy increases along with baseline cardiovascular risk. Among available statins inducing equivalent cholesterol reductions, generic simvastatin has the lowest daily costs. Assuming stable market volume, an estimated cost saving for the Italian National Health Service of about 1 million Euro per year is expected from the introduction of the generic drug. Further cost savings may accrue for a potential switch from more expensive statins to simvastatin. Albeit individual responses to statins are unpredictable, the choice to start with lower cost molecules can limit initial drug investment and dampen the negative financial impact of treatment interruptions and switches.
Costs and efficacy ofolanzapine and risperidone in schizophrenia
Authors: Mapelli Vittorio
Published: June 2016

Introduction: schizophrenia is a serious and long lasting psychiatric disease. The new “atypical” antipsychotic drugs, introduced in the 90s, have substantially improved the effectiveness of medical treatments, compared to previous neuroleptic drugs. Nowadays they tend to be used as first choice drugs. The ddd cost of atypicals may differ by 20% and health authorities may have an incentive to deliver the less costly drug, especially if they are generic. However the various drugs show differential effectiveness rates and a rational choice should consider both cost and effectiveness. Objective: the purpose of this analysis is to review the existing evidence on cost-effectiveness studies of olanzapine and risperidone, the two most prescribed drugs in Italy. Six published studies were identified, but attention was focused on two articles that reported consistent and methodologically sound results. Results: most reviewed studies are cost-minimization analyses, since effectiveness indicators show no significant statistical difference between the two drugs, and are inconclusive since the results depend on the evaluation setting. However one observational retrospective study showed a significant severity reduction over 12 months for patients treated with olanzapine (-2.46 on HoNOS scale; p<0.05), compared to a smaller non significant reduction of the risperidone group (-0.57). Despite the higher drug cost, the average total cost per reduced severity score was lower for olanzapine than for risperidone patients (€ 4,554 vs. € 10,897). The only medical and related health care costs for risperidone patients were higher than total costs for olanzapine patients. Another study comparing cohorts of patients with similar starting severity showed a significant severity reduction and global functioning increase over 12 months for olanzapine but no significant increase for risperidone patients (-0.35, p<0.01 on CGI scale; +3.66, p <0.05 on GAF scale, compared respectively to -0.27, p<0.05 and +2.00 n.s.). Again average cost per reduced severity/increased functioning score was higher for risperidone than olanzapine patients (€ 4,568 vs. € 4,170 for CGI and € 2,284 vs. € 1,139 for GAF scales respectively). Conclusion: the use of olanzapine in the treatment of schizophrenia is the most cost-effective alternative for the SSN (Italian National health service), as it minimizes the cost per score of severity reduction or functioning increase. Even if the price of risperidone were to be reduced by 50% (becoming a generic), total 12 months treatment costs would exceed those of olanzapine in its highest ddd (30 mg).
Palonosetron in the prevention of chemotherapy-induced nausea and vomiting in Italy: pharmacoeconomic and clinical aspects
Authors: Pradelli Lorenzo , Eandi Mario
Published: June 2016

Despite considerable improvements in the last two decades, chemotherapy-induced nausea and vomiting (CINV) remains a frequent and very bothersome medical problem. It is estimated that about one half to two thirds of all chemotherapy-treated patients experience CINV, the frequency depending on the chemotherapy regimen used and on patient-specific features. The impact of CINV, which may be acute, delayed or even anticipatory in experienced patients, on health-related quality of life (HRQoL) is substantial in all domains.  Until recently, effective treatment choices included corticosteroids and first-generation 5-HT3 antagonists, which have been supported by aprepitant, the first clinically available NK1 antagonist, and by palonosetron, considered the first second-generation 5-HT3 antagonist for its high receptor-subtype selectivity and affinity and long plasmatic half-life. In this paper, clinical pharmacology of the latter drug is briefly outlined and recent Italian papers on the epidemiology and HRQoL impact of CINV are reviewed, as well as national pharmacoeconomic evalutations conducted on palonosetron. The role in therapy of palonosteron and its potential for improved clinical, HRQoL and economic outcomes is discussed.
Valutazione economica dello studio MIRACL
Authors: De Portu Simona , Montella Sabato , Cammarota Simona , Mantovani Lorenzo G.
Published: June 2016

Introduction: the MIRACL study (“Effects of atorvastatin on early recurrent ischemic events in acute coronary syndrome”) has evaluated the effects of atorvastatin on early recurrent ischemic events in acute coronary syndromes. It has demonstrated that, for patients with acute coronary syndrome, lipid-lowering therapy with atorvastatin (80 mg/die) reduces recurrent ischemic events in the first 16 weeks, mostly recurrent symptomatic ischemia requiring rehospitalization. Aim: the goal of this pharmacoeconomic study is to evaluate the MIRACL study in the Italian context. Methods: the analysis is based on clinical outcome data from the MIRACL study. Clinical outcomes measured in the study include: death, cardiac arrest, nonfatal myocardial infarction (MI), fatal MI, angina pectoris, stroke, congestive heart failure (CHF), and surgical or percutaneous coronary revascularizations. Economic evaluation was carried out conducting a cost/effectiveness analysis, comparing economic and clinical consequences of high doses atorvastatin (80 mg) vs placebo in patients with unstable angina or acute myocardial infarction. We identified and quantified medical costs: drug costs according to the Italian National Therapeutic Formulary and hospitalizations were quantified based on the Italian National Health Service tariffs (2006). Effects were measured in terms of mortality and morbidity reduction (number of deaths, life years gained and frequency of hospitalizations). All direct medical costs were taken from the perspective of the Italian National Health System during a 16-week period. We conducted one and multi-way sensitivity analyses on unit cost and effectiveness. We also conducted a threshold analysis. Results: the cost of atorvastatin therapy over the 16 weeks period amounted to approximately 162,489 euro per 1,000 patients. The total cost of atorvastatin high dose was about 2.2 millions euro, the incremental cost per patient free from event is 6,601 euro. Discussion: This evaluation found that atorvastatin therapy is cost-effective. Sensitivity analysis shows that cost consequences parameters are substantially sensitive to fluctuation.
Valutazione economica dello studio IDEAL
Authors: Menditto Enrica , Citarella Anna
Published: June 2016

Introduction: the IDEAL (“High-dose atorvastatin vs usual-dose simvastatin for secondary prevention after myocardial infarction”) study was carried out to compare intensive lowering of low-density lipoprotein (LDL)-cholesterol using the highest recommended dose of atorvastatin 80 mg with simvastatin 40 mg. Aim: our aim was to investigate the economic consequence of high dose of atorvastatin vs usual-dose of simvastatin in reducing major coronary events in patients with a history of acute myocardial infarction (AMI). Methods: the analysis is based on clinical outcome data from the IDEAL study. We conducted a cost-effectiveness analysis, comparing high dose of atorvastatin (80 mg/die) versus usual-dose of simvastatin (20 mg/die) in the perspective of the Italian National Health Service. We identified and quantified medical costs: drug costs according to the Italian National Therapeutic Formulary and hospitalizations were quantified based on the Italian National Health Service tariffs (2006). Effects were measured in terms of mortality and morbidity reduction (number of deaths, life years gained and frequency of hospitalizations). We considered an observation period of 4.8 years. The costs borne after the first 12 months were discounted using an annual rate of 3%. We conducted one and multi-way sensitivity analyses on unit cost and effectiveness. We also conducted a threshold analysis. Results: the cost of simvastatin or atorvastatin therapy over the 4.8 years period amounted to approximately 2.3 millions euro and 2.6 millions euro per 1,000 patients respectively. Atorvastatin was more efficacious compared to simvastatin and the overall cost of care per 1,000 patients over 4.8 years of follow-up was estimated at 4.3 millions euro in the simvastatin and 4,18 millions euro in the atorvastatin group, resulting into a cost saving of 121,518 euro that is 2.8% of total costs occurred in the simvastatin group. Discussion: this study is the first economic evaluation of IDEAL study based on the Italian context. Atorvastatin therapy is dominant since it is both less costly and more effective than simvastatin. Results of sensitivity analysis showed that atorvastatin therapy remains dominant even in the most unfavourable hypotheses.
Valutazione economica dello studio CARDS
Authors: De Portu Simona , Menditto Enrica , Mantovani Lorenzo G.
Published: June 2016

Introduction: cardiovascular diseases (CVD) are the major component of premature mortality, generate disability and are a relevant source of cost. The growing incidence of CVD is associated with lifestyle and other modifiable risk factors. Prevention and preclinical detection of CVD reduce morbidity and mortality. Type 2 diabetes is associated with a substantially increased risk of cardiovascular disease. Objective: the aim of the study was to evaluate the health economic consequence of medical therapy with atorvastatin for primary prevention of major cardiovascular events in patients with type 2 diabetes in Italy. Materials and method: in order to reach our objective we drew clinical information from the CARDS study. This economic evaluation was carried out conducting a cost/effectiveness analysis from the perspective of National Health Service (NHS). The analysis was applied to a time horizon in conformity with the observational period adopted in the CARDS study (3.9 years). An incremental cost/effectiveness ratio (ICER) was calculated and is expressed as cost per life years gained (LYG). In order to test the robustness of the results, a one-way sensitivity analysis was performed. Results: the total cost of atorvastatin therapy over 3.9 years amounts to around 1.5 million of euros per 1,000 patients. The total cost of adding atorvastatin to standard care in people treated for primary prevention of major cardiovascular events in type 2 diabetes as those involved in the CARDS study would entail an additional cost of about 1,2 million of euros per 1,000 patients treated per 3.9 years, with an incremental cost/effectiveness ratio (ICER) equivalent to 36,566 euros per patient per LYG. Discussion: the current study is the first economic evaluation of CARDS study to the Italian situation. The results of the current study show that hypolipemic therapy with atorvastatin 10 mg in diabetic individuals is to be considered cost effective.
The discovery of “sale amarissimo antifebbrile” (“bitter febrifugal saline”) by Bartolommeo Rigatelli, i.e. the origins of pharmacoeconomics
Authors: Marson Piero , Pasero Giampiero
Published: June 2016

When considering the history of salycilates, it has to be underlined that a number of Italian scientists made significant contributions on such a topic. Among these, two pharmacists, Bartolommeo Rigatelli in Verona and Francesco Fontana in Lazise, carried out the first extraction of the active component of willow bark in 1824. Rigatelli named the drug “sale amarissimo antifebbrile” (“bitter febrifugal saline”). In his report some references of pharmacoeconomics are sketched out, thus indicating the attention that the Austrian government on the North Italian districts gave to the management policy. In fact, Rigatelli carried out an economic account of the use of salicin extracts as an antipyretic agent instead of the chincona bark which had been imported from South America at that time and was very expensive. This historical report gives rise to outline a brief history of pharmacoeconomics.
Evaluation of health resources expenditure in two groups of psychotic patients treated with olanzapine and typical neuroleptics in a Italian Mental Health Department in Calabria Region
Authors: Caputo Anna , Guidi Luca , Biricolti Giovanni , Torchia Sergio
Published: June 2016

Numerous Italian and international trials have studied the global costs of treatment with olanzapine and typical neuroleptics. Our analysis confirms those results. In our study, treatment with olanzapine, as compared to typical neuroleptics, was associated with a greater reduction in emergency interventions (hospitalisations), with an increased use of rehabilitation services and with a small increase in the number of working days. The differences between the two groups for this variable were not great, while the differences in the assessment scores appeared important and statistically significant. The results of present study are relative to the practice of one Italian Mental Health Department and, for this reason, cannot be generalized. Anyway, they are another indication of increased efficiency of atypicals treatment over older neuroleptics in schizophrenia.
IDEAL trial: economic analysis
Authors: De Portu Simona , Montella Sabato , Menditto Enrica , Cammarota Simona , Citarella Anna , Mantovani Lorenzo G.
Published: June 2016

Introduction: the IDEAL (“High-dose atorvastatin vs usual-dose simvastatin for secondary prevention after myocardial infarction”) study was carried out to compare intensive lowering of low-density lipoprotein (LDL)-cholesterol using the highest recommended dose of atorvastatin 80 mg with simvastatin 20 mg. Aim: our aim was to investigate the economic consequence of high dose of atorvastatin vs usual-dose of simvastatin in reducing major coronary events in patients with a history of acute myocardial infarction (AMI). Methods: the analysis is based on clinical outcome data from the IDEAL study. We conducted a cost-effectiveness analysis, comparing high dose of atorvastatin (80 mg/die) versus usual-dose of simvastatin (20 mg/die) in the perspective of the Italian National Health Service. We identified and quantified medical costs: drug costs according to the Italian National Therapeutic Formulary and hospitalizations were quantified based on the Italian National Health Service tariffs (2008). Effects were measured in terms of morbidity reduction (frequency of hospitalizations). We considered an observation period of 4.8 years. The costs borne after the first 12 months were discounted using an annual rate of 3%. We conducted one and multi-way sensitivity analyses on unit cost and effectiveness. Results: the cost of atorvastatin therapy over the 4.8 years period amounted to approximately 2.4 millions euro per 1,000 patients. The total cost of atorvastatin high dose was about 3.9 millions euro, the incremental cost per patient free from event is 31.176,03 euro. Discussion: this evaluation found that atorvastatin therapy is cost-effective. Results were sensitive to either clinical or economic variables.
PROVE-IT trial: economic analysis
Authors: De Portu Simona , Montella Sabato , Cammarota Simona , Citarella Anna , Mantovani Lorenzo G.
Published: June 2016

Introduction: the PROVE-IT (“Intensive versus moderate lipid lowering with statins after acute coronary syndromes”) was a comparison of pravastatin 40 mg/die versus atorvastatin 80 mg/die in patients with an acute coronary syndrome (ACS). Aim: our aim was to investigate the economic consequence of high dose of atorvastatin vs usual-dose of pravastatin in Italian patients with a history of acute coronary syndrome. Methods: the analysis is conducted on the basis of clinical outcomes of the PROVE-IT study. We conducted a cost-effectiveness analysis, comparing high dose of atorvastatin (80 mg/die) versus usual-dose of pravastatin (40 mg/die) in the perspective of the Italian National Health Service. We identified and quantified medical costs: drug costs according to the Italian National Therapeutic Formulary and hospitalizations were quantified based on the Italian National Health Service tariffs (2008). Effects were measured in terms of morbidity reduction (number of deaths and frequency of hospitalizations). We considered an observation period of 24 months. The costs borne after the first 12 months were discounted using an annual rate of 3%. We conducted one and multi-way sensitivity analyses on unit cost and effectiveness. Results: the cost of pravastatin or atorvastatin therapy over the 2 years period amounted to approximately 664.684 millions euro and 909.006 euro per 1,000 patients respectively. Atorvastatin was more efficacious compared to pravastatin and the overall cost of care per 1,000 patients over 24 months of follow-up was estimated at 2.58 millions euro in the pravastatin and 2.57 millions euro in the atorvastatin group, resulting into a cost saving of about 11.000 euro. Discussion: this study demonstrates that high dose atorvastatin treatment leads to a reduction of direct costs for the National Health System. Atorvastatin therapy is dominant since it is both less costly and more effective than pravastatin. Results were sensitive to either clinical or economic variables.
Bolzano
Authors: Cavallo Maria Caterina , Cipriani Filippo , Gerzeli Simone , Demarteau Nadia , Marocco Alessia , Bamfi Francesco
Published: June 2016

In Bolzano province 84,8% of women (aged 25-64) are screened regularly, meaning every 3 years. Considering local tariffs and vaccine acquisition cost, the vaccination of 12-year-old girls with a 90% coverage could prevent 7 cases of cervicocarcinoma and 3 related deaths and thus results to be cost-effective (40.541 €/QALY). When the vaccination programme is extended to 16-year-old girls a further 6 cancer cases and 3 deaths could be prevented, with a very similar cost-effectiveness ratio. In Bolzano province, the net cost for woman vaccinated is 216 € for the single cohort and 218 € for the multiple cohort.
Trento
Authors: Cavallo Maria Caterina , Cipriani Filippo , Gerzeli Simone , Demarteau Nadia , Marocco Alessia , Bamfi Francesco
Published: June 2016

In Trento province 72,4% of women (aged 25-64) are screened regularly, meaning every 3 years. Considering local tariffs and vaccine acquisition cost, the vaccination of 12-year-old girls with a 90% coverage could prevent 8 cases of cervicocarcinoma and 4 related deaths and thus results to be cost-effective (30.267 €/QALY). When the vaccination programme is extended to 16-year-old girls a further 8 cancer cases and 3 deaths could be prevented, with a very similar cost-effectiveness ratio. In Trento province, the net cost for woman vaccinated is 197 € for the single cohort and 199 € for the multiple cohort.
Veneto
Authors: Cavallo Maria Caterina , Cipriani Filippo , Gerzeli Simone , Demarteau Nadia , Marocco Alessia , Bamfi Francesco
Published: June 2016

In Veneto region 72,8% of women (aged 25-64) are screened regularly, meaning every 3 years.
Considering regional tariffs and vaccine acquisition cost, the vaccination of 12-year-old girls with a 90% coverage could prevent 72 cases of cervicocarcinoma and 31 related deaths and thus results to be cost-effective (29.052 €/QALY). When the vaccination programme is extended to 16-year-old girls a further 67 cancer cases and 28 deaths could be prevented, with a very similar cost-effectiveness ratio. In Veneto region, the net cost for woman vaccinated is 184 € for the single cohort and 188 € for the multiple cohort.
Friuli Venezia Giulia
Authors: Cavallo Maria Caterina , Cipriani Filippo , Gerzeli Simone , Demarteau Nadia , Marocco Alessia , Bamfi Francesco
Published: June 2016

In Friuli Venezia Giulia region 75,1% of women (aged 25-64) are screened regularly, meaning every 3 years. Considering regional tariffs and vaccine acquisition cost, the vaccination of 12-year-old girls with a 90% coverage could prevent 15 cases of cervicocarcinoma and 6 related deaths and thus results to be cost-effective (27.766 €/QALY). When the vaccination programme is extended to 16-year-old girls a further 14 cancer cases and 6 deaths could be prevented, with a very similar cost-effectiveness ratio. In Friuli Venezia Giulia region, the net cost for woman vaccinated is 167 € for the single cohort and 169 € for the multiple cohort.
Umbria
Authors: Cavallo Maria Caterina , Cipriani Filippo , Gerzeli Simone , Demarteau Nadia , Marocco Alessia , Bamfi Francesco
Published: June 2016

In Umbria region 67,5% of women (aged 25-64) are screened regularly, meaning every 3 years.
Considering regional tariffs and vaccine acquisition cost, the vaccination of 12-year-old girls with a 90% coverage could prevent 13 cases of cervicocarcinoma and 6 related deaths and thus results to be cost-effective (23.398 €/QALY). When the vaccination programme is extended to 16-year-old girls a further 13 cancer cases and 5 deaths could be prevented, with a very similar cost-effectiveness ratio. In Umbria region, the net cost for woman vaccinated is 155 € for the single cohort and 159 € for the multiple cohort.
Molise
Authors: Cavallo Maria Caterina , Cipriani Filippo , Gerzeli Simone , Demarteau Nadia , Marocco Alessia , Bamfi Francesco
Published: June 2016

In Molise region 48,4% of women (aged 25-64) are screened regularly, meaning every 3 years. Considering regional tariffs and vaccine acquisition cost, the vaccination of 12-year-old girls with a 90% coverage could prevent 8 cases of cervicocarcinoma and 3 related deaths and thus results to be cost-effective (18.457 €/QALY). When the vaccination programme is extended to 16-year-old girls a further 8 cancer cases and 4 deaths could be prevented, with a very similar cost-effectiveness ratio. In Molise region, the net cost for woman vaccinated is 191 € for the single cohort and 194 € for the multiple cohort.
Puglia
Authors: Cavallo Maria Caterina , Cipriani Filippo , Gerzeli Simone , Demarteau Nadia , Marocco Alessia , Bamfi Francesco
Published: June 2016

In Apulia region 43,9% of women (aged 25-64) are screened regularly, meaning every 3 years.
Considering regional tariffs and vaccine acquisition cost, the vaccination of 12-year-old girls with a 90% coverage could prevent 127 cases of cervicocarcinoma and 52 related deaths and thus results to be cost-effective (13.471€/QALY). When the vaccination programme is extended to 16-year-old girls a further 133 cancer cases and 54 deaths could be prevented, with a very similar cost-effectiveness ratio. In Apulia region, the net cost for woman vaccinated is 137€ for the single cohort and 141€ for the multiple cohort.
Calabria
Authors: Cavallo Maria Caterina , Cipriani Filippo , Gerzeli Simone , Demarteau Nadia , Marocco Alessia , Bamfi Francesco
Published: June 2016

In Calabria region 36,1% of women (aged 25-64) are screened regularly, meaning every 3 years. Considering regional tariffs and vaccine acquisition cost, the vaccination of 12-year-old girls with a 90% coverage could prevent 66 cases of cervicocarcinoma and 27 related deaths and thus results to be cost-effective (14.934 €/QALY). When the vaccination programme is extended to 16-year-old girls a further 72 cancer cases and 29 deaths could be prevented, with a very similar cost-effectiveness ratio. In Calabria region, the net cost for woman vaccinated is 175 € for the single cohort and 179 € for the multiple cohort.
L’introduzione del vaccino anti-HPV bivalente adiuvato con AS04 nelle regioni italiane: impatto economico ed effetti sulla salute delle donne
Authors: Cavallo Maria Caterina , Cipriani Filippo , Gerzeli Simone , Demarteau Nadia , Marocco Alessia , Bamfi Francesco
Published: June 2016

Introduction: the impact of cervical cancer prevention, in particular through HPV female vaccination, has been published for many countries at the national level. However, to our knowledge no attempt has been made to address the impact at a regional level. Since the Italian health reforms of the early 1990s, introducing “managerialism”, decentralization and quasi-market mechanisms, regional authorities have consequently been experimenting with different organizational and funding models to achieve an acceptable combination of equity, efficiency, freedom of choice and cost-containment.
Methods: a Markov model, previously described and successfully adapted to the national scenario [La Torre, 2007], has been used to explore the impact of preventive cervical cancer vaccination with Cervarix™ at a regional level in Italy. Resource use was based on a standard therapeutic path applied to all regions. However we quantified the impact of the so-called “decentralization progress” by collecting regional data on: pap-test coverage, tariffs for treatments and cost of the vaccination course. We performed for each Italian region a cost-effectiveness analysis combined with a regional budget impact analysis. The regional analyses compared HPV vaccination, both of a single female cohort (12 years old) and a multiple female cohort (12+16 years old), plus screening to screening only. Results: 21 regional reports were produced presenting regional results on screening coverage, treatments costs, ICER and ICUR, net cost per subject vaccinated etc. Conclusions: national and regional analyses have two different aims: the former wants to address national regulatory agencies and needs to be representative of the national population whereas the latter deals with the real budget-holders, accountable in the eyes of patients. Furthermore in the Italian scenario, characterized by decentralization and local autonomy, a further level of detail is essential in order to describe the specific local settings and implications of a new health intervention.
Piemonte
Authors: Cavallo Maria Caterina , Cipriani Filippo , Gerzeli Simone , Demarteau Nadia , Marocco Alessia , Bamfi Francesco
Published: June 2016

In Piedmont region 65% of women (aged 25-64) are screened regularly, meaning every 3 years.
Considering regional tariffs and vaccine acquisition cost, the vaccination of 12-year-old girls with a 90% coverage could prevent 69 cases of cervicocarcinoma and 29 related deaths and thus results to be cost-effective (24.955 €/QALY). When the vaccination programme is extended to 16-year-old girls a further 66 cancer cases and 28 deaths could be prevented, with a very similar cost-effectiveness ratio. In Piedmont region, the net cost for woman vaccinated is 187 € for the single cohort and 190 € for the multiple cohort.
Sartans: differences, similitudes and costs
Authors: Zaniolo Orietta , Iannazzo Sergio
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), which were introduced about 10 years ago. During this period they 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. In patients with heart failure, valsartan, candesartan and, partially, losartan have been shown to be associated with positive outcomes both as monotherapy, when ACE-inhibitors are contraindicated or not tolerated, and in combination with ACE-inhibitors standard therapy. Among ARBs, valsartan is the only that is also approved for treatment of patients with both heart failure and recent myocardial infarction. In light of the high costs related to cardiovascular disorders, agents that reduce cardiovascular risk, like ARBs, represent a potential long-term health cost saving strategy, if used according to guidelines in approved indications. Valsartan has a daily cost which is lower than the mean cost of the class. Furthermore, this drug shows one of the lowest costs for patient brought to blood pressure goals in its class. In this paper, economic evaluations conducted on the results of large trials were reviewed. Their results add economic rationale to the therapeutic algorithms recommended by clinical guidelines on heart failure management; using valsartan, or other evaluated ARBs, in heart failure patients who are intolerant or contraindicated to ACE-inhibitors therapy, is expected to be highly cost/effective. In combination with ACE-inhibitors in those patients not on beta-blocker therapy, its cost/effectiveness is somewhat worse, but still acceptable, with an estimated cost of 15,000 USDs for life year saved. In summary, when used for approved indications, valsartan offers attractive economic features for the healthcare provider and has a positive impact on the cardiovascular morbidity and health-related quality of life of these patient populations.
Epidemiological and economic aspects of diabetes in the Campania Region, Italy
Authors: Cammarota Simona , Morsanutto Andrea , Menditto Enrica , Citarella Anna , De Portu Simona
Published: June 2016

Aim: to assess the economic and epidemiologic impact of diabetes in Campania, a region of approximately 5.7 million inhabitants in the south of Italy. Method: we collected, from an electronic database, all prescriptions for antidiabetic drugs reimbursed in the first half year of 2005 in 8 local health authorities (60% of the overall population) of Campania. The diabetic cohort was defined as the population of subjects receiving at least 2 prescriptions of an antidiabetic agent in 6-month, classified according to their therapeutic role using Anatomic Therapeutic Chemical (ATC) classification. Characterization is given of the patients and their antidiabetic medication. Subsequently, the prescription of concomitant treatment, in comparison with a control group, is presented. Drugs cost and drugs consumption were quantified using NHS prospective (expressed in Euro 2005) and Defined Daily Dose system (DDD) respectively. Results: the diabetic cohort included 183,614 subjects (5.3% of the observed population), mean age was 65.0 years and female represented 54.8% of the sample. Total cost for diabetic patients represents 16.8% of the total drug expenditure. The average drug/cost/patient was € 355.7; only 19.0% was spent for antidiabetic drugs. The reported use of medication was higher for subjects with diabetes compared with the control population regarding overall use (2,363.5 versus 1259.8 DDD/1,000 inhabitants/die), the use of cardiovascular drugs (1,499.3 versus 663.5 DDD/1,000 inhabitants/day), use of haematologic drugs (277.1 versus 120.3 DDD/1,000 inhabitants/day), and use of ophthalmological drugs (48.3 versus 21.0 DDD/1,000 inhabitants/day). Discussion: chronic-degenerative pathologies, such as diabetes, implies a relevant social and economic impact. Expenses that are associated to the treatment and the prevention of complications, in particular cardiovascular problems, are registered among the main items listed in the healthcare budget.
Cost-efficacy analysis of hormonal treatments for advanced prostate cancer
Authors: Iannazzo Sergio , Pradelli Lorenzo
Published: June 2016

Introduction: prostatic cancer is the second more frequent cancer in Italy (after lung cancer) and is the third cancer-related death cause. Age is the principal risk factor and, given the ageing process undergoing in the Italian population, it seems clear that the public sanitary expenditure to treat the disease is bound to increase, arising the need to perform pharmacoeconomic evaluations of the therapeutic strategies available. Methods: we performed a cost/utility analysis, through a Markov model, of several hormonal therapies in patients with advanced prostate cancer who underwent radical prostatectomy, from the biochemical recurrence to death. Nine androgen suppression therapies were considered: orchiectomy, two nonsteroidal antiandrogens (NSAA), four luteinizing hormone-releasing hormone (LHRH) agonists, cyproterone acetate and the association of a NSAA and a LHRH (BAT). In the simulation the androgen suppression therapies were started at the PSA recurrence and never stopped until death. The model used the Italian NHS prospective and a time horizon corresponding to patient’s lifetime. Drug costs were calculated for each therapy, considering the less costly brand. Results: all the considered therapies produced a life expectancy (LE) of about 12 life years (LYs) with a small variability ranging from 12.3 LYs for BAT (the most effective) to 11.37 LYs for NSAA-flutamide (the least effective). Quality adjusted life expectancy ranged from 9.98 QALYs for BAT to 9.28 QALYs for NSAA-flutamide. The average cost per patient presented a more enhanced variability, from 12,538 Euro for orchiectomy to 59,496 Euro for NSAA-bicalutamide. Among all the alternatives orchiectomy resulted the most cost/effective alternative with a cost/utility ratio of about 1,300 Euro/QALY. In the LHRH-agonists class leuprorelin was the most cost/effective with about 2,200 Euro/QALY. A one-way sensitivity analysis showed a substantial stability of the results. Conclusions: BAT resulted the most effective therapy, but also the one associated with the highest expected cost. Orchiectomy was marginally less effective but at the same time generated the lowest cost and, thus, represented the most cost/effective strategy. Nonetheless, its application in actual clinical practice is difficult and quite always refused by patients. Among the class of LHRH-agonists leuprorelin (considering the less costly brand, Eligard®) dominated the alternatives and, thus, could provide an excellent therapeutic strategy.
Usefulness and limitation of DDD and PDD analyses. 12 months of solid oral antipsychotics prescribing data for the NHS-reimbursed treatment of schizophrenia in Italy
Authors: Pradelli Lorenzo
Published: June 2016

The estimation of real-world pharmaceutical costs in a given setting is one of the crucial steps in pharmacoeconomic comparisons among drugs used in that setting. For the purpose of this estimation, information regarding available pharmaceutical forms, alongside price and market share, for every considered drug is needed. Furthermore, it’s necessary to know, at least approximately, drug quantities averagely consumed in each episode, in the case of acute therapies, or on a daily basis in chronic therapies. This data is difficult to measure in non-experimental settings, and is generally approximated using the statistical average of the drug quantity prescribed by physicians for a given condition. This paper will briefly review definitions and appropriate uses of DDDs (defined daily dose), and PDDs (prescribed daily dose), and then illustrate the expressed concepts on the basis of a practical example constructed on the analysis of last available 12 months of solid oral antipsychotics prescribing data for the NHS-reimbursed treatment of schizophrenia in Italy.
L’engagement du spectateur de théâtre de rue. Revivre l’espace urbain
Authors: Aventin Catherine
Published: June 2016

En tant qu’architecte, c’est par une approche pluridisciplinaire que Catherine Aventin étudie les arts de la rue, d’un point de vue spatial et sensible par le biais des ambiances architecturales et urbaines. Elle travaille entre autres sur la réception de ce type d’action artistique, où la scène peut être une rue, une place, voire une ville entière. Son article aborde la réception par les différentes composantes de l’espace public à l’oeuvre (physique, sociale et sensible) et montre quels liens peuvent se créer entre le lieu de représentation, l’événement artistique et les pratiques et représentations sociales. Elle présente aussi des stratégies développées par les spectateurs lors de représentations, ainsi que les changements de perception et de représentation des espaces après ces spectacles. Pour cela, elle s’appuie sur ses enquêtes et analyses menées en France (particulièrement à Grenoble et à Calais), principalement sur la base d’observations participantes, de spectacles de différentes échelles (intimes comme s’adressant à une ville entière) et de tous types (fixes, déambulatoires, courts ou durant plusieurs jours).
Frequency of and Factors Associated with a Proxy for Critical Falls Among People Aging with Multiple Sclerosis
Authors: Bisson Etienne J. , Peterson Elizabeth W. , Finlayson Marcia
Published: June 2016

Background: Critical falls, defined in the literature as involving an inability to get up after the fall, have been associated with morbidity and mortality in older adults but have not been examined in people with multiple sclerosis (MS). To highlight the importance of the critical fall concept in MS, this exploratory study sought to identify the frequency of and factors associated with a proxy for critical falls in people with MS.

Methods: Of 354 adults with MS 55 years and older interviewed, 327 reported a story about their most recent fall that included information about fall-related experiences, including whether they received help to get up after a fall. We used this information as a proxy for critical falls in a logistic regression analysis.

Results: A total of 177 individuals (54.1%) received help to get up after their most recent fall. Logistic regression analysis revealed six factors associated with this proxy for critical falls: fall leading to a fracture (OR = 4.21), leg weakness (OR = 3.12), living with others (OR = 2.48), female sex (OR = 1.96), balance or mobility problems (OR = 1.90), and longer disease duration (OR = 1.04).

Conclusions: Receiving help after a fall is common for people aging with MS, suggesting that critical falls need to be further studied. Findings support the need for fall management education that includes action planning for proper assistance and balance and strength training to increase the ability to get up safely after a fall.
Since “Groundwater and Surface Water–A Single Resource”: some U.S. Geological Survey advances in modeling groundwater/surface-water interactions
Authors: Feinstein Daniel
Published: June 2016

Field and interpretive studies conducted by T.C. Winter and U.S. Geological Survey colleagues, and summarized in the 1998 publication “Groundwater and Surface Water – A Single Resource”, inspired a new generation of research centered on extensions of the groundwater-flow code MODFLOW to more sophisticated simulation of coupled groundwater and surface-water systems. Guided by emerging concerns with water availability, safe yields from wells, health of aquatic habitat, and climate change, the changes to MODFLOW involve: 1) the ability to more precisely and accurately represent the interface between surface and subsurface flows and 2) the consideration of a variety of mechanisms that influence their interaction. A review of the most important changes to the code is supplemented in this article by selected case studies in an effort to show the scope of the advances. The updates discussed include the Streamflow Routing (SFR), Lake (LAK), and Unsaturated-Zone Flow (UZF) Packages in MODFLOW-2005 and the Groundwater Management (GWM), Local Grid Refinement (LGR), and Newton (NWT) formulation versions of MODFLOW-2005. New developments feature the integration of rainfall-runoff modeling with MODFLOW in GSFLOW, coupling of GFLOW and MODFLOW in a hybrid code, and the forthcoming unstructured grid version of MODFLOW. They promise continued advances in the ability to use science to protect the single water resource.
Some key issues in the design of water wells in unconsolidated and fractured rock aquifers
Authors: Misstear Bruce
Published: June 2016

The key well design issues considered in this paper are the length of the intake section; the hydraulic efficiency of the well; the length of grouted upper casing for wells in fractured rock aquifers and the potential trade-off between well yield and security against pollution; and the economics of well design. For wells in thick, relatively uniform unconsolidated aquifers, the well depth and screen length can be estimated using a simple discharge-drawdown relationship. This approach can help avoid constructing unnecessarily deep wells if alternative guidance to screen the bottom third of the aquifer was followed in such situations. Hydraulic efficiency is an important consideration in well design: the paper highlights that whereas screen entrance velocity has been a topic of much discussion in the literature, well upflow velocity has received less attention, but can be an important contributor to well losses in small diameter screens. In fractured hard rock aquifers, there may be a compromise required in well design between maximising well yield by exploiting shallow fracture zones whilst also providing adequate sanitary protection to the well by installing an upper grouted casing. Recent data from Ireland on the distribution of hydraulic conductivity with depth in poorly productive fractured rock aquifers are used to calculate the reduction in well yield that would result from increasing the length of the grouted upper well casing. Economic aspects of well design are especially important where there are a large number of wells to be drilled and/or where wells are required in poor rural communities in developing countries. The principles of cost-effective boreholes for developing countries are summarised, noting the opportunities for small-diameter shallow wells constructed with inexpensive manual or lightweight mechanical drilling rigs.
L’idrogeologia italiana in movimento: Flowpath 2012
Authors: Petitta Marco
Published: June 2016

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Sistemi a circuito aperto/circuito chiuso: un confronto
Authors: Cultrera Matteo
Published: June 2016

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Thermal conductivity distributed from a Thermal Response Test (TRT) in a borehole heat exchanger (BHE)
Authors: Blasi A. , Menichetti M.
Published: June 2016

The Thermal Response Test (TRT) is the most versatile tool to determine the thermal propriety of the underground for designing and sizing of the borehole heat exchangers (BHE). The TRT permits to get the average thermal conductivity (λ) across the whole stratigraphy, the thermal resistance (Rb) of the borehole / grout / rocks and the undisturbed temperature of the soil (Tg). The ground temperature is influenced by climate, topographical, geological and hydrological factors. Vertical temperature changes allows to get the relationships with the lithology and especially with the groundwater. Vertical temperature log, acquired during and after the TRT, permits to calculate the distributed thermal conductivity over each stratigraphic interval. This method permits to verify how the different lithologies and the groundwater contribute to the heat exchange in the borehole/ground system, so called geoexchange. The experimental site test indicates that the marls and clayed-marls levels show a higher thermal inertia than the sandstone ones and then lower values of thermal conducivity. The sandstones have a higher thermal conductivity with a rapid cooling and they provide the main contribution to the ground heat exchange. The distributed thermal conductivity is an useful tool for designing the BHE with the best performance, a better economic return and with low environmental impacts.
Si costituisce la FEDERAZIONE fra AIF, ANIPA, ANISIG, IATT
Authors: Chiarugi Stefano
Published: June 2016

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Acqua (pulita) per tutti. Henry Darcy e l’acquedotto di Digione
Authors: Luzzini Francesco
Published: June 2016

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La manutenzione dei pozzi per acqua: cause della perdita di efficienza dei pozzi e principali tecniche di intervento
Authors: Cempini Nicola
Published: June 2016

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