Global & Regional Health Technology Assessment最新文献

{"title":"Socio-economic impact of epilepsy in Italy.","authors":"Francesco Saverio Mennini,&nbsp;Paolo Sciattella,&nbsp;Matteo Scortichini","doi":"10.33393/grhta.2022.2427","DOIUrl":"https://doi.org/10.33393/grhta.2022.2427","url":null,"abstract":"<p><p>The World Health Assembly recognizes the growing economic and societal burden of neurological disorders, a leading cause of disability and the second cause of mortality in the world. In this context we analysed the socio-economic impact of epilepsy in Italy with a specific focus on hospitalizations and costs related to disability pensions (DPs) and ordinary disability allowances. In the case of epilepsy, between 2009 and 2015 we observed an alarming increasing trend for DPs (+26%), indicating that substantial expenses must be supported throughout the patients' lifetimes by both the social security system and the National Health Service (NHS) on top of the impact on caregivers. We also analysed the hospital expenditure on epilepsy through the information available in the Hospital Discharge Cards between 2015 and 2018. Almost all admissions (76% ordinary hospitalizations, 24% day hospitals) were acute (95%), followed by rehabilitation (4%) and long-term care (1%). The cost of acute and ordinary hospitalizations was by far the highest in 2018, the last year of analysis. This large expense due to hospitalizations could be reduced through the implementation of different organizational and management approaches. Our recommendation is that the policy maker should consider the best approach to ensure an early diagnosis for patients and provide early access to drugs and/or surgery. Finally, the adoption of new innovative treatments should improve effectiveness and, at the same time, reduce the expense of the NHS, of the social system as a whole, with a tangible improvement in patients' quality of life.</p>","PeriodicalId":12627,"journal":{"name":"Global & Regional Health Technology Assessment","volume":"9 Suppl 2","pages":"10-13"},"PeriodicalIF":0.5,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/09/76/grhta-9-S2-10.PMC9796602.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10520981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New evidence in adjunctive treatment of focal-onset seizures in adults: a critical appraisal.","authors":"Simona Lattanzi","doi":"10.33393/grhta.2022.2420","DOIUrl":"https://doi.org/10.33393/grhta.2022.2420","url":null,"abstract":"<p><p>Anti-seizure medications (ASMs) represent the pillar of the treatment of epilepsy. The rate of drug-resistant epilepsy remained substantially unchanged over time and there is still the need for new and more effective treatment options. Brivaracetam, cenobamate, eslicarbazepine acetate, lacosamide and perampanel are 'third-generation' ASMs. The aim of this article is to summarize the currently available evidence about the relative efficacy and tolerability of the 'third-generation' ASMs as adjunctive treatment of focal-onset seizures in adults. So far, no randomized controlled study directly compared these ASMs, and their comparative efficacy and tolerability have been indirectly evaluated by one network meta-analysis. Sixteen trials were included in the network meta-analysis. The efficacy endpoints were the rates of seizure response and seizure freedom, defined as ≥ 50% and 100% reduction in baseline monthly seizure frequency. The tolerability endpoints were the rate of patients who developed any treatment emergent adverse events (TEAEs) and any TEAE leading to drug discontinuation. Cenobamate had the greatest likelihood of being the best option for the ≥ 50% and 100% seizure frequency reduction. Brivaracetam and lacosamide had the greatest likelihood to rank as the best-tolerated treatments for the occurrence of any TEAE and TEAE leading to discontinuation. Although network meta-analyses are not substitutes of direct comparisons, they can provide valuable evidence about the hierarchy of interventions. Additional real-world data can be useful complement to characterize the clinical profile and therapeutic potentialities of third-generation ASMs.</p>","PeriodicalId":12627,"journal":{"name":"Global & Regional Health Technology Assessment","volume":"9 Suppl 2","pages":"14-19"},"PeriodicalIF":0.5,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/73/ab/grhta-9-S2-14.PMC9796607.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9083796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A multicriteria decision analysis (MCDA) applied to three long-term prophylactic treatments for hereditary angioedema in Spain.","authors":"Néboa Zozaya,&nbsp;Teresa Caballero,&nbsp;Teresa González-Quevedo,&nbsp;Pedro Gamboa Setien,&nbsp;Mª Ángeles González,&nbsp;Ramón Jódar,&nbsp;José Luis Poveda-Andrés,&nbsp;Encarna Guillén-Navarro,&nbsp;Agustín Rivero Cuadrado,&nbsp;Álvaro Hidalgo-Vega","doi":"10.33393/grhta.2022.2333","DOIUrl":"https://doi.org/10.33393/grhta.2022.2333","url":null,"abstract":"<p><strong>Introduction: </strong>Hereditary angioedema (HAE) is a rare genetic disease that impairs quality of life and could be life-threatening. The aim of this study was to apply a multicriteria decision analysis to assess the value of three long-term prophylactic (LTP) therapies for HAE in Spain.</p><p><strong>Methods: </strong>A multidisciplinary committee of 10 experts assessed the value of lanadelumab (subcutaneous use), C1-inhibitor (C1-INH; intravenous), and danazol (orally), using placebo as comparator. We followed the EVIDEM methodology that considers a set of 13 quantitative criteria. The overall estimated value of each intervention was obtained combining the weighting of each criterion with the scoring of each intervention in each criterion. We used two alternative weighting methods: hierarchical point allocation (HPA) and direct rating scale (DRS). A reevaluation of weightings and scores was performed.</p><p><strong>Results: </strong>Lanadelumab obtained higher mean scores than C1-INH and danazol in all criteria, except for the cost of the intervention and clinical practice guidelines. Under the HPA method, the estimated values were 0.51 (95% confidence interval [CI]: 0.44-0.58) for lanadelumab, 0.47 (95%CI: 0.41-0.53) for C1-INH, and 0.31 (95%CI: 0.24-0.39) for danazol. Similar results were obtained with the DRS method: 0.51 (95%CI: 0.42-0.60), 0.47 (95%CI: 0.40-0.54), and 0.27 (95%CI: 0.18-0.37), respectively. The comparative cost of the intervention was the only criterion that contributed negatively to the values of lanadelumab and C1-INH. For danazol, four criteria contributed negatively, mainly comparative safety.</p><p><strong>Conclusion: </strong>Lanadelumab was assessed as a high-value intervention, better than C1-INH and substantially better than danazol for LTP treatment of HAE.</p>","PeriodicalId":12627,"journal":{"name":"Global & Regional Health Technology Assessment","volume":"9 ","pages":"14-21"},"PeriodicalIF":0.5,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e3/ad/grhta-9-14.PMC9768612.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9084274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Le modalità distributive dei presidi per stomia e incontinenza nel setting sanitario italiano: un questionario di valutazione e il burden sociale della distribuzione diretta.","authors":"Filippo Rum,&nbsp;Francesca Orsini,&nbsp;Vincenzo Falabella,&nbsp;Pier Raffaele Spena,&nbsp;Americo Cicchetti","doi":"10.33393/grhta.2022.2292","DOIUrl":"https://doi.org/10.33393/grhta.2022.2292","url":null,"abstract":"Distribution methods of ostomy and incontinence aids in the Italian healthcare setting: an evaluation questionnaire and social burden of direct distribution Background: The distribution of ostomy and incontinence devices takes place through different modalities according to the regional provisions in force. A first possibility is represented by direct distribution by the local health authorities. A second possibility consists of indirect distribution through affiliated retailers, typically pharmacies and authorized retailers of medical devices. A third form of distribution concerns home distribution. Methods: A survey has been administered to patients’ associations in order to investigate the degree of patients’ satisfaction with the distribution methods of medical devices necessary for the conditions associated with ostomy and incontinence and to provide an estimate of the indirect costs associated with distribution methods in the Italian healthcare context through the development of a budget impact model. Results: The distribution methods associated with a greater degree of satisfaction seem to be indirect and home distribution. Regarding the results of the budget impact mode, in our simulation, a diffusion of home distribution compared to direct and indirect distribution could lead to savings equal to 2,479,519 € over the three-year time horizon considered. Conclusion: The analysis conducted demonstrates how an increase in home distribution in the context of devices associated with people with ostomy or who practice self-catheterization can be associated with resource savings for the entire society (indirect costs avoided). The survey also demonstrates how this distribution method is associated with a good degree of satisfaction on the part of the users who use it.","PeriodicalId":12627,"journal":{"name":"Global & Regional Health Technology Assessment","volume":"9 ","pages":"36-44"},"PeriodicalIF":0.5,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/53/75/grhta-9-36.PMC9768608.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10518581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Il costo a carico dei pazienti del percorso per eleggibilità ai farmaci PCSK9 e follow-up di un anno: i risultati dello Studio PRIOR.","authors":"Arianna Bertolani,&nbsp;Roberto Ravasio,&nbsp;Paola Raimondo,&nbsp;Claudio Jommi","doi":"10.33393/grhta.2022.2415","DOIUrl":"https://doi.org/10.33393/grhta.2022.2415","url":null,"abstract":"Background. Several health care services are required to get eligibility to PCSK9-inhibitors medicines and the follow-up of patients being treated. The ultimate goal is making prescriptions appropriate and monitoring the effects of these drugs. Some recent papers (opinion / consensus documents) highlighted the necessity to make simpler this clinical pathway. Our paper illustrates the cost of this pathway incurred by patients (direct healthcare and non-healthcare costs, productivity losses by patients and their possible care-giver due to the time dedicated to healthcare services). \u0000Methods. The study relied on a retrospective data collection through a structured questionnaire administered to 240 patients, being on treatments with PCSK9-inhibiotrd drugs for at least one year. Patients were recruited in 4 Italian healthcare centres from June 2020 to July 2021. \u0000Results. Recruited patients are 64 years old on average. 64% of patients are males and 36% are actively employed and working. Mean cost incurred by patients amounts to € 926,1. Direct healthcare costs, direct non-healthcare costs and productivity losses equal to € 463,5 (50%), € 136,7 (15%) and € 325,9 (35%) respectively. Healthcare services fully covered by the National Health Service account for 56% of the total. Co-payments are applied to 26% of healthcare services, whereas patients pay the full price for 18% healthcare services. \u0000Discussion. Getting eligibility to PCSK9-inhibitors and managing patients’ follow-up generate important costs incurred by patients. Furthermore, these costs are very different across healthcare centres. We are fully aware that appropriateness of prescriptions and patients’ follow-up are very important. However, simplifying the clinical pathway would bring economic advantages and could make more homogenous the way this pathway is managed by healthcare centres.","PeriodicalId":12627,"journal":{"name":"Global & Regional Health Technology Assessment","volume":"9 ","pages":"73-81"},"PeriodicalIF":0.5,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2d/c4/grhta-9-73.PMC9768598.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10518586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dieci priorità nel trattamento del paziente con sindrome coronarica acuta.","authors":"Giovanni Esposito,&nbsp;Fabrizio Ricci,&nbsp;Giovanni Battista Zito","doi":"10.33393/grhta.2022.2392","DOIUrl":"https://doi.org/10.33393/grhta.2022.2392","url":null,"abstract":"Ten priorities in the treatment of the ACS patient From the topics addressed in the articles of this Special Issue, dedicated to acute coronary syndromes (ACS), some priorities have emerged summarizing the complexity of the management of these patients, which must take into account not only clinical and pharmacological factors but also logistical and organizational aspects, as well as elements of health policy. Only the synergy between these different aspects can bring out the solution for the optimization of ACS management, in terms of prevention, diagnosis, treatment and improvement of the patient's quality of life.","PeriodicalId":12627,"journal":{"name":"Global & Regional Health Technology Assessment","volume":"9 Suppl 1","pages":"27-29"},"PeriodicalIF":0.5,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/39/5a/grhta-9-S1-27.PMC9796601.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10513775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analisi di costo-utilità di ceftolozano/tazobactam rispetto a meropenem in pazienti con polmonite acquisita in ospedale (HABP) o polmonite associata a ventilazione meccanica (VABP).","authors":"Francesco Saverio Mennini,&nbsp;Martina Paoletti,&nbsp;Chiara Bini,&nbsp;Andrea Marcellusi,&nbsp;Marco Falcone,&nbsp;Massimo Andreoni","doi":"10.33393/grhta.2022.2287","DOIUrl":"https://doi.org/10.33393/grhta.2022.2287","url":null,"abstract":"Cost-utility analysis of ceftolozane/tazobactam vs meropenem in patients with hospital-acquired pneumonia (HABP) or ventilator-associated pneumonia (VABP) Objective: This study aims to evaluate the cost-effectiveness of ceftolozane/tazobactam compared to meropenem for the treatment of patients with hospital-acquired pneumonia (HABP) or ventilator-associated pneumonia (VABP) from the Italian National Health Service (NHS) and social perspective. Method: A decision tree and a Markov model were developed in order to forecast long-term and short-term disease effects respectively. A hypothetical target population of 1,000 HABP/VABP patients was followed for a lifetime time horizon. In the short-term decision tree, two different settings were developed in order to evaluate the value of empirical therapy compared with the start of treatment after confirmation of the antibiogram. Treated and cured patients enter the long-term Markov model following the mortality of the general population. Direct and indirect costs were considered accordingly with the analysis perspective. Results: The analysis showed that ceftolozane/tazobactam, in both treatment settings (empirical and confirmed), may be a cost-effective option compared to meropenem from the NHS and social perspective (ICER equal to € 1,913 and € 2,203 in the empirical treatment setting and € 6,163 and € 6,597 in the confirmed treatment setting for NHS and social perspective respectively). Conclusions: Introduction of ceftolozane/tazobactam within the Italian healthcare context can represent a valid therapeutic solution both from an economic and an efficacy profile point of view.","PeriodicalId":12627,"journal":{"name":"Global & Regional Health Technology Assessment","volume":"9 ","pages":"45-57"},"PeriodicalIF":0.5,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/41/34/grhta-9-45.PMC9768596.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10518584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"La gestione a lungo termine del paziente a rischio: territorio e ospedale, ruolo e sinergie.","authors":"Giovanni Battista Zito","doi":"10.33393/grhta.2022.2390","DOIUrl":"https://doi.org/10.33393/grhta.2022.2390","url":null,"abstract":"Long-term management of the patient at risk: outpatient clinic and hospital, role and synergies Cardiovascular and cerebrovascular diseases are the main cause of death worldwide. In particular, ischemic heart disease is associated with increased mortality risk and decreased quality of life. Population aging is going to increase the overall prevalence of cardiovascular diseases, which is strictly age-related, with a growing economic burden on health systems and society. Effective intervention strategies to control modifiable risk factors for cardiovascular diseases and thereby to reduce the incidence of new events are crucial to limit the huge impact of such diseases on health and quality of life. A strict collaboration between hospitals, where acute events are managed, and outpatient clinics, where patients are followed in the long-term, is the starting point to optimize treatment and secondary prevention, improving adherence to therapy and patient satisfaction.","PeriodicalId":12627,"journal":{"name":"Global & Regional Health Technology Assessment","volume":"9 Suppl 1","pages":"14-16"},"PeriodicalIF":0.5,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5d/54/grhta-9-S1-14.PMC9796595.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10520263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and economic consequences of ozenoxacin vs. other topical antibiotics for the treatment of impetigo: a real-life study in Spain.","authors":"Jaime Rodríguez-Quintosa,&nbsp;Cintia Cristina Ago,&nbsp;Antoni Sicras-Mainar,&nbsp;Renata Villoro,&nbsp;Inés Pérez-Román","doi":"10.33393/grhta.2022.2439","DOIUrl":"https://doi.org/10.33393/grhta.2022.2439","url":null,"abstract":"<p><strong>Background: </strong>Impetigo is a common dermatological paediatric infection that can be treated with topical antibiotics: the common are mupirocin (MUP), fusidic acid (FA) and, most recently, ozenoxacin (OZ).</p><p><strong>Aim: </strong>This study assesses the clinical and economic consequences of the use of OZ vs. MUP and vs. FA for the treatment of impetigo in routine clinical practice in Spain.</p><p><strong>Methods: </strong>This is a retrospective observational study using real-life data from electronic medical records of patients with impetigo who started treatment with OZ, MUP or FA (maximum follow-up: 3 months; n = 10,974). We compared treatment duration, comorbidities, use of systemic medication, complications, utilization of resources and associated costs across treatments (p<0.05). Cost-effectiveness of OZ was assessed from a social perspective. Complication rates and treatment duration were the effectiveness measures.</p><p><strong>Results: </strong>Mean age was 12.6 (standard deviation [SD]: 16.6) years; 48.6% were male; treatment: 9.3% (OZ), 56.4% (MUP), 34.5% (FA). The percentage of patients ending treatment after 2 weeks was 87.6% (OZ) vs. 83.2% (MUP) vs. 82.4% (FA); p<0.001; complication rates were 1.8% (OZ), 3.3% (MUP) and 3.2% (FA), p<0.001; mean costs were €158 (OZ), €265 (MUP) and €287 (FA), p<0.001.</p><p><strong>Conclusions: </strong>OZ is a cost-effective and dominant alternative for the treatment of impetigo.</p>","PeriodicalId":12627,"journal":{"name":"Global & Regional Health Technology Assessment","volume":"9 ","pages":"133-137"},"PeriodicalIF":0.5,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/67/f4/grhta-9-133.PMC9616209.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10521001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gestione del paziente con sindrome coronarica acuta.","authors":"Giovanni Esposito,&nbsp;Fabrizio Ricci,&nbsp;Giovanni Battista Zito","doi":"10.33393/grhta.2022.2388","DOIUrl":"https://doi.org/10.33393/grhta.2022.2388","url":null,"abstract":"","PeriodicalId":12627,"journal":{"name":"Global & Regional Health Technology Assessment","volume":"9 Suppl 1","pages":"1"},"PeriodicalIF":0.5,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a4/9a/grhta-9-S1-1.PMC9796594.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10513776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}