Farmeconomia-Health Economics and Therapeutic Pathways最新文献

{"title":"Cost analysis of inappropriate treatments for suspected dermatomycoses","authors":"E. Fiammenghi, A. Patalano, V. Conte, G. Calabrò","doi":"10.7175/fe.v16i2.1172","DOIUrl":"https://doi.org/10.7175/fe.v16i2.1172","url":null,"abstract":"Superficial mycoses are estimated to affect more than 20-25% of the world’s population with a consistent increase over the years. Most patients referred to our clinic for suspected dermatomycoses have already been treated with pharmacotherapy, without a previous mycological examination and many show changes in the clinical manifestations. Indeed, some medications, such as steroids, antiviral, antibiotics and antihistamines are not able to erase a fungal infection, but also they can cause atypical clinical manifestations. The consequences of inappropriate treatment include delayed diagnosis, prolonged healing time, and additional costs. The aims of this study were (1) to evaluate the incidence of increased costs attributable to inappropriate therapy sustained by the National Health Service and patients and (2) to highlight the importance of mycological evaluation before starting treatment, in order to improve diagnostic accuracy. An observational retrospective and prospective study was performed from September 2013 to February 2014, in 765 patients referred to our center (University Hospital “ Federico II”) in Naples, Italy, for suspected mycological infection. The following treatments (alone or in combination) were defined as inappropriate: (1) cortisone in a patient with at least one positive site; (2) antifungals in (a) patients with all negative sites or (b) ineffective antifungal treatment (in terms of drug chosen, dose or duration) in those with all positive sites; or (3) antibiotics; (4) antivirals or (5) antihistamines, in patients with ≥ 1 positive site. Five hundred and fifty patients were using medications before the assessment visit. The total amount of avoidable costs related to inappropriate previous treatments was € 121,417, representing 74% of the total treatment costs. 253/550 patients received drugs also after the visit. For these patients, the cost of treatment prescribed after mycological testing was € 42,952, with a decrease with respect to the total consumption of drugs at the time of access to the Mycology Laboratory of € 34,781. Thus, our cost analysis shows that it is important to obtain a reduction of costs for pathologies that need to be confirmed by examinations before starting treatment.","PeriodicalId":41585,"journal":{"name":"Farmeconomia-Health Economics and Therapeutic Pathways","volume":"11 1","pages":"39-44"},"PeriodicalIF":0.5,"publicationDate":"2015-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78927440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospital Based Health Technology Assessment: an example from Siena","authors":"P. Manzi, P. Barberini, F. Dori","doi":"10.7175/FE.V16I1.943","DOIUrl":"https://doi.org/10.7175/FE.V16I1.943","url":null,"abstract":"The Health Technology Assessment (HTA) has emerged in recent years as a useful tool in healthcare decision-making. It is a multidisciplinary process that summarizes information about the medical, social, economic and ethical issues related to the use of a health technology and provides evidence-based information on how to allocate resources. The experience of Siena University Hospital is an example of multidisciplinary hospital-based HTA. In the present paper we summarize the organization of HTA commission and the assessment methodology of the purchase, rental or sale of medical equipment and medical devices. Furthermore we illustrate the data concerning the commission activities in 2013.","PeriodicalId":41585,"journal":{"name":"Farmeconomia-Health Economics and Therapeutic Pathways","volume":"48 1","pages":"7-13"},"PeriodicalIF":0.5,"publicationDate":"2015-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85094693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of new healthcare legislation and price policy on healthcare services provider at the time of financial crisis. A 10 years study","authors":"I. Malovecká, Konstantinos Papargyris, D. Mináriková, V. Foltán, Anežka Jankovská","doi":"10.7175/FE.V16I1.1040","DOIUrl":"https://doi.org/10.7175/FE.V16I1.1040","url":null,"abstract":"Monitoring, calculation and assessment of healthcare services prosperity in the community pharmacy with the help of financial analysis indicators for the years 2003-2012, using financial statements was conducted, with respect to profitability, debt, liquidity, working capital, and efficiency parameters. These ratios reflect various changes that hold between years 2003 and 2012. Under the time of financial crisis, recession and serious socio-economic changes the profitability parameter Gross Profit ranged from 2003-2011 = 16.12-22.79% (average = 19.20%; mean = 19.78%; σ = 2.41), but in 2012 decreased on 14.35%. Net Profit ranged 2003-2011 = 10.96-18.3% (average = 14.62%; mean = 16.62%; σ = 4.92), while in 2012 reached only 2.29%. Debt ratio ranged from 2003-2012= 2.33-4.81 (average = 3.44; mean = 3.07; σ = 0.82). Liquidity parameters Current Ratio spread between 2003-2012 = 1.13-1.71 (average = 1.43; mean = 1.46; σ = 0.15) and Quick Ratio spread between 2003-2012 = 0.72-1.27 (average = 1.07; mean = 1.09; σ = 0.15). Working Capital Ratio ranged from 2003-2012 = 2.66-12.94 (average = 9.58; mean = 10.06; σ = 3.1) and efficiency ratios were measured either. All changes that have taken place in the society had an impact on community pharmacy finance by worsening its profitability, liquidity, working capital and some of efficiency parameters. Therefore the stability of community pharmacy may be threatened and may affect its future performance.","PeriodicalId":41585,"journal":{"name":"Farmeconomia-Health Economics and Therapeutic Pathways","volume":"51 8 1","pages":"15-24"},"PeriodicalIF":0.5,"publicationDate":"2015-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83038074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness of intravitreal therapy in Age-Related Macular Degeneration","authors":"P. Neri, I. Arapi, C. Eandi, V. Pirani, C. Mariotti, A. Giovannini","doi":"10.7175/fe.v15i4.976","DOIUrl":"https://doi.org/10.7175/fe.v15i4.976","url":null,"abstract":"Age-related macular degeneration (AMD) is still referred to as the leading cause of severe and irreversible visual loss world-wide. Advances in medical research have identified vascular endothelial growth factor (VEGF) as an important pathophysiological player in neovascular AMD and intraocular inhibition of VEGF as one of the most efficient therapies. Anti-VEGFs currently used to treat AMD included a monoclonal antibody (bevacizumab), an antibody fragments (ranibizumab), a fusion protein (aflibercept), and an aptamer (pegaptanib). The wide introduction of anti-VEGF therapy has led to an improvement in the prognosis of patients affected by AMD, with a consequent effects on the burden of care due to highly priced drugs, increasing patient numbers, and long-term disease chronicity. Aim of this review is to present an overview of available therapeutic strategies in AMD in term of clinical efficacy and economic sustainability.","PeriodicalId":41585,"journal":{"name":"Farmeconomia-Health Economics and Therapeutic Pathways","volume":"98 1","pages":"129-138"},"PeriodicalIF":0.5,"publicationDate":"2014-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76511885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacoeconomic aspects related to the 13-valent pneumococcal conjugate vaccine: preliminary analysis of the data from the ASL of Viterbo","authors":"S. Dari, F. Verginelli, S. Aquilani","doi":"10.7175/FE.V15I4.980","DOIUrl":"https://doi.org/10.7175/FE.V15I4.980","url":null,"abstract":"INTRODUCTION: Streptococcus pneumoniae is a pathogen of considerable importance to public health because it causes morbidity and mortality on the world population. It has more than 90 serotypes with different epidemiological characteristics and pathogenicity. Some categories of the population are particularly vulnerable to infection. The Regional Plan for the Prevention of Lazio for vaccination, based on the national plan for the prevention for vaccination involves the active offer of vaccination no 13-valent PCV, with a target of at least 90% in children 24 months of age. OBJECTIVE: To begin to assess the real economic impact of disease attributable to Pneumococcus, starting from the analysis of hospital discharge records (SDO) of the Viterbo's ASL. METHODS: The model is structured follows the observational approach of 33 months, from January 2012 to September 2014, selecting the SDO with a principal diagnosis of Streptococcus Pneumoniae diseases and those with a principal diagnosis of respiratory diseases without etiological diagnosis, which, with good approximation, it can be considered responsible for Streptococcus pneumoniae 40%. RESULTS: From the preliminary analysis of the data, evaluating only patients diagnosed due to Pneumococcus, is known as the only pediatric cases hospitalized are between 0 and 1 year. Therefore one might assume that vaccination disbursed to the child population with 13-valent PCV, has ensured effective protection to persons of the age group 2-18 years. CONCLUSIONS: The importance of this study is the observation conducted on an ASL, (similar in size and catchment area to many Italian realty) of the vaccination coverage effects, as provided by PRPV Lazio Region, on hospitalizations by Pneumococcus. The study offers a moment of reflection for decision makers, as it would be interesting to conduct pharmacoeconomic’s analysis in the presence of vaccination strategies extended to adults, especially for those at risk, associated with diagnostic tests etiological more specific.","PeriodicalId":41585,"journal":{"name":"Farmeconomia-Health Economics and Therapeutic Pathways","volume":"15 1","pages":"155-159"},"PeriodicalIF":0.5,"publicationDate":"2014-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78174544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The trend of pharmaceutical expenditure in Italy: from the report OsMed 2013 to the monitoring 2014","authors":"M. Eandi","doi":"10.7175/FE.V15I4.975","DOIUrl":"https://doi.org/10.7175/FE.V15I4.975","url":null,"abstract":"","PeriodicalId":41585,"journal":{"name":"Farmeconomia-Health Economics and Therapeutic Pathways","volume":"35 1","pages":"97-98"},"PeriodicalIF":0.5,"publicationDate":"2014-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75816114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Economic impact of the use of Hyalubrix® in the treatment of hip osteoarthritis in Italy","authors":"A. Migliore, A. Belisari, Lucia S D'Angiolella, E. Bizzi, U. Massafra, P. Piscitelli, L. Mantovani","doi":"10.7175/fe.v15i4.977","DOIUrl":"https://doi.org/10.7175/fe.v15i4.977","url":null,"abstract":"The present study aims at evaluating the economic impact of the use of hyaluronic acid (Hyalubrix®60/HyalOne) as an alternative to surgery in the treatment of hip osteoarthritis, consistently with the therapeutic protocol envisaged in the Ortobrix study. To quantify the cost and efficacy of the treatment options under evaluation, the perspective of both the Italian NHS and the Society was considered. To this end, a decision analysis model was created over a 4-year period, to quantify the cost of treatments, procedures and adverse events, as well as the benefits expressed as survival rates and reduced lost workdays. The results show that, since the treatment with Hyalubrix® enables to avoid or delay the need for Total Hip Replacement (THR) surgery, it is possible to reduce mortality, adverse events and total costs. Hyalubrix®, given in the hip by ultrasound-guided intra-articular injection as an alternative to surgery is the most favourable option, helping preserve the survival rate over a 4-year period, of approximately 1 in 100 patients considered candidates for THR, preserve work capacity for a total differential amount of 500 days, and achieve considerable savings in economic terms, of approximately 550,000 € and 600,000€ euros from the NHS and the Societal perspectives, respectively.","PeriodicalId":41585,"journal":{"name":"Farmeconomia-Health Economics and Therapeutic Pathways","volume":"415 1","pages":"139-146"},"PeriodicalIF":0.5,"publicationDate":"2014-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86842947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The economic impact associated with cerebrovascular events related to non-valvular atrial fibrillation (NVAF) in Italy: the role of apixaban","authors":"L. Pradelli, M. Calandriello, R. D. Virgilio, M. Bellone, M. Tubaro","doi":"10.7175/fe.v15i1s.972","DOIUrl":"https://doi.org/10.7175/fe.v15i1s.972","url":null,"abstract":"Farmeconomia. Health economics and therapeutic pathways 2014; 15(Suppl 1) © SEEd All rights reserved appropriate therapeutic choice: taking into account the embolic and hemorrhagic patient risk, and the risk associated with the use of anticoagulant therapy. The pharmacoeconomic analyses below have been carried out by adapting a decision tree/ Markov model simulating the clinical experience of NVAF patients according to their probability of incurring an ischemic event, or cardiovascular disease. The first paper reports on a cost/effectiveness analysis of the use of apixaban relative to the standard of care in the prevention of thromboembolic events in vitamin K antagonist suitable and unsuitable patients. The second presents a budget impact analysis that compares NVAF patients eligible for treatment with NOACs in two scenarios – with and without apixaban. Clinical comparative effectiveness parameters among NOACs originate from on adjusted indirect comparison (Bucher’s method) using warfarin as common comparator. We hope that this information will support informed decisions by clinicians and especially payers. The presented supplement of Farmeconomia. Health Economics and Therapeutic Pathways focuses on the economic impact associated with cerebrovascular events related to non-valvular atrial fibrillation (NVAF) from the Italian National Health System (NHS) perspective. A brief look into the scientific literature provides an overview on the burden of AF in the Italian population. In 2010, it was estimated that about one million of Italian patients are living with AF [1] and about 70% of them is affected by NVAF [2]. The prevalence of NVAF increases with age: much more than 10% of NVAF patients are over 80 years. The number of affected patients is expected to increase in the next years [2]. AF is associated with stroke and systemic embolism, and increased mortality. The current preventive measures include Vitamin K antagonists and antiplatelet agents, and recently new oral anticoagulants (NOACs) joined them. NOACs are offering a new option at the disposal of physicians to better manage risk of stroke and systemic embolism in NVAF patients. Physicians have to take the","PeriodicalId":41585,"journal":{"name":"Farmeconomia-Health Economics and Therapeutic Pathways","volume":"1 1","pages":"3-4"},"PeriodicalIF":0.5,"publicationDate":"2014-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80454004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Budget impact analysis of apixaban versus other NOACs for the prevention of stroke in Italian atrial fibrillation patients","authors":"L. Pradelli, M. Calandriello, R. D. Virgilio, M. Bellone, M. Tubaro","doi":"10.7175/FE.V15I1S.973","DOIUrl":"https://doi.org/10.7175/FE.V15I1S.973","url":null,"abstract":"OBJECTIVE: This study aims to perform a budget impact analysis of the use of three available novel oral anticoagulant agents (NOACs) for preventing thromboembolic events in Italian patients with non‑valvular atrial fibrillation (NVAF). METHODS: Estimated Italian population of patients was run through a previously published lifetime decision tree/Markov model simulating their treatment with the available therapeutic options: dabigatran at two dose levels (110 mg/bid for the over 80 years old, 150 mg/bid for younger NVAF patients), rivaroxaban (20 mg/uid), and apixaban (5 mg/bid). Effectiveness and safety estimates derive from an adjusted indirect treatment comparison using warfarin as link. The main clinical events considered in the model are ischemic and hemorrhagic stroke, systemic thromboembolism, bleeds (both major and clinically relevant minor) and cardiovascular hospitalizations, besides treatment discontinuations. Epidemiological data and unit costs, actualized to 2013, are collected from Italian published sources. The budget impact analysis evaluates the financial impact of apixaban introduction by comparing expected 1,2, and 3 years costs in hypothetical scenarios: with and without apixaban. Italian NVAF patient population estimation is based on official apixaban reimbursement criteria, applying the characteristics of the trial population to national epidemiologic data. Numbers of patients for each regimen are estimated by projecting share evolution. Sensitivity analysis is performed on an alternative non‑experimental population of NVAF patients. RESULTS: Among available NOACs, apixaban was expected to be the least expensive in an estimated patient population of 364,000 Italian patients, allowing for savings of € 1,180,549, € 3,841,429 and € 5,368,918 at 1,2, and 3 years, respectively. Results of the simulation run on an alternative non‑experimental population of NVAF patients yields comparable estimates. CONCLUSIONS: The different safety and effectiveness profiles of the three available NOACs emerging from the adjusted indirect comparison indicate that apixaban could improve health care expenditure control while maintaining or increasing therapeutic appropriateness in the Italian NVAF population.","PeriodicalId":41585,"journal":{"name":"Farmeconomia-Health Economics and Therapeutic Pathways","volume":"341 1","pages":"5-14"},"PeriodicalIF":0.5,"publicationDate":"2014-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76385855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Venous tromboembolism treatment: budget impact analysis of rivaroxaban in Italy","authors":"D. Roggeri, A. Roggeri, V. Pengo","doi":"10.7175/FE.V15I4.968","DOIUrl":"https://doi.org/10.7175/FE.V15I4.968","url":null,"abstract":"BACKGROUND: Venous thromboembolism (VTE) is frequently leading to severe complications, particularly deep vein thrombosis (DVT) and pulmonary embolism (PE), and requires high cost healthcare intevention. Rivaroxaban, a novel oral factor Xa inhibitor approved for treatment of DVT, PE and reduction of the risk of recurrence, may represent a cost‑effective anticoagulant choice. OBJECTIVE: This study aims to evaluate the economic impact of the use of rivaroxaban for preventing DVT and PE in Italy. METHODS: We conducted a budget impact analysis to estimate clinical outcomes and economic consequences associated to rivaroxaban vs. standard therapy (low molecular weight heparin + vitamin K antagonists) in the prevention of DVT and PE, over a three‑year time horizon. In the analysis we performed two hypothesis: complete replacement of LMWH/VKA with rivaroxaban (hypothesis 1) and partial and progressive replacement of LMWH/VKA in the first three years of reimbursement (hypothesis 2). Only direct healthcare costs have been considered. RESULTS: Total replacement of LMWH/VKA with rivaroxaban in DVT and PE is associated to a reduction of recurrent symptomatic thromboembolism, major bleeding, vascular events and mortality, with an expenditure saving of about € 11.3 mln (DVT) and € 6.6 mln (PE), corresponding to an average savings per patient treated with rivaroxaban amounted to € 112.9 and € 123,3, respectively. In hypothesis 2 it is estimated that 22%, 25%, and 27% of DVT patients and 12%, 16%, and 20% of PE patients, would be treated with rivaroxaban over the first three years. This would translate into a total saving on healthcare expenditure of € 8.4 mln for DVT and € 3.2 mln for PE and reduction of length of stay with a slight increase in pharmaceutical expenditure. CONCLUSIONS: Rivaroxaban provides significant advantages in terms of events avoided and related costs that would result in a reduction in the total expenditure on the Italian NHS.","PeriodicalId":41585,"journal":{"name":"Farmeconomia-Health Economics and Therapeutic Pathways","volume":"30 1","pages":"113-127"},"PeriodicalIF":0.5,"publicationDate":"2014-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83465765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}