Farmeconomia-Health Economics and Therapeutic Pathways最新文献

{"title":"[Cost-effectiveness analysis of ocriplasmin in the treatment of vitreomacular traction in Italy]","authors":"Lucia S D'Angiolella, Riccardo Miglietta, F. Bandello, S. Rizzo, L. Mantovani","doi":"10.7175/FE.V16I4.1221","DOIUrl":"https://doi.org/10.7175/FE.V16I4.1221","url":null,"abstract":"BACKGROUND: Vitreomacular traction (VMT) caused by vitreomacular adhesion (VMA), is a pathological condition when the vitreous humor has an abnormally strong attachment to the central part of the retina. Ocriplasmin recently approved for the treatment of VMT, including when associated with macular hole (MH) of diameter less than or equal to 400 microns, is a recombinant truncated form of the human serine protease plasmin with retained enzymatic activity, administered by intravitreal injection. We estimated long-term benefits and costs associated with the resolution of traction, following treatment with ocriplasmin versus Standard of Care (SoC), from National Health Service (NHS) perspective. METHODS: A lifetime Markov model has been adopted for Italy in order to estimate costs and outcomes, gained for patients with VMT, with and without MH, treated with ocriplasmin. Health effects have been expressed as Life Years (LY) and Quality adjusted LY gained (QALY), and estimated based on time spent in Visual Acuity (VA) states, defined by best and worst seeing eye, disutility impact associated with surgical interventions, adverse events and metamorphopsia. Deterministic and probabilistic analysis have also been conducted. RESULTS: Over a lifetime ocriplasmin versus SoC generated incremental benefits in terms of QALYs and overall treatment costs in each patients subgroups. Patients with VMT and VMT+MH treated with ocriplasmin had an incremental survival benefits of 0.1123 and 0.0772 QALYs respectively. Therefore, it is expected to come at an incremental cost of 1,873 € and 2,185 € for VMT and VMT+MH patients respectively. The associated ICER is 16,683 € and 28,294 € per QALY gained. Both sensitivity analyses for each of the subgroups confirmed the robustness of the model results. CONCLUSION: Compared to SoC, ocriplasmin is a cost effective therapy option in the treatment of VMT, including when associated with MH. [Article in Italian]","PeriodicalId":41585,"journal":{"name":"Farmeconomia-Health Economics and Therapeutic Pathways","volume":"133 1","pages":"93-102"},"PeriodicalIF":0.5,"publicationDate":"2015-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89020969","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 regulatory and Health Technology processes in Europe and drug market access. The case of cystic fibrosis","authors":"M. Martinez, P. Serrano, A. S. Santamera","doi":"10.7175/FE.V16I4.1207","DOIUrl":"https://doi.org/10.7175/FE.V16I4.1207","url":null,"abstract":"In order to reach the European market, a new drug needs to receive a positive evaluation regarding its quality, safety and efficacy by regulatory health authorities and also obtain a positive HTA appraisal regarding its cost-effectiveness by HTA bodies. Regulators and HTA bodies are collaborating in several projects at European level in order to harmonize the scientific requirements of both evaluations to the maximum extent possible. The comparison of the regulatory evaluation performed by EMA for Kalydeco and the HTA appraisals issued by several EU bodies exemplifies the dilemma between scientific evidence and local economic considerations and the difficulties in the achievement of harmonization and therefore equity in the access to drugs.","PeriodicalId":41585,"journal":{"name":"Farmeconomia-Health Economics and Therapeutic Pathways","volume":"50 1","pages":"103-110"},"PeriodicalIF":0.5,"publicationDate":"2015-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85123608","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":"Comparison between traditional and goal directed perfusion in cardiopulmonary by-pass. Adaptation of a differential cost analysis","authors":"M. Povero, L. Pradelli","doi":"10.7175/fe.v16i1S.1201","DOIUrl":"https://doi.org/10.7175/fe.v16i1S.1201","url":null,"abstract":"BACKGROUND: A previous patient-level discrete event simulation (DES) model was developed to perform an economic evaluation of GDP strategy with respect to TP in US. Aim of this supplement is provide results of the adaptations of the differential cost analysis to Belgium, Canada, France, Germany, Italy, and UK. METHODS: A Discrete Event Simulation model was developed to compare TP and GDP strategy in patients undergoing CPB. National perspective was adopted to calculate costs associated to each event while GDP strategy was exploited the introduction of Sorin Heartlink (HL) Card/GDP Card and Sorin Connect (electronic data management system). RESULTS: GDP reduces the total cost with respect to traditional perfusion; furthermore the cost of GDP strategy (Sorin GDPTM Monitor and Sorin ConnectTM) is completely offset by the saving in hospital stay. CONCLUSION: GDP seems to improve significantly the main outcomes related to CPB surgery, when compared to TP techniques. Additional costs due to perform GDP strategy have no impact on the total cost since completely offset by the savings in hospital cost.","PeriodicalId":41585,"journal":{"name":"Farmeconomia-Health Economics and Therapeutic Pathways","volume":"3 1","pages":"3-16"},"PeriodicalIF":0.5,"publicationDate":"2015-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88801816","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 of illness of advanced ovarian carcinoma in Italy: results of an empirical, single-centre study","authors":"C. Lazzaro, F. Plotti, S. Capriglione, M. Ferrario, R. Angioli","doi":"10.7175/FE.V16I3.1181","DOIUrl":"https://doi.org/10.7175/FE.V16I3.1181","url":null,"abstract":"AIM: To perform an empirical, single-centre, retrospective and secondary cost of illness (COI) study of advanced ovarian carcinoma (AOC) in Italy. METHODS: Demographic, clinical, health care and non-health care resource consumption data concerning a convenience sample of subsequent patients in 1st line of treatment (100 patients), 2nd line of treatment A (surgery + chemotherapy; 30 patients) and 2nd line of treatment B (chemotherapy only; 20 patients) were obtained from a database created in 2011 by the Obstetrics and Ginecology Unit at Campus Biomedico teaching hospital, Rome. Patients were followed-up for 2 years. Resources were valued according to the above mentioned database and literature, following the societal viewpoint. Costs are expressed in Euro (€) 2014 and reported as mean and standard deviation (SD). RESULTS: One-year COI for 1st line of treatment reaches € 44,999.7 (SD: €28,757.3), € 55,410.8 (SD: € 32,454.6) and €46,895.6 (SD: € 28,407.4) for 2nd line of treatment A and B, respectively. Regardless the line of treatment, COI is mainly driven by cost borne by patient and her family. Due to the high costs of relapse the mean COI per patient after 2 years from the diagnosis of AOC equals € 81,869.4 (SD: € 30,660.9), or 182% of the COI for the 1st line of treatment. CONCLUSIONS: Despite some limitations, our results show that increasing progression-free survival could well reduce the COI for AOC in Italy.","PeriodicalId":41585,"journal":{"name":"Farmeconomia-Health Economics and Therapeutic Pathways","volume":"93 1","pages":"61-76"},"PeriodicalIF":0.5,"publicationDate":"2015-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81944798","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":"Comparison between traditional and goal directed perfusion in cardiopulmonary by-pass. A differential cost analysis in US","authors":"M. Povero, L. Pradelli","doi":"10.7175/FE.V16I3.1200","DOIUrl":"https://doi.org/10.7175/FE.V16I3.1200","url":null,"abstract":"OBJECTIVES: High oxygen delivery (DO2) during cardiopulmonary bypass (CPB) is associated with better renal outcome in cardiac surgery. Traditional perfusion (TP) techniques, targeted on body surface area and CPB temperature, achieves high DO2 in about 50% of the cases while a goal directed perfusion (GDP) approach can lead to more than 90% of cases achieving high DO2 with a consequent reduction in Acute Kidney Injury (AKI) rate of about 40%. Aim of this study is to perform an economic evaluation of GDP strategy with respect to TP in US. METHODS: A Discrete Event Simulation model was developed to compare TP and GDP strategy in patients undergoing CPB. The patient’s pathways from operation to discharging from hospital was simulated: AKI incidence, in-hospital mortality, hospital length of stay, transfusions were correlated to probability to achieve high DO2 target using published correlations. National perspective was adopted to calculate costs associated to each event while GDP strategy was exploited the introduction of Sorin Heartlink (HL) Card/GDP Card and Sorin Connect (electronic data management system). RESULTS: GDP strategy saved more than 3 days in hospital and 11% of AKI episodes. The cost-saving is $ 3,137 (95% CI: 1,122-4,951); the cost of HL Card/GDP Card+Connect ($ 180, 95% CI: 113-249) is more than offset by savings in hospital stay that result the main driver in cost ($ 3,222, 95% CI: 1,235-4,950). Deterministic sensitivity analysis shows that the total savings are mainly influenced by nadir haematocrit during CPB and hospital LOS/cost per day both in ICU and in ward. CONCLUSIONS: GDP seems to improve significantly the main outcomes related to CPB surgery, when compared to TP techniques. Additional costs due to perform GDP strategy have no impact on the total cost since completely offset by the savings in hospital cost.","PeriodicalId":41585,"journal":{"name":"Farmeconomia-Health Economics and Therapeutic Pathways","volume":"356 1","pages":"77-86"},"PeriodicalIF":0.5,"publicationDate":"2015-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80138597","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":"Using Patient-Reported Outcomes to Include the Patient in Research, Care, and Quality","authors":"P. Gaur, N. Jeswani, N. Ganesan","doi":"10.7175/FE.V16I3.1203","DOIUrl":"https://doi.org/10.7175/FE.V16I3.1203","url":null,"abstract":"","PeriodicalId":41585,"journal":{"name":"Farmeconomia-Health Economics and Therapeutic Pathways","volume":"4 1","pages":"57-59"},"PeriodicalIF":0.5,"publicationDate":"2015-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73050418","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 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":"Patient reported outcomes to support drug development decision making","authors":"A. Nixon, D. Wild, W. Muehlhausen","doi":"10.7175/FE.V16I2.1187","DOIUrl":"https://doi.org/10.7175/FE.V16I2.1187","url":null,"abstract":"","PeriodicalId":41585,"journal":{"name":"Farmeconomia-Health Economics and Therapeutic Pathways","volume":"36 1","pages":"35-37"},"PeriodicalIF":0.5,"publicationDate":"2015-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77803355","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":"Low-protein diet for chronic kidney disease in the Caserta Local Health Unit: the SaniARP Initiative","authors":"C. Troncone, E. Menditto, V. Orlando, D. Valiante, G. Farina, M. Tari","doi":"10.7175/FE.V16I2.1176","DOIUrl":"https://doi.org/10.7175/FE.V16I2.1176","url":null,"abstract":"INTRODUCTION: In clinical practice, the interest in the use of low-protein food for patients suffering from chronic kidney disease has increased. Currently, these products are not yet contemplated in the essential levels of assistance but the Italian regions deliver, low-protein food discretionally using their own funds. The Campania Region, in 2010, interrupted the distribution of these products. With the exception of Caserta which took up distribution again in 2013. OBJECTIVE: The aim of this paper is to describe an initiative put in place by Caserta which has decided to invest in prevention. MATERIALS AND METHODS: A treatment plan for the distribution designed by a team of in-house nephrologists and data are recorded using Saniarp, a web-based platform. RESULTS: In the observation period patients with a prescription of low-protein food products were 869. The mean age was 61 years. The average cost patient / month for the nutritional treatment was 59 Euro. The average cost patient / month for any type of drug was 632 Euro. In particular, 48 Euro for EPO, 277 Euro for Chelate Agents, 16 Euro for antihypertensive therapy. DISCUSSION AND CONCLUSIONS: The policy put in place by the LHU Caserta improved care of kidney patients. The results available to date are still incomplete and do not enable us to clearly assess the benefits both in clinical and economic terms which can be produced by a low-protein diet in kidney patients. In the perspective of third party payers to budget this expense it appears entirely sustainable especially in view of the fact that this dietary treatment might delay the onset of dialysis therapy and lead to lower comorbidity for the patient.","PeriodicalId":41585,"journal":{"name":"Farmeconomia-Health Economics and Therapeutic Pathways","volume":"33 1","pages":"45-50"},"PeriodicalIF":0.5,"publicationDate":"2015-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89455190","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":"Process reengineering: the experience of electrophisiology center of the Local Health Unit of Viterbo","authors":"Mario Malavasi, S. Dari","doi":"10.7175/FE.V16I2.1189","DOIUrl":"https://doi.org/10.7175/FE.V16I2.1189","url":null,"abstract":"Farmeconomia. Health economics and therapeutic pathways 2015; 16(2) © SEEd All rights reserved professionali, professionisti amministrativi addetti al controllo di gestione, alla contabilità analitica e all’analisi statistica e dei costi, con lo scopo di individuare e reingegnerizzare i processi di sala operatoria [4,5]. Le procedure studiate sono state due: impianto di pacemaker (PM) o defibrillatore impiantabile (ICD) e sostituzione di PM o ICD. È stato messo a confronto il primo semestre 2012, utilizzando i dati inseriti nel registro operatorio cartaceo, con il secondo semestre 2014, prendendo le informazioni inserite nel software di gestione del registro operatorio. Nello specifico sono stati individuati in entrambi i casi tre tipologie di tempi procedurali: preoperatorio (dall’ingresso nel blocco operatorio all’incisione della cute), operatorio (dall’incisione alla sutura della cute) e postoperatorio (dalla sutura all’uscita dal blocco operatorio) [2]. Lo scenario individuato è stato rielaborato grazie ai software Windows Acces ed Excell ed i risultati sono stati espressi come media ponderata e rapporto percentuale tra metodologia tradizionale e innovativa. Come illustrato in Tabella I, relativamente all’impianto di PM/ICD, il tempo preoperatorio è passato da 31 minuti della procedura tradizionale a 23 minuti, con una riduzione del 35% e quello postoperatorio da 22 a 14 minuti con una riduzione del 57%: complessivamente il paziente in media è stato in sala La reingegnerizzazione dei processi in sanità La reingegnerizzazione dei processi è un metodo di analisi nato nella realtà privata, per prevedere un ripensamento delle procedure aziendali al fine di ottimizzarle in termini di costi e tempi. Negli ultimi anni è divenuto sempre più uno strumento in uso nella Pubblica Amministrazione prendendo il nome di Public Organization Reengineering [1]. Questo nasce prevalentemente quale strumento operativo per proporre progetti efficaci, ottenendo risultati che migliorino la qualità dei servizi erogati [2]. La reingegnerizzazione dei processi dell’Elettrofisiologia dell’ASL di Viterbo ha avuto inizio nel secondo semestre del 2012, con una sperimentazione che è andata a regime nel 2013 e che a tutt’oggi è un quotidiano strumento operativo [3]. Obiettivo di questo brief report è confrontare la gestione tradizionale con quella informatizzata attraverso l’utilizzo del software di gestione del registro operatorio che accoglie dati personali e sensibili del paziente, nonché tempistica di Sala Operatoria. A due anni consolidati si può veramente parlare di ottimizzazione dei tempi?","PeriodicalId":41585,"journal":{"name":"Farmeconomia-Health Economics and Therapeutic Pathways","volume":"42 1","pages":"51-53"},"PeriodicalIF":0.5,"publicationDate":"2015-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78179458","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}