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[Complementary Strategy of RSVpreF Vaccination/Nirsevimab versus Nirsevimab Alone for the Prevention of RSV Infection in Infants in Italy: A Cost-Minimization Analysis]
No full textOBJECTIVE: To assess the economic impact of two preventive strategies against respiratory syncytial virus (RSV) infection in Italian newborns: universal administration of nirsevimab versus a complementary approach combining maternal RSVpreF vaccination and selective use of nirsevimab.METHODS: A cost-minimization analysis was conducted over a 3-year time horizon, based on the assumption of equal clinical efficacy between the two strategies, as supported by published evidence. The analysis compared: (1) the exclusive use of nirsevimab in all newborns, and (2) a complementary strategy with RSVpreF vaccination during pregnancy for infants born in the RSV season (October–March), combined with targeted use of nirsevimab for extremely and very preterm infants and for those born outside the protective window of maternal immunization. Only drug acquisition costs were included, assuming equivalent healthcare resource use in both scenarios. Epidemiological and cost data were derived from national birth statistics, literature, and public pricing sources.RESULTS: Assuming a birth cohort of 379,890 infants per year and 70% coverage, the annual cost of universal nirsevimab administration (Scenario 1) was €61,162,290, amounting to €183,486,870 over three years. In the complementary strategy (Scenario 2), annual costs were €55,062,016, totaling €165,186,049. This represents a saving of €6.1 million per year and €18.3 million over three years, equivalent to a 10% reduction in expenditure.CONCLUSIONS: In the Italian context, a complementary RSV prevention strategy combining maternal vaccination with targeted neonatal immunization may offer substantial cost savings for the national health system, without compromising clinical efficacy. These findings support the implementation of integrated and flexible immunization programs and highlight the potential role of maternal RSV vaccination in enhancing both sustainability and effectiveness of public health strategies
A Real-World Analysis of Patients with Triple Class Exposed Multiple Myeloma in Italy: Epidemiology Estimates, Treatment Pattern and Economic Burden
Full text linkOBJECTIVES: This research aimed to provide updated epidemiological estimates of multiple myeloma (MM) in Italy and to characterize the clinical journey, treatment patterns, and economic burden focusing specifically on the subset of patients who have been exposed to all three major therapeutic classes: proteasome inhibitors, immunomodulatory drugs, and antiCD38 monoclonal antibodies (triple-class exposed, TCE).METHODS: A retrospective analysis was conducted using Italian healthcare administrative databases covering 12 million individuals. The research included (i) an epidemiological analysis of MM prevalence and incidence, and (ii) a longitudinal analysis of TCE patients identified between January 2017 and June 2023. Inclusion criteria required exposure to the three major MM drug classes. Healthcare resource utilization (HCRU) and direct costs from the Italian National Health Service perspective were assessed at one-year follow-up.RESULTS: As of August 2022, MM incidence was 9/100,000 and prevalence 40.9/100,000; TCE prevalence was estimated at 4.1/100,000, projecting to 2,557 TCE patients in Italy. From 6,102 MM patients, 894 were identified as TCE; 887 had sufficient follow-up for inclusion. TCE patients had a mean age of 67 years and a mild comorbidity burden (Charlson Index = 0.7). Among 309 recent TCE cases (2022–2023), 35.6% became TCE in first-line therapy and 46.5% in second-line. HCRU analysis (n=461) showed high service use, with annual per-patient costs averaging €119,899—88% attributable to MM-related drugs.CONCLUSIONS: This real-world analysis highlights a growing population of TCE MM patients in Italy, with increasing exposure to combination therapies earlier in treatment. The findings underscore the substantial clinical and economic burden posed by this population, reinforcing the need for novel therapeutic options to improve outcomes and manage costs within the healthcare system
[Enhanced Influenza Vaccines Under Review by the ECDC and the Latest Scientific Literature]
No full textDecatecholaminization of Septic Shock Patients in Intensive Care Unit: an Economic Assessment in the Italian Setting
Full text linkINTRODUCTION: Prolonged administration of norepinephrine to critically ill patients can lead to serious adverse events. In this context, the concept of “decatecholaminization” has emerged over the past decade, involving the association of vasopressin with norepinephrine to reduce catecholamines need. Additionally, beta-blockers can help prevent increased heart rate resulting from sepsis treatments. This study presents an economic analysis evaluating the economic implications of the decatecholaminization use in patients with septic shock treated in intensive care unit (ICU) from the Italian National Health Service (NHS) perspective.METHODS: Two analyses were conducted: (1) a patient-level comparison of costs between two real-world cases, one treated with decatecholaminization and one without this approach, and (2) a cohort-level analysis using a pharmacoeconomic model to project cost differences for the Italian National Health Service (NHS) before and after implementing decatecholaminization.RESULTS: In the patient-level analysis, the use of decatecholaminization results in increased pharmacological expenses (+€210), and cost reduction in resource utilization (-€30,412). Similarly, the cohort-level shows higher pharmacological costs (+€192 per patient) and lower cost for other resources (-€1,264 per patient) in the future vs current scenario, resulting in a cumulative cost reduction of -€1,072 per patient. Considering an eligible population of 39,207 patients, decatecholaminization results in a total cost reduction of approximately €42.4 million.CONCLUSION: This analysis supports the economic viability of decatecholaminization as an effective treatment for comprehensive management of septic shock. Further evaluation in real-world settings is needed to validate these findings and optimize clinical application
Optimizing Treatment of Schizophrenia: Clinical and Economical Potential for Patient Switching to Long‑Acting Injectables
Full text linkINTRODUCTION: Long-acting injectable antipsychotics (LAIs), due to a lower frequency of administration, could address the well-established challenge of non-adherence to oral ones. We conducted a Network Meta-Analysis (NMA) to assess the relationship between administration frequency and effectiveness. The recent introduction of a semi-annual paliperidone palmitate formulation, along with the arrival of monthly paliperidone generics, could emphasize LAI’s advantages. Aim of this paper is to present the results derived from an updated version of our previous NMA. These results are used to fuel a budget impact model built to evaluate the economic implications of optimizing dosing intervals.METHODS: We compare the current distribution of patients among available LAI active substances and dosing frequencies with an optimized scenario. In this scenario, 20% of patients are switched to the next permitted regimen with a longer inter-dosing interval. Drug acquisition costs and relapse management costs are taken into account over a one-year simulation period; these last items are estimated by means of the event rates obtained from the updated meta-analysis. The optimized scenario incorporates the reduced cost resulting from the expiration of patents.RESULTS: Throughout the analysis, a total of 11,600 patients were able to switch from shorter to longer dosing intervals, leading to an overall optimization of quality of care. The greater expenditure incurred by the Italian National Health Service (NHS) in the acquisition of newer and longer-lasting drugs is offset by savings associated with the arrival of generics of monthly paliperidone palmitate and the shift toward less-relapsing regimens. The net impact on the NHS budget is a saving of more than 19 million Euros.CONCLUSION: This economic saving has the potential to initiate a virtuous process: it could be reinvested to fund a further shift from oral daily therapies, which are less expensive but marked by poor compliance, to LAIs. According to our simulation, nearly 40 thousand patients could undergo this transition, without additional expenses for the NHS
[Cost per Responder Analysis of Filgotinib in Patients Suffering from Ulcerative Colitis]
Full text linkOBJECTIVE: To evaluate the costs and benefits associated with the use of biologics and Janus kinase inhibitors (JAKi) for the treatment of bio-experienced patients suffering from ulcerative colitis in Italy.METHODS: This pharmacoeconomic analysis compared JAKi (filgotinib, tofacitinib and upadacitinib) and biologics (vedolizumab and ustekinumab). A decision tree model with a 1-year time horizon was built in MS Excel in order to estimate treatment cost and clinical efficacy expressed in terms of clinical response (CR), clinical remission (CRe) and mucosal healing (MH). Efficacy of each treatment was estimated using relative risks elaborated from a recent network meta-analysis of 17 RCTs. The investigated population concerned patients previously treated with biologic drugs (bio-experienced). Both induction and maintenance phases were considered and dose escalation (when allowed) was planned for patients not reaching an appropriate response after induction. Outcomes included total treatment cost (acquisition and administration), overall response rate, and cost per responder at one year.RESULTS: According to the model results, the treatment associated with the best clinical response at 1 year was vedolizumab (69.6%) followed by filgotinib (60.9%) and upadacitinib (60.1%). Despite differences in efficacy, filgotinib resulted in the lowest cost per responder, in every outcome, compared with all the other alternatives. The same trend applies when observing results at the end of the induction phase only. Results were robust to probabilistic sensitivity analyses, filgotinib has a posterior probability to be better than the other alternatives higher than 96% according to all the three response definitions (CR, CRe, and MH).CONCLUSIONS: Generally, JAKis and vedolizumab were associated with higher treatment response. Among the alternatives included in the analysis, filgotinib has the lowest cost per responder for all the outcomes included. These findings could help deliver more effective and efficient healthcare in the NHS.
[Implantation of Reveal LINQ in Different Italian Scenarios: How to Further Improve?]
Full text linkINTRODUCTION: The manuscript describes the long-term cardiac rhythm monitoring system, known as Reveal LINQ, along with an analysis of the evolution in the Italian cardiology practice that its introduction has brought and may still bring given the smaller size and the implantable procedure, performed even by nursing personnel.METHODS: The project was articulated, firstly, to understand how the Reveal LINQ implantation is organized in 4 different Italian hospital facilities and to estimate the associated costs. For each of the involved facilities, data on the operating room type, length of hospital stay, resource consumption, and unit costs associated with the implantation procedure were collected. Direct costs for the hospital were calculated, including personnel work, materials used, and overhead. After that, we identified the ideal pathway (IP) that may enhance and optimize efficiency and resources consumption, without compromising the quality of care. The hypothetical cost savings resulting from the adoption of IP were estimated.RESULTS: According to our analysis, total cost per procedure ranges between 2,500 and 3,100 Euros, depending on the hospital facility. The IP is based on the use of an outpatient setting in which trained nursing personnel performs the implantation procedure. The shift from current clinical practice to ideal setting has the potential to decrease administrative costs, overhead expenses, and working time, leading to an average cost saving of 333 euros per procedure. It varies between 115 and 650 Euros, according to the starting background of each facility.CONCLUSIONS: The article concludes by emphasizing the introduction of a dedicated outpatient tariff as key incentive for the transition toward the ideal pathway and, consequently, for enhancing the overall efficiency of the Health Service
Cost-Effectiveness of Dimethyl Fumarate Compared to Teriflunomide for Relapsing Remitting Multiple Sclerosis Patients in Italy: Results of an Updated Analysis
Full text link[Clinical and psychodynamic aspects of the therapeutic work with the anorexic personality]
Full text linkA psychodynamic profile at the origin of anorexia was described. In order to provide reliability to the considerations presented, the work made use of a sample of anorexic and depressed patients compared with controls, to whom a series of statistically processed personality tests were administered. This methodology brought to light that anorexic profile originated in childhood (adverse attitudes enacted by the personality of parental figures), interpreted by the child as a refusal of her own (fat) corporeity and the tendency to process information, express emotions and affections, react and act accordingly. These traits characterize the nascent personality and become apparent in adolescence (disesteem, insecurity, immaturity, social isolation, and sexual issues). Therefore, clinical work on the personality and anorexic behavior should aim at understanding the meanings attributed to the food and the body to initiate a correction and change. Such an intervention would tend to facilitate a gradual change in the original feeling and thinking of these dimensions in anorexia
