Farmeconomia. Health economics and therapeutic pathways
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Hospital Based Health Technology Assessment: an example from Siena
Full text linkThe 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
Comparison between traditional and goal directed perfusion in cardiopulmonary by-pass. Adaptation of a differential cost analysis
Full text linkBACKGROUND: 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
Hospital oncology costs among the cohort of elderly in an aging South-Eastern European nation
No full textComparison between traditional and goal directed perfusion in cardiopulmonary by-pass. A differential cost analysis in US
Full text linkOBJECTIVES: High oxygen delivery (DO2) during cardiopulmonary bypass (CPB) is associated with better renal outcomein cardiac surgery. Traditional perfusion (TP) techniques, targeted on body surface area and CPB temperature, achieveshigh DO2 in about 50% of the cases while a goal directed perfusion (GDP) approach can lead to more than 90% of casesachieving high DO2 with a consequent reduction in Acute Kidney Injury (AKI) rate of about 40%. Aim of this study isto perform an economic evaluation of GDP strategy with respect to TP in US. METHODS: A Discrete Event Simulationmodel was developed to compare TP and GDP strategy in patients undergoing CPB. The patient’s pathways from operationto discharging from hospital was simulated: AKI incidence, in-hospital mortality, hospital length of stay, transfusions werecorrelated 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/GDPCard and Sorin Connect (electronic data management system). RESULTS: GDP strategy saved more than 3 days in hospitaland 11% of AKI episodes. The cost-saving is 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 haematocritduring CPB and hospital LOS/cost per day both in ICU and in ward. CONCLUSIONS: GDP seems to improve significantlythe main outcomes related to CPB surgery, when compared to TP techniques. Additional costs due to perform GDP strategyhave no impact on the total cost since completely offset by the savings in hospital cost
Cost of illness of advanced ovarian carcinoma in Italy: results of an empirical, single-centre study
Full text linkAIM: 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
Low-protein diet for chronic kidney disease in the Caserta Local Health Unit: the SaniARP Initiative
Full text linkINTRODUCTION: In clinical practice, the interest in the use of low-protein food for patients suffering from chronic kidneydisease 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
Cost differentials of dental outpatient care across clinical dentistry branches
Full text linkBackground: Dental care presents affordability issues in Central & Eastern European transitional economies due to lack of insurance coverage in most countries of the region and almost complete out-of-pocket payments by citizens.Objective: Real world estimates on cost differentials across clinical dentistry branches, ICD-10 diagnostic groups and groups of dental services.Methods: Prospective case-series cost analysis was conducted from the patient perspective. A six months time horizon was adopted. Sample size was 752 complete episodes of treatment in 250 patients, selected in 2012/2013 throughout several specialist state- and private-owned dental clinics in Serbia. All direct costs of dental care were taken into account and expressed in Euros (€).Results: Mean total costs of dental care were € 46 ± 156 per single dentist visit while total costs incurred by this population sample were € 34,424. Highest unit utilization of services belongs to conservative dentistry (31.9%), oral surgery (19.5%) and radiology (17.4%), while the resource with the highest monetary value belongs to implantology € 828 ± 392, orthodontics € 706 ± 667 and prosthetics € 555 ± 244. The most frequently treated diagnosis was tooth decay (33.8% unit services provided), pulpitis (11.2%) and impacted teeth (8.5%), while most expensive to treat were anomalies of tooth position (€ 648 ± 667), abnormalities of size and form of teeth (€ 508 ± 705) and loss of teeth due to accident, extraction or local periodontal disease (€ 336 ± 339).Conclusion: Although the range of dental costs currently falls behind EU average, Serbia’s emerging economy is likely to expand in the long run while market demand for dental services will grow. Due to threatened financial sustainability of current health insurance patterns in Western Balkans, getting acquainted with true size and structure of dental care costs could essentially support informed decision making in future
Cost‑effectiveness analysis of hexaminolevulinate (Hexvix®) guided cystoscopy in Non‑Muscle Invasive Bladder Cancer patients (NMIBC) in Italy
Full text linkOBJECTIVE: To estimate the incremental cost‑effectiveness of hexaminolevulinate (Hexvix®) + Blue Light (H+BL) cystoscopy (compared to white light cystoscopy only) when used at initial transurethral resection of the bladder tumour (TURBT) for patients diagnosed with non‑muscle invasive bladder cancer (NMIBC) in Italy.METHODS: A cost‑effectiveness model has been developed to estimate the incremental cost‑effectiveness of introducing H+BL at initial TURBT for patients diagnosed with NMIBC in Italy. The model consists of two parts: 1) a short term decision tree which estimates the outcome of the initial diagnostic procedure, and 2) a Markov cohort model which is used to estimate long term outcomes through extrapolation based on data and assumptions about patient management, the natural history of the disease and the empirical efficacy of H+BL in improving diagnosis detection and reducing recurrence. Cost‑effectiveness results are expressed as incremental costs per QALY gained. Univariate and probabilistic sensitivity analyses are conducted to test the robustness of the model to changes in inputs and assumptions.RESULTS: Base case results suggest that Hexvix® is a dominant strategy when used in the resection of NMIBC. Hexvix® is expected to be associated with 0.070 incremental QALYs, with cost savings of € 435 per patient. Sensitivity analyses suggest that the cost of Hexvix® and the relative risk of recurrence in intermediate and low risk groups are key drivers in the model. Probabilistic analyses indicate that Hexvix® is expected to be cost‑effective in >99% of iterations, assuming a willingness to pay threshold of € 25,000 per QALY.CONCLUSION: In conclusion, Hexvix® is expected to be a cost‑effective strategy when used in the resection of NMIBC in Italy.