Farmeconomia. Health economics and therapeutic pathways
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Valutazione economica dello studio AVERT
Get PDFIntroduction: the AVERT study (“Aggressive lipid-lowering therapy compared with angioplasty in stable coronary artery disease”) compared aggressive cholesterol-lowering (with the statin atorvastatin) to angioplasty in patients with mild to moderate coronary artery disease. Aim: our aim was to investigate the economic consequence of high dose of atorvastatin vs percutaneous coronary revascularization followed by standard therapy in Italian patients with stable coronary artery disease Methods: clinical information were taken from the AVERT study. We conducted a cost-effectiveness analysis, comparing high dose of atorvastatin (80 mg/die) versus angioplasty in the perspective of the Italian National Health Service. We identified and quantified medical costs: drug costs according to the Italian National Therapeutic Formulary and hospitalizations were quantified based on the Italian National Health Service tariffs (2006). Effects were measured in terms of mortality and morbidity reduction (number of deaths, life years gained and frequency of hospitalizations). We considered an observation period of 18 months. The costs borne after the first 12 months were discounted using an annual rate of 3%. We conducted one and multi-way sensitivity analyses on unit cost and effectiveness. We also conducted a threshold analysis.
Results: the cost of atorvastatin therapy or angioplasty over the 18 months period amounted to approximately 779 euro and 5.5 millions euro per 1,000 patients respectively. Atorvastatin was more efficacious compared to angioplasty and the overall cost of care per 1,000 patients over 18 months of follow-up was estimated at 1.8 millions euro in the atorvastatin group and 7.2 millions euro in the angioplasty group, resulting into a cost saving of 5.4 millions euro that is 74,9% of total costs occurred in the angioplasty group. Discussion: this study demonstrates that high does atorvastatin treatment leads to a reduction of direct costs for the National Health System if compared to angioplastic treatment. Atorvastatin therapy is dominant since it is both less costly and more effective than angioplasty. Results of sensitivity analysis showed that atorvastatin therapy remains dominant even in the most unfavourable hypotheses
Bayesian statistic methods and theri application in probabilistic simulation models
No full textBayesian statistic methods are facing a rapidly growing level of interest and acceptance in the field of health economics. The reasons of this success are probably to be found on the theoretical fundaments of the discipline that make these techniques more appealing to decision analysis. To this point should be added the modern IT progress that has developed different flexible and powerful statistical software framework. Among them probably one of the most noticeably is the BUGS language project and its standalone application for MS Windows WinBUGS. Scope of this paper is to introduce the subject and to show some interesting applications of WinBUGS in developing complex economical models based on Markov chains. The advantages of this approach reside on the elegance of the code produced and in its capability to easily develop probabilistic simulations. Moreover an example of the integration of bayesian inference models in a Markov model is shown. This last feature let the analyst conduce statistical analyses on the available sources of evidence and exploit them directly as inputs in the economic model
Valutazione economica dello studio PROVE-IT
Get PDFIntroduction: the PROVE-IT (“Intensive versus moderate lipid lowering with statins after acute coronary syndromes”) was a comparison of pravastatin 40 mg/die versus atorvastatin 80 mg/die in patients with an acute coronary syndrome (ACS). Aim: our aim was to investigate the economic consequence of high dose of atorvastatin vs usual-dose of pravastatin in Italian patients with a history of acute coronary syndrome. Methods: the analysis is conducted on the basis of clinical outcomes of the PROVE-IT study. We conducted a cost-effectiveness analysis, comparing high dose of atorvastatin (80 mg/die) versus usual-dose of pravastatin (40 mg/die) in the perspective of the Italian National Health Service. We identified and quantified medical costs: drug costs according to the Italian National Therapeutic Formulary and hospitalizations were quantified based on the Italian National Health Service tariffs (2006). Effects were measured in terms of mortality and morbidity reduction (number of deaths, life years gained and frequency of hospitalizations). We considered an observation period of 24 months. The costs borne after the first 12 months were discounted using an annual rate of 3%. We conducted one and multi-way sensitivity analyses on unit cost and effectiveness. We also conducted a threshold analysis. Results: the cost of pravastatin or atorvastatin therapy over the 2 years period amounted to approximately 1.3 millions euro and 870,000 euro per 1,000 patients respectively. Atorvastatin was more efficacious compared to pravastatin and the overall cost of care per 1,000 patients over 24 months of follow-up was estimated at 3.2 millions euro in the pravastatin and 2.5 millions euro in the atorvastatin group, resulting into a cost saving of about 700,000 euro that is 27% of total costs occurred in the pravastatin group. Discussion: this study demonstrates that high does atorvastatin treatment leads to a reduction of direct costs for the National Health System. Atorvastatin therapy is dominant since it is both less costly and more effective than pravastatin. Results of sensitivity analysis showed that atorvastatin therapy remains dominant even in the most unfavourable hypotheses
Palonosetron in the prevention of chemotherapy-induced nausea and vomiting in Italy: pharmacoeconomic and clinical aspects
No full textDespite considerable improvements in the last two decades, chemotherapy-induced nausea and vomiting (CINV) remains a frequent and very bothersome medical problem. It is estimated that about one half to two thirds of all chemotherapy-treated patients experience CINV, the frequency depending on the chemotherapy regimen used and on patient-specific features. The impact of CINV, which may be acute, delayed or even anticipatory in experienced patients, on health-related quality of life (HRQoL) is substantial in all domains.
Until recently, effective treatment choices included corticosteroids and first-generation 5-HT3 antagonists, which have been supported by aprepitant, the first clinically available NK1 antagonist, and by palonosetron, considered the first second-generation 5-HT3 antagonist for its high receptor-subtype selectivity and affinity and long plasmatic half-life. In this paper, clinical pharmacology of the latter drug is briefly outlined and recent Italian papers on the epidemiology and HRQoL impact of CINV are reviewed, as well as national pharmacoeconomic evalutations conducted on palonosetron. The role in therapy of palonosteron and its potential for improved clinical, HRQoL and economic outcomes is discussed.
Simvastatin: between clinics and health economics
No full textStatins reduce the incidence of cardiovascular events, one of the most important public health problems and among the main leading causes of death. Their use has been increasing in the last decade and today they represent the first drug class in terms of public expenditure. In view of the introduction of generic simvastatin in the Italian market, this paper outlines a pharmacological and economic profile of this compound. Despite two decades of life, simvastatin remains competitive with other HMG-CoA inhibitors, inducing a dose-dependent, up to 43% cLDL reduction. In clinical trials evaluating hard endpoints, simvastatin treatment achieved a strong reduction of cardiovascular events, revascularization procedures and mortality. Review of the main published pharmacoeconomic studies on simvastatin consistently indicated good cost/effectiveness ratios in most geographic contexts; convenience of this therapy increases along with baseline cardiovascular risk. Among available statins inducing equivalent cholesterol reductions, generic simvastatin has the lowest daily costs. Assuming stable market volume, an estimated cost saving for the Italian National Health Service of about 1 million Euro per year is expected from the introduction of the generic drug. Further cost savings may accrue for a potential switch from more expensive statins to simvastatin. Albeit individual responses to statins are unpredictable, the choice to start with lower cost molecules can limit initial drug investment and dampen the negative financial impact of treatment interruptions and switches
Atti del I Convegno. Laboratorio dose unitaria Galenica clinica e gestione del rischio: modelli ed esperienze
No full textTelithromycin (Ketek®)in lower respiratory tract infections: economic aspects
No full textThe aim of the paper is to compare Italian healthcare-related costs and effectiveness of 7- and 5- day course with telitromicin (Ketek®) 800 mg od vs. 10-day clarithromycin 500 mg bid in patients with Community-acquired pneumonia (CAP) and Acute exacerbations of chronic bronchitis (AECB), respectively. Clinical as well as healthcare-related resource consumption data were collected from two Medline indexed articles reporting results of three international trials. Since differences in effectiveness among the compared antibiotic courses did not reach statistical significance, two cost-minimization analyses were performed from Italian National Healthcare Service (INHS) perspective. CAP and AECB-related hospitalizations were evaluated according to INHS DRGs tariffs, whereas drugs were costed according to Italian National Therapeutic Formulary. Costs are expressed in euros 2005. When compared to 10-day clarithromycin 500 mg bid, savings related to 7-day telitromicin 800 mg od approach 102,10 euros per CAP patient (IC 95: -177,89 euros − -26,31 euros;
Pharmacoutilization of anti-inflammatory and gastroprotective drugs in patients with osteoarthritis: comparison between COXIBs and conventional NSAIDs by using administrative records
No full textThe aim of the study was to analyze anti-inflammatory and gastroprotective drug utilization in patients with osteoarthritis comparing conventional non-steroidal anti-inflammatory drugs (NSAIDs) versus cyclo-oxygenase 2 (COX 2) inhibitors. A retrospective observational cohort study was conducted and health-assisted subjects from the Local Health Units of Turin and Caserta were enrolled. Data linkage techniques were used to cross demographical, pharmaceutical and nosological databases. All subjects aged ≥18 years who were hospitalized for osteoarthritis from July 1st 2002 to June 30th 2004 were enrolled in the study. Concurrent prescriptions of non-steroidal anti-inflammatory and gastroprotective drugs were considered. Other demographic and clinical characteristics were recorded. A total of 1,002 subjects with a diagnosis of osteoarthritis treated with NSAIDs were enrolled. Of these subjects, 438 patients were treated with non selective NSAIDs (80.8%), 104 with COXIBs (19.2%) and 460 with multiple therapy. There were no significant differences between the demographic and clinical characteristics of the three groups. Gastroprotective drugs were prescribed in 37.0% and 35.6% of subjects treated with NSAIDs and COXIBs, respectively. Gastroprotective drug prescriptions increased from the index date to the follow-up period (from 20.4% to 41.1% of subjects treated with NSAIDs). In high-risk subjects with gastrointestinal events, gastroprotective drug utilization was undersized and increased from the index date to the follow up period (from 19.4% to 40.8% of high-risk subjects). Evidence from this study indicated that non selective NSAIDs and COXIBs are used indiscriminately with respect to patient characteristics and gastroprotection