Farmeconomia. Health economics and therapeutic pathways
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Livello di dipendenza dai Servizi Territoriali e costi relativi al trattamento della schizofrenia
Get PDFThe present study was designed to evaluate the level of dependence from Mental Health Care Department, in Casale Monferrato, of three groups of psychotic patients treated with olanzapine (31), risperidone (30) or typical neuroleptics (31). The observation was retrospective, lasting one year (2003-2004), and collected data relative to health care resources as specialist visits, home interventions operated by nurses or physicians, drug administration, rehabilitation, psychotherapy, hospitalizations. The data collected allowed to evidentiate substantial differences among olanzapine and risperidone treated patients, usually younger, versus typical treated patients, usually older and more chronic. In general, atypical treated patients, evidentiate a reduction of home nurse intervention in respect to typical treated patients while olanzapine shows a trend in hospitalization and specialist visits reduction versus risperidone. Total health care costs are not significantly different among the three groups but evidentiate interventions more oriented to rehabilitation in the group treated with olanzapine while risperidone treated patients needed a major number of hospitalizations. Typical treated patients requested, instead, an high number of home intervention due to their chronic conditions and cognitive imparement
Prevenzione e terapia precoce del diabete mellito di tipo II: aspetti farmacoeconomici
Get PDFType II (non-insulin-dependent) diabetes is one of the most widespread chronic patologies in the developed countries and its prevalence in Italy is about 2-3% of the population. Type II diabetes is also associated with several other metabolic abnormalities such as central obesity, hypertension, and dyslipidemia, which contributes to the very high rate of cardiovascular morbidity and mortality. Therefore Type II diabetes involves a significant financial burden on the health care system. The purpose of this paper is to explain the composition of the healthcare costs of managing people with Type II diabetes and the economic repercussions due to the adoption of an aggressive strategy against the pathology. To carry out this evaluation we considered the CODE-2 (The Cost of Diabetes in Europe - Type II) Study results, the American Diabetes Association Position Statement, the Diabetes Prevention Program and the UK Prospective Diabetes Study. Evidence exists to show that introducing prevention program or an early therapy can avert or delay significantly the onset of cardiovascular morbidity in Type II diabetes patients. According to the pharmacoeconomical criteria, this very desiderable clinical goal is associated to a little increase of the health expenditures, and sometimes also to a costs saving
Impiego di tramadolo nelle diverse patologie dolorose
Get PDFPain represents a major health problem that afflicts a significant number of patients, resulting in personal suffering, reduced productivity and substantial health care costs, specially in chronic conditions. Chronic pain, such as low back pain, osteoarthritis, neuropathic and oncologic pain, requires a global management based on clinical evaluation, defining of the adequate therapeutic strategy and assiduous cares. Generally, patients with chronic pain need two different analgesic formulation: one at fixed doses and prolonged duration of action for control of baseline pain and one fast-release drug for treatment of breakthrough pain. Main guidelines recommend use of the same active principle for both these formulations. Tramadol, a dual action analgesic agent, used for controlling moderate to severe pain control in acute and chronic diseases, is available in several different oral formulations. This is important because, apart from efficacy and tolerability, that are the most important criteria to evaluate a therapy, the choice of a formulation with an uncomplicated dosing regimen can increase compliance and, consequently, clinical results, and ameliorate patient quality of life. For the treatment of chronic pain, the appropriate analgesic dosage can be achieved through a gradual titration: this permits to minimize adverse effects and cost of therapy.With tramadol this action can be realized with 50 mg extended-release capsules, that represent the minimal effective dose. When adequate pain relief is obtained, it’s possible to reduce frequency and complexity of dosing regimen using a new once-daily tablet of tramadol. Fast-release orodispersible tramadol tablet, with its practical advantage (rapid disintegration in the mouth without need of water), can be used for the control of breakthrough and acute pain. The cost of treatment with tramadol results relatively low, also when two daily episodes of breakthrough pain are considered
Terlipressina: profilo farmacologico clinico, terapeutico e farmacoeconomico nel trattamento delle varici esofagee
Get PDFThe formation and rupture of esophageal and gastric varices are severe but common complications of hepatic cirrhosis. They represent the cause underlying more than one forth of all deaths in cirrhotic patients and exact an impressive burden in terms of survival, quality of life and health care resource consumption. Therapeutic options for the control of active variceal hemorrhage comprise pharmacological agents, endoscopic techniques and surgery. Of these, the only options immediately available in the absence of highly specialized medical personnel are vasoactive drugs, namely vasopressin and derivatives and somatostatin and derivatives. Despite this clear advantage, the role of pharmacological treatment is still debated; furthermore, there’s no consensus on the drug of choice for variceal bleeding control. In this paper the main pharmacological and clinical features of terlipressin, a synthetic vasopressin analog, are outlined, as well as a frame for its pharmacoeconomical evaluation. Terlipressin is the only vasoactive drug that demonstrated survival benefits in cirrhotic patients with active variceal hemorrhage, even in those treated with endoscopic sclerotherapy, and is characterized by a favorable risk/benefit ratio. The relative cost-effectiveness of the different drugs, nevertheless, is yet to be determined by methodologically rigorous studies, partly because at the present state of the research there still are clinical and economical uncertainties to be cleared
L’impatto farmacoeconomico del trattamento della schizofrenia con antipsicotici tipici ed atipici: l’esperienza di un DSM della Regione Sicilia
Get PDFIl presente lavoro è stato realizzato con il patrocinio del Dipartimento Ispettorato Regionale Sanitario dell.Assessorato per la Sanità della Regione Sicilia, nella persona del Dirigente Generale Dott. Saverio Ciriminna BACKGROUND: The comparatively high acquisition costs of the new antipsychotic drugs have induced the mental health community to look closely at their potential benefits. OBJECTIVE: To compare the clinical and economic outcomes associated with olanzapine, risperidone and typical neuroleptics treatment for schizophrenia. METHODS:Amulticenter, observational, two-years long, retrospective and prospective study was conducted with 229 psychotic patients (in charge by psychiatric Centers of Regione Sicilia - Italy). Clinical outcomes were assessed using changes in CGI (Clinical Global Impression) and PANSS (Positive and Negative Syndrome Scale) scores. The economic data collection included pharmacological and non-pharmacological resources consumption (hospitalizations, medical/nurse visits, etc.). The economic evaluation was conducted in the perspective of the Local Psychiatric Services. RESULTS: The results in terms of clinical performance indicated an advantage (statistically significant) in the olanzapine group of patients. The pharmacological costs were significantly lower (p0,05). Treatment with olanzapine was associated with a lower non-pharmacological resources consumption and showed a general reduction (
Profilo farmacologico clinico e farmacoeconomico di un gel oftalmico a base di carbomero 974P e PVA (Siccafluid®) nella terapia della cheratocongiuntivite secca
Get PDFBACKGROUND: The dry eye sindrome refers to a group of disorders of the tear film due to reduced tear production or excessive tear evaporation that is associated with symptoms of ocular discomfort and may cause disease of the ocular surface. Dry eye syndrome varies in severity, duration and etiology. The cornerstone of dry eye syndrome therapies includes the intraocular gel or ophthalmic solutions instillation, reaching correct artificial lubrication. Molecules that can produce a stable lubricating film are the carbomers. METHODS: In the first step of our work we reviewed the data from literature reporting about carbomers’ characteristics in respect to other lacrimal substitutes. Then, a pharmacoeconomical analysis has been performed on ophtalmic gels derived from carbomers 974P and PVA. RESULTS: Dry eye sindrome, if not adequately treated, determines a deterioration of the patient’s quality of life, other than high secondary costs. CONCLUSION: The high therapeutical index of carbomers 974P and PVA-based gels, in addition to the their limited cost (totally free for Sjögren patients in Italy), suggests that this product is characterized by one of the best benefits-to-costs ratios in the treatment of dry eye sindrome
Sulodexide: implicazioni cliniche ed economiche
Get PDFSulodexide is a highly purified glycosaminoglycan approved for leg ulcers treatment. It contains two principal components: heparan sulfate, a fast-moving heparin fraction, (80%) and dermatan sulfate (20%). Sulodexide is available as an oral agent and as an injectable preparation. Its pharmacological action is obtained by dose-dependent coagulation factors inhibition: dermatan sulfate upgrades the physiological action of a selective thrombin inhibitor, heparin cofactor II, and heparan sulfate depresses activated factor X, via an increase of antithrombin III action. The antithrombotic action is enhanced by platelet aggregation inhibition and by the activation of the fibrinolytic system. This paper summarizes the results of some of the main trials that evaluated sulodexide in the treatment of peripheral occlusive arterial disease and venous leg ulcers; a trial on prevention of recurrent deep venous thrombosis with sulodexide is also reviewed. We analyzed data about the clinical and economical impact of chronic venous insufficiency with a particular attention to the cost of medication, hospitalization and management of leg ulcers. The hypothetical savings correlated to the reduction of leg ulcers incidence and healing time attainable with sulodexide have been estimated. A comparison between the different acquisition costs of the drugs frequently used to treat leg ulcers is also provided. Finally we reviewed some quality of life trials in which the psychological and sociological influence of the disease and its treatments on the patient are assessed
Interruzione del trattamento nei pazienti con schizofrenia che ricevono olanzapina o aripiprazolo: metanalisi degli studi clinici controllati
Get PDFBACKGROUND: In schizophrenia the drop-out rate can be used as proxy of effectiveness. The drop-out evaluation is also important considering the relevant economic impact for NHS of an antipsychotic therapy discontinuation in terms of patient hospitalization and other related healthcare resources consumption. OBJECTIVE: To analyze the differences in the rates of drop-out from clinical trials between olanzapine and aripiprazole. METHODS: Literature search was based on MEDLINE, on Iowa-IDIS and Drugdex databases (1966-Dec 2004). Analysis included 12 randomized controlled trials (3.778 patients), 8 for olanzapine (2.559 patients) and 4 for aripiprazole (1.219 patients). RCT inclusion criteria were: a) Patients affected by schizophrenia; b) Randomized assignment to olanzapine or aripiprazole treatment group; c) Number of patients included in the treatment group higher than 100; d) Drop-out frequency evaluation between 4th and 26th weeks of follow-up. RESULTS: The rate of treatment discontinuation was greater for aripiprazole than for olanzapine (42,2% vs. 31,6% respectively). The comparison between drop-out percentages is statistically significant (
L’analisi delle decisioni negli studi di farmacoeconomia
Get PDFThis paper is a review of the decision tree methodology. This is a very useful technique in complex decision making, when the consequences of the decisions are distant in time and the information upon which we can rely is uncertain. Decision trees are the basic structure underlying most applications of decision analysis in medicine. However, in this review we only cover their application to the pharmaco-economic field. The main steps of this decision analysis are explained. Thereafter, a case study from the literature is used as an example, i.e. an application of the decision tree analysis to a study aimed at comparing two different drugs in the treatment of gastro-esophageal reflux. The main focus of our paper is on the statistical aspects, which include the definition and quantification of the outcome variables, the definition and quantification of the probabilities of occurrence of the uncertain events considered in the decision tree, and the sensitivity analysis. The knowledge of the basic laws of the probability theory is mandatory for assigning correct values to the parameters of the decision tree (outcomes and probabilities). Finally, the sensitivity analysis is an important part of the work to be performed in the last stage of the decision analysis in order to measure the degree of robustness of the results when varying the assumptions