Farmeconomia. Health economics and therapeutic pathways
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Rettifica al lavoro: considerazione cliniche ed economiche nel trattamento del cancro della prostata: analisi costo/efficacia di bicalutamide vs. flutamide in combinazione con LHRH
No full textCosti ed effetti di Risperidone Long Acting (RLA) rispetto ad antipsicotici atipici nel trattamento dei soggetti schizofrenici in Italia
Get PDFObjective: to estimate the costs and effects of long-acting risperidone (LAR) in the treatment of schizophrenic patients in Italy, as compared to conventional and oral atypical antipsychotics. Methods: a discrete event model was used. The model simulates patients. history for every single therapeutic alternative and selects incident events, on the basis of pre-defined probability distribution-powered, randomized repetitions. The model operates on two types of parameters: patient characteristics and time-dependent variables. Patient characteristics (age, sex, illness profile and severity, probability of incurring in an adverse event and potential dangerousness) remain fixed during the 5 simulated years. Time-dependent variables are subject to changes and include outpatient visits, severity of psychotic episodes, symptom-scores, compliance, incidence of adverse effects, site of treatment and dangerousness. Three treatments have been selected: scenario 1 begins with LAR, switches to olanzapine and then to clozapine; scenario 2 starts with olanzapine, switches to oral risperidone and ends with clozapine. Direct medical costs have been computed on the basis of psychiatric visits, drug costs and costs of the institution in which the patient is treated (hospital, rehabilitation clinic, etc.) Outcome measures were number of psychotic episodes in 5 years, total time spent during these episodes and cumulative score of positive and negative symptoms at 5 years. Information on alternatives, transition probabilities, model structure and health resources utilization were derived from the literature and from a panel of experts. Results: it has been estimated that LAR is economically dominant (more effective at lower cost) respect to oral atypical antipsychotics, being able to prevent 0.87 psychotic episodes per patient, with a net cost saving of 4,773 euro per patient. Sub-group analysis indicate that LAR is always more effective than the considered alternatives and, in general, also less costly than oral atypical antipsychotics. Sensitivity analyses confirmed the robustness of the model to several variations of key parameters. Conclusions: LAR therapy dominates oral atypical antipsychotics
Analisi Costo Minimizzazione delle preparazioni di Interferon Beta per il trattamento della Sclerosi Multipla
Get PDFThe multiple sclerosis (MS) is a neurologic disease that is characterized by a progressive demielinization of the white matter of the central nervous system. In the lasts decades, several therapies have been introduced after randomized, double-blind, placebo controlled trials. These trials supported the efficacy of Interferon-beta (INF- b) in reducing relapsing frequency and slowing the progressive disability, mainly in cases affected by relapsing- remitting MS course. In Italy four different preparations of INF-b are available for MS treatment having different INF-b types (i.e., INF-b1a e INF-b1b), different administration schemes, different INF-b doses and ways of administration. Recently, the biological activity of these preparations have been compared using the same assay system against the same INF-b standard. The aim of this study was to carry out a cost-minimization analysis, on the MS treatments in Italy comparing of the available preparations in terms of cost per microgram standardized by the level of biological activity. The economic evaluation has been conducted adopting the hospital perspective. Health resources have been valued considering euro currency during 2004. According to registered treatment protocol, the results showed that the micrograms per week of INF-b standardized by the level of biological activity ranged from 30mg of Avonex® to 132mg of Rebif44®. Under the same levels of biological activity, Rebif44® resulted the INF-b preparation with the lower cost per micrograms (1.95 euro), followed by Rebif®22 and Betaferon® that had a similar cost (2.90 e 2.97 respectively). Avonex® resulted the INF-b preparation with the highest cost per micrograms (6,37 euro), about three times higher than that of the preparation with the lowest cost
Gli inibitori della pompa protonica nelle patologie acido correlate: il ruolo di rabeprazolo in una strategia di cost-minimisation
Get PDFThe clinical management of acid-related diseases incurs the consumption of a relevant part of the health resources in Italy, as indicated by the fact that PPIs (proton pump inhibitors) represented the first pharmacological class in terms of drug expenditures in 2002, making up 6,3% of the total. It’s therefore of primary importance to evaluate the economical consequences of their utilization, beyond the clinical outcomes. In the present article a cost-minimization analysis is performed, basing on drug consumption data and focusing on the new reference-price based criteria introduced by the Italian Ministry of Health for the reimbursement of pharmaceuticals. A model for the economical evaluation of the use of PPIs was developed, based on the assumption that all the active substances in this class share the same clinical benefit, and following a stepdown approach, in which the PPIs are administered full-dose for a month, followed by a one year maintenance period at half-dose. The model yielded the following results: rabeprazole is the most cost-saving drug of this class in the Italian setting, permitting important savings on an hypothetical 1.000 patient population, ranging from 13.000 euro, when compared to omeprazole, to 279.000 euro, if related to the most expensive substance, esomeprazole. In other terms, on the basis of the assumed equal effectiveness of the considered alternatives, the costs incurred for the treatment of 1.000 patients with esomeprazole would be sufficient to treat 1.769 patients with rabeprazole
Farmacoeconomia dei COXIB nella patologia osteoarticolare: revisione della letteratura
Get PDFA new class of anti-inflammatory agents, the selective inhibitors of cyclooxygenase-2 (COXIBs), has been recently introduced into the market for the treatment of osteoarthritis and reumatoid arthritis. Randomized and controlled clinical trials showed a similar efficacy and a better tolerability profile of COXIBs compared with conventional non-steroidal anti-inflammatory drugs (NSAIDs). The aim of this study was to perform a scientific literature review relating to the economic impact produced by COXIBs’ introduction. The research of references included the following databases: MEDLINE, EMBASE and the NHS (Economic Evaluation Database) of the York University. A total of 67 in extenso pubblications have been extracted. Of these 13 papers having the specific objective to evaluate the economic implications of COXIBs in comparison to conventional NSAIDs was analysed. In ten cases (77%), cost-effectiveness analyses were performed. The European context was considered in eight cases (62%), while that of North America and Asia were investigated in four and one case, respectively. The analysis of costs took always into account direct costs of the management of arthritis exclusively (drugs, and resources associated with the treatment of gastrointestinal side effects). Indirect and intangible costs were never considered. The results of this review highlight that the higher tollerability profile of COXIBs may generate a cost-saving. This cost-saving seems to be basically due to the reduced frequency of gastroprotective agents coprescription and also to a lesser appearance of severe gastrointestinal side effects compared with conventional NSAIDs. Besides the disease management improving, the cost-saving associated with COXIBs can completely or partially offset the net increase of expense induced by their higher price of purchase
Il costo medio per tipologia di prestazione nei centri trasfusionali
Get PDFIn Italy the collection, validation and separation of blood and its derivatives for transfusional interventions are carried out by some 380 transfusional centers (TCs), mainly located within greater health care structures. The aim of the CORSA (Costi Raccolta Sangue) study was to furnish an estimate of the mean cost of the main transfusional services on a sample of the Italian TCs. Of the centers contacted, only 13,3% were able to deliver the unit costs necessary to perform the full-cost, fully-allocated analysis conducted. Of the three services examined (apheresis of plasma and platelets, whole blood collection), the selective collection of thrombocytes resulted the most expensive, as opposed to whole blood collection. The mean cost of a erythrocyte, plasma and platelet unit resulted of 17,7, 21,6 and 89,8 •, respectively, although the variation among centers was substantial. To main conclusions can be drawn by the CORSA study. First, the very low percentage of TCs able to provide the necessary data for a complete economical analysis highlights an important delay in the modernizing process of health care management, started in 1992 with the aim to ameliorate resource allocation. Second, the study was not able to establish a relationship between production volume and production cost, indicating the absence of scale economy features in transfusional processes
Moxifloxacina: profilo farmacologico, terapeutico e farmacoeconomico
Get PDFMoxifloxacin is a new fluorquinolone antibiotic, recently introduced among the treatment options for upper and lower airways infections. It possesses a wide antibiotic spectrum, covering the major pathogens involved in the genesis of community acquired pneumonia (CAP), acute exacerbations of chronic bronchitis (AECB) and acute bacterial sinusitis (ABS). It acts in a concentration-dependent manner by inhibition of bacterial DNAgirase and topoisomerase IV, has a long biological half-life (about 12 hours), good oral bioavailability, excellent tissue diffusion and a better safety profile than other quinolones, because of the lack of phototoxicity and the scarsity of clinically significant drug interactions. The clinical results of moxifloxacin in CAP, AECB and ABS have been compared with those of available alternative antibiotics in several multicentric, double-blind studies, and the new fluorquinolone resulted at least as effective as the comparators, with similar tolerability profiles. These studies demonstrated a high correlation among the eradication of the pathogen and the clinical recovery of the patients. The pharmacodynamics, pharmacokinetics and clinical results of moxifloxacin render it one of the most attractive options for the empirical treatment of upper and lower airways infections, more so since its pharmacoeconomic profile appears to be very convenient. In fact, the low dosing frequency (once daily), the possibility of oral administration, the quick onset of the therapeutic action, the high clinical and microbiological success rate even with low duration cycles (5 days) and the good safety profile make the cost/efficacy ratio of moxifloxacin in the treatment of common airways infections very advantageous in comparison to those of all available treatment alternatives
Commenti al lavoro di Colombo GL, Muzio A “Gli inibitori di pompa protonica nelle patologie acido-correlate: il ruolo di rabeprazolo in una strategia di cost minimisation”
No full textMesalazina: profilo farmacologico, terapeutico e farmacoeconomico
Get PDFThe term inflammatory bowel diseases (IBD) refers to two distinct clinical entities: Crohn.s disease and ulcerative cholitis, two chronic and non-specific disorders of unknown origin. Although quite uncommon and usually not life-threatening, IBDs have a strong economical impact, as they tend to affect patients in high productivity ages and require long and demanding therapies, medical and sometimes surgical. The pharmacological approaches to IBD treatment include aminosalicylates, corticosteroids and immunosuppressive agents. Aminosalicylic acids are the most widely used agents for maintaining remission and for the cure of mild-tomoderate forms of IBDs. This paper outlines the main pharmacological and clinical properties of one of these drugs, mesalamine (mesalazine). Mesalamine is the active moiety of sulfasalazine, an effective but not always tolerated agent. Mesalamine is available in several pharmaceutical forms, to be administered either by the oral or by the rectal route. As the therapeutic action of aminosalicylates is ascribed to their topical action on the inflamed intestine, while the adverse effects are believed to be caused by the systemically adsorbed (mainly in the first tract of the small bowel) fraction, slow-release formulations are usually preferred. From an economical point of view, mesalamine appears to have a moderate acquisition cost, widely offset by the savings induced on direct sanitary and, most importantly, indirect costs of IBDs. In particular, the availability of a generic drug with advanced colon-delivery technology provides the physician with the opportunity to treat patients with the best available technology at a reasonable price
Analisi dei costi di buprenorfina vs metadone nella terapia dei soggetti con dipendenza da oppiacei
Get PDFIn the last decades, methadone has virtually represented the only available option for the treatment of opioid addicts in Italy. Early in the year 2000 buprenorphine has been introduced on the market as a possible alternative to methadone. While most of the research conducted so far in our country has focused on possible differences in clinical outcomes, depending on the pharmacological differences among the two molecules, the economical aspects of the choice between the two drugs have barely been addressed. In this paper we present a pharmacoeconomical comparison between buprenorphine and methadone in the treatment of heroin dependence by the Italian health service, adopting the perspective of the Society. For this purpose, we constructed a decision analysis model comprising the possible clinical pathways a patient can go through following the inclusion in the therapeutic programs of the SerT. Two types of incremental costs have been considered in the model: direct health costs, i.e. drug acquisition and medical staff costs, and indirect cost, due to loss of working hours for the administration of the drug. The analysis was conducted with a cost-minimization approach, mandatory in the absence of reliable data on clinical differences, and with a time perspective of 12 months. Our results indicate that buprenorphine, despite its higher pharmaceutical cost, is the more convenient option for the treatment of opioid dependence in Italy, as it permits a significant saving of productivity losses. The difference in indirect costs relies on the shorter mean treatment time with buprenorphine and on the possibility of reducing dosing frequency, which allows many patients to attend health services only thrice in week, instead of the daily visits to the SerT necessary for most methadone-treated patients. The results were challenged in a series of sensibility analysis conducted on all relevant and uncertain paramenters, and in no case the option methadone resulted more convenient than buprenorphine, confirming the reliability of the results obtained in the base case scenario