Farmeconomia. Health economics and therapeutic pathways
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Analisi costo/efficacia della doxofillina vs. teofillina nella terapia dell’asma cronica reversibile dell’adulto
Get PDFDoxofylline is a methyl-xanthine with bronchodilator activity which clinical efficacy in the treatment of asthma and COPD is equivalent to theophylline. Clinical trials prooved that while doxofylline is as effective as theophylline in the treatment of asthma, it is associated with lesser side effects. For our pharmacoeconomical evaluation, we employed the data of an international multi-centric study that compared the efficacy and tolerability of 12 weeks of treatment with either theophylline 250 mg tid, or doxofylline 400 mg tid, or placebo. The efficacy was evaluated with pulmonary function tests and by recording the number of asthma attacks and beta-2 agonist puffs: doxofylline 1200 mg/day and theophylline 750 mg/day resulted equally effective, but the former resulted better tolerated, as the adverse effects were lesser in number and severity. We performed a cost/effectiveness analysis in order to compare the two treatments, considering the perspective of the Italian health system (SSN) and of the Italian society. For the purposes of this analysis, the efficacy indices we considered were two: one simple, consisting in the number of avoided asthma attacks (AAA), and a more complex one, i.e. UATD (Utility Adjusted Therapy Days). For the construction of this index, we extracted the survival curve of the patients remaining in therapy; this curve showed that the cumulative number of therapy days is significantly greater in the doxofylline group, although the percentage of dropouts is similar at the end of the three months: this is due to the fact that the drop-outs in the theophylline group occur earlier after treatment start. The number of therapy days was then weighed for an utility index inversely proportional to the main daily number of avoided asthma attacks, thus obtaining the UATDs. The results of the cost/effectiveness analyses showed that doxofylline dominates theophylline treatment in asthma, as it is less expensive and more effective (in terms of AAAs and UATDs) for both considered decision-makers, i.e. Italian SSN and society. The consistency of these results was further confirmed by oneway sensitivity analyses
Analisi della persistenza e delle risorse allocate nel trattamento farmacologico dell’ipertensione arteriosa
Get PDFIn this study, the persistence with treatment and resources allocated in antihypertensive pharmacotherapy has been evaluated. Administrative databases of the Local Health Unit of Ravenna listing patients baseline characteristics, drug prescriptions and hospital admissions were used to perform a population-based retrospective study. All new users 20 years old or over receiving a first prescription for diuretics, beta-blockers, calcium channel-blockers, ACE inhibitors or AII-Antagonists between January 1st, 1997 and December 31st, 1997 were included. A one-year follow-up for prescriptions of anti-hypertensive drugs were considered. According to duration of therapy, treated population was divided in persistent patients (continuers and switchers) and non-persistent patients. A total of 16,783 patients was included in the study of whom 64.9% were non-persistents. Persistence with treatment seems to be associated with the class of anti-hypertensive drug initially prescribed, and with patient-related factors. Patients initially prescribed for AII-Antagonists were more likely to persist than those starting on the other antihypertensive classes. Annual antihypertensive treatment cost accounted for • 1,076,053.55 of which 25.4% for non-persistent patients. An appropriate use of claims data may be considered as a powerful tool, providing detailed epidemiological and economic information concerning the antihypertensive treatment
Le conseguenze sulla spesa farmaceutica pubblica di un nuovo inibitore di pompa protonica: esomeprazolo
Get PDFAim of the present study is to check the economic advantage of esomeprazole, a new proton pump inhibitor that suppresses gastric acid secretion. The efficacy and tolerability of esomeprazole have been already demonstrated, now the pharmacoeconomic studies must investigate the possible savings for the SSN in case of esomeprazole immission on the Italian market. In this paper the authors present two pharmacoeconomic evaluations, the first based on cost/efficacy analysis, the second based on cost minimization analysis. For both analyses, the term of comparison is omeprazole, “gold standard” in the treatment of acid reflux-related pathologies. The effect in terms of volumes (DDD) and costs of the introduction of esomeprazole in the italian market has also been simulated
Mutua disponibilità, prezzi e rimborsabilità di farmaci autorizzati con procedura centralizzata europea
Get PDFThe european pharmaceutical market doesn’t seem to be a common integrated european market as far as prices and reimbursements within different countries are concerned. Moreover, to better define such differences, little information is available because of the lack of homogeneous and updated european databases. The aim of this study is to assess mutual availability, prices and reimbursements of innovative drugs authorised by EMEA under European Centralised Procedure between 1995-2000 and marketed in five european countries (Italy, Spain, United Kingdom, France and Denmark). Our results demonstrate that the adoption of different drug-price definition models, within different Member States, is the main cause of the heterogeneity. Currently, in countries adopting a controlled drug-price system, prices are lower than prices set in countries that adopt an uncontrolled drug-price system. In this regard, Italy ranks in a middle position as products marketed in Italy generally have prices lower than in the United Kingdom and Denmark, and higher than in France and Spain. Product availability and level of drug breakthrough in the national markets seem to greatly affect the variations we noted among prices and reimbursements in different countries. Differences we observed emphasize the need of finding a common methodology at european level, in order to define the proven “therapeutic benefit” and the “therapeutic advantage” of innovative drugs, allowing a “right price” and reimbursement to the entitled
Farmaci orfani e malattie rare: un confronto internazionale delle normative di riferimento
Get PDFOrphan drugs are defined as medicines with low economic returns, so that their production is not a profitable business far pharmaceutical companies. The present study analyses the main characteristics and the role of orphan drugs in four countries (United States of America, .Japan, Australia and European Union), by considering the regulation and the market situation of each State. All countries have introduced a specific legislation on orphan drugs to stimulate the research activity of pharmaceutical industry. The first law was the Orphan Drug Act of the United States of America in 1982. A common limit of all regulations is the strict correlation between “orphan drugs” and “rare diseases”. In fact, the term “orphan” does not refer only to rare disease, but also to other elements that can determine low economic returns for the industry (e.g. drugs with high cost of research and development, drugs that cannot be patented)
Traiettorie tecniche e Metodologia QWERTY: come si applicano alle innovazioni farmaceutiche
Get PDFHypertension is a problem that has a social component and a biological one. The history of the biological solutions has been an increase in research activities and an increase in the number of new products introduced in the pharmaceutical market and adopted as usual therapies. This article analyzes each of the main innovations in the treatment of moderate arterial hypertension and their competitive inter-relationships using a conceptual frame based on the recent theory of innovation. These innovations compete with each other for a market, similar to what happens with other areas and products. The concept of trajectories and the analysis of the competition process among them has not previously been applied to a pharmaceutical market and offers an exciting new avenue for insurance organizations, government health agencies, provider groups, and manufacturers to analyze trends and events in an organized and consistent framework. Learning by using, pharmacological interrelatedness, and pharma-institutional networks are the main analytical tools used to explain the competing processes among the different trajectories considered
Valutazione dell’impatto delle politiche del prezzo di riferimento sul mercato degli H2-antagonisti nella British Columbia, Canada
Get PDFIn this study we assess the implementation and impact of reference-based pricing (RBP) in British Columbia (BC), Canada, and other OECD (Organization for Economic Cooperation and Development) jurisdictions within an evaluative framework. This was accomplished by conducting a review of prior studies and an analysis of secondary utilization and cost data. Our review of previous work found the introduction of RBP in other OECD jurisdictions was followed by a temporary reduction in pharmaceutical expenditure growth but the rate of growth soon returned to those of previous years. Early results from the BC experience show similar declines in expenditures within reference drug categories, but it remains to be seen if this will continue in the long term. Although early results suggest RBP in BC may be achieving its goals, more work is needed before it can be declared a success. A more balanced evaluation will need to address nonmonetary issues such as impact on the quality of patient care or extent of cost shifting to other areas of the health system. The policy questions raised in this study indicate decision makers should be cautious when thinking of any wider application of referencebased pricing
Gli studi di “cost of illness” in Italia: una review della letteratura
No full textThe cost of illness studies (COI) attempt to measure the economic burden of a specific pathology. A standardised protocol identifies three components in the COI studies: direct costs, indirect costs and intangible costs.Aim of this paper is to review the status of COI studies in Italy, searching Medline, the New York City University database, the IES database and the S.A.V.E. database according to these keywords: “Cost of Illness Italy” and “Italian Cost Analysis”. The research detected 24 studies, but only 17 complete studies has been included in this review. For being reliable, the study had to present detailed informations about: - kind of approach (bottom-up or top-down); - annual average cost for single patient and single pathology; - pathology incidence or prevalence; - methods for calculating direct and indirect costs. The studies in this review examine the following pathologies: Alzheimer’s disease, diabetic foot, schizophrenia, type 2 diabetes, epilepsy, measles, dyspepsia, hypertension, asthma, varicella, osteoporosis, benign prostatic hyperplasia, urinary incontinence, hepatitis A and hepatitis B
I costi diretti dei servizi psichiatrici in un dipartimento di salute mentale
Get PDFThe present study aimed to evaluate the mean unit cost of psychiatric services, broken down by type of output. The analysis concerned a psychiatric service (with a Psychiatric Ward in General Hospital (PWGH), a Day-Care Center, a Community Residential Facilitie (CRF) and a NHS Mental Center (NHSMC), located in the North of Italy, selected among the 14 participants of the SCORE (Schizophrenia COsts and REsources) project. The most important result of this study was to estimate a baseline unit cost which can be used for assessing the total cost of a psychiatric disease. The study was conducted according to the full cost method. However, drugs and examinations were not included in this analysis, assuming that these costs are tightly related to the specific psychiatric pathology considered. Personnel was the most relevant component of total cost, accounting for 65% in PWGH, 61% for NHSMC and 65% for CRF. The estimated unit cost was L.536.000 for a day of stay in PWGH, L.590.000 for a day hospital day in PWGH, L.110.000 for an outpatient consultation in PWGH, L.59.000 for a day in a Day-Care Center and L.375.000 for a day in CRF
Fluvoxamina: profilo farmacoeconomico
Get PDFIn this study we mean to outline a brief pharmacoeconomic review of fluvoxamine, considering only its antidepressant use. Essential objective is to highlight all the variables of cost effectiveness, tolerance and safety that can lead some types of differential costs. This study analyses the epidemiology and the economic burden of depression and a pharmacoeconomic profile of fluvoxamine, with its characteristics of effectiveness, tolerance, safety and handiness. The pharmacoeconomic evaluation is conducted according to the cost minimization analysis (CMA), considering fluvoxamine, Selective Serotonine Reuptake Inhibitors (SSRI) and antidepressant tricycic as native treatments. Fluvoxamine differs from the others SSRI far the purchase cost and it’s more convenient than the antidepressant tricycic treatment, especially for long term therapy. Economic benefits can be distributed in a balanced way between the Italian national healthcare system (NACS), the society and the patients