Farmeconomia. Health economics and therapeutic pathways
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I costi della sepsi in Italia
Get PDFThe aim of this study is to evaluate additional hospitalisation costs and intangible costs (mortality) in patients with sepsis (intended as severe sepsis or sepsis shock) in Italy. The evaluation is based on clinical data from the Italian Sepsis Study, a prospective, multicentre study conducted in 99 Intensive Care Units (ICUs)located across Italy. Each ICU enrolled the first two (or three) patients admitted each month, during the year April 1993 to March 1994. In particular, data collected included the Average Length Of Stay (ALOS) in ICU and later in the regular ward, and the mortality within four weeks and in hospital. Out of the 2,946 patients enrolled, 2,641 never developed sepsis and were considered as the control group (comparability was confirmed based on gender, age, and comorbidity). The additional (respective to the control group) ALOSs of the patients with sepsis were valued in monetary terms using per diem full costs, inflated to 2000: 1,033.43 Euro for l day in ICU (published data) and 299.54 Euro for l day in the regular ward (estimated data based on published materials). Statistical significance was tested with Student t test. The hospitalisation cost of a patient with sepsis (21,571.88 Euro) is significantly higher (+86%) than that patient without sepsis (11,590.84 Euro), due to a longer (+ 163%) stay in the expensive ICU, not balanced by shorter stay in the regular ward. Also intangible costs are significantly higher: the risk for an ICU patient with sepsis to die in hospital is 3 times higher than that of an ICU patient without sepsis. In particular, those patients developing sepsis after admission are more costly and with a higher mortality risk
Automedicazione: una risorsa economica da valorizzare
No full textAt the beginning of this new millennium, when the request for health care exceeds overall economic growth, resorting to self-medication allows to free up healthcare resources and it has a positive outcome for public health care systems and also for the individual. Self-medication is defined as the application of prescription-free medicines (OTC) to consumers in order to cure minor ailments. Aim of this study is to present the social and economic value of self-medication, comparing the Italian situation with other national situations inside European Union, especially France, U.K. and Germany. In Italy the OTC market is still late and the present study examines the different explanations, considering the trade-off between OTC products and health public spending, the geographical distribution and the possible savings for the for public health care system
Valutazione dei costi di trattamento dei disturbi psicotici con olanzapina, risperidone e neurolettici tipici di un DSM italiano
Get PDFObjective of the present retrospective analysis was to evaluate resources consumption for psychotic patients treatment with olanzapine (OLZ), risperidone (RIS) or typical neuroleptics (NL) during year 2000 in the Dipartimento di Salute Mentale (DSM) of Ravenna. The screening of total number of psychotic patients followed in the Ravenna DSM during year 2000 generated 26 cases treated with OLZ, 22 treated with RIS and 17 treated with NL that were respecting criteria of equivalence for age and illness severity. For these patients we analyzed pharmacological, non pharmacological (medical visits, nurse visits, social assistance, rehabilitative sessions) and hospital interventions during the year of observation, choosing the point of view of the DSM for costs attribution. The analysis of pharmacological interventions evidentiated a major usage of associated neuroleptics in the RIS and NL groups in respect to OLZ (
La valutazione dei costi: uno studio applicato all’unità operativa di diagnostica per immagini
Get PDFThe aim of the analysis was to evaluate the reasons that caused the poor economic results and performances of a Radiology Department located in a public hospital. The models of Decision Support System were utilized in order to conduct the studies. These models represent clearly a current economic situation and allow simulations in order to estimate in a preventive way the economic results of different alternative actions. The economic analysis was conducted according to the extended direct costing method utilizing a single performance (product) as a calculation unit. The simulations were carried out in accordance to the “price-cost-volume analysis” method that identifies the break even point for the families of products. These analysis resulted in a significant improvement of the awareness relative to the economic actions of the operative managerial decisions: the main factor in the process of the decision making for the public healthcare structure is to respond to the needs of the potential users and therefore to satisfy the demand, the increase of which is immediately signalised by the lengthening of the awaiting list. For the structure which is incorporated in the hospital frame there is the necessity to provide the service towards inside the hospital both relative to the patients and to the performances of first aid supported by the emergency department. It is important to stress that, even if limited or conditional, there is a space for improvement: the first step in this direction is to analyse in order to recognize and to measure, if not able to improve that what is unknown and not measured before
Il mercato dei dispositivi per stomia in cinque paesi europei: lezioni per l’Italia
Get PDFAim of the present study is to analyze the international market of the ostomy devices in Italy, France, Germany, U.K. and Denmark. The ostomy systems are technologically mature devices, and the more interesting market developments are about innovative modality of distribution and patients technical support, like home distribution. For every country it has been applied a common pattern, based on four aspect of the ostomy devices market: 1. the legislative aspect; 2. the prescription procedure; 3. the different models of distribution; 4. the competitive systems of pharmaceutical industry. All the data in this study has been galthered through relevant literature and interviews with the area operators. The ostomy devices are repayable against medical prescription in all the studied countries; significant legislative differences are registered in the repayment prices determination. For all the studied countries, in the decisional process related to the choice of one or another device, the essential role is played by the ostomy hospital nurse, that advises the patient immediately after the surgery. Finally, the more significant examples to innovate purchase and distribution process of ostomy devices in Italy comes from Denmark and U.K., where the home distribution is already available and it is working
Modello di analisi decisionale della gestione terapeutica della polmonite acquisita in comunità e creazione di valore
Get PDFThe pharmacoeconomical analysis of the strategies in the disease management of the Community-Acquired Pneumonia (CAP) is a very good starting point for considering the value creation utility. The value creation represents a basic target for the health area, both in short term management and in strategic management: in fact, creating value means to satisfy people health interests and needs. The cost-benefit analysis (CBA) is the more functional economic valuation method, fitting the value creation model in the best possible way. In fact it examines the greatest number of variables that generates costs and benefits, having an influence on the value creation. In the CAP specific case, the question is if it’s possibile to reduce the average days of stay and/or to reduce the admissions to hospital, considering if this changes can generate a health value creation by causing more benefits than costs. This study presents data and values related to infectious disease hospitalization to analyse the resources economy from days of stay cutback and admission to hospital number
Una checklist per la gestione dei costi nel trattamento dell’HIV
Get PDFThe human immunodeficiency virus (HIV) infection is currently one of the major health problems in the world. Since the first occurrence of the infection 17 years ago until today, many people have died of its devastating consequences and an enormous amount of health-related funds have been spent on the problem. The pandemic is still growing in some areas, and its negative impact on society is in-creasing. This is the main reason why scientists are trying to find the best way to reduce costs and still keep the same level of management or, in some ways, even improve it (e.g., new combination of drugs in one pill—fewer pills to be taken per day). Since HIV infection has been. a fatal, severe, and widespread disease, a so-called global problem, very early in the course of the pandemic the idea of economic evaluation was raised. Published studies mostly presented the antiretroviral drugs in the frames of pharmacoeconomic models or costs of HIV/AIDS according to development of the disease through longer time periods. The cost sections that have to be considered in any pharmacoeconomic study of HIV management are briefly presented. Often the presented costs are confusing and could be misleading. Direct, indirect, and intangible costs are described
Stato di salute degli italiani e prospettive di spesa sanitaria e farmaceutica
Get PDFIn december 2000 the Italian National Institute of Statistics (INSTAT) published some extracts from the latest statistical survey about the state of health and the resort to medical services in Italy. The research is based on a sample of 52.300 italian families. Since 1980 the average lifetime in Italy grew five years longer: today the average expectancy for a man is 76 years old, and for a woman is 82 years old. All these deep demographic transformations involve an important increase in the chronic-degenerative pathologies. This rise will take up a great deal of public and private health resources. The most frequent chronic-degenerative pathologies are arthrosis or arthritis (18% of italian people) and the high blood pressure (11,5%). After the age of 45, the chronic-degenerative pathologies show a clear growth: some diseases are prevalent in women (e.g. osteoporosis), other prevail in men (e.g. chronic brochitis and stomach ulcer). To better understand the intensity of the resort to medical services, the statistical survey also consider the perception of the health state in Italy. The overall analysis show that the drug consumption (and the health resources consumption generally) is based on a complexity of social and cultural elements; therefore in some particular areas the control of the medical expenditure is more diffucult then in others
È possibile coniugare risparmio e miglioramento nelle aziende USL?
Get PDFThe present study aimed to evaluate if it’s possible to reduce the costs for the anti-infective medicine in a ward for the infectious disease. Analytic accounts data, related to the cost for three kind of drugs (antibiotic, antimicrobic and antriretroviral) will be presented. The analytic account is referred to the Bologna USL Firm (Presidi ospedalieri Bellaria and Maggiore) and to the Hospital Unit for the infectious disease (Ospedale Maggiore) in the year 1999. The Hospital Unit for the infectious disease consists of two ward for day of stay (32 beds), one day hospital for 10 beds and one divisional outpatients’ clinic. In 1999 there were 650 hospitalized (and discharged) patients and 783 day hospital patients. The overall cost for the Bologna USL Firm was L. 11.068.023.000, accounting L. 7.253.846.000 (65.5%) for the antiretroviral drug, L. 1.958.115.000 (17%) for the antibiotic drug and L. 1.856.062.000 (16.8%) for the antimicrobic drug and other antinfective medicine. The expenditure for the Hospital Unit for the infectious disease was L. 7.543.851.000, accounting L. 7.008.163.000 (92.9%) for the antiretroviral drug, L. 256.167.000 (3.4%) for the antibiotic drug and L. 279.521.000 (3.7%) for the antimicrobic drug and other antinfective medicine
Creare Valore Sanitario: nuove prospettive per il management delle aziende sanitarie
Get PDFThe value creation is the primary target of a firm and to this pattern is inspired each managerial instrument, behaviour and action. For particular firms as health companies, the pattern of value creation can be well – grounded, provided that it takes care of their particular attributes. Therefore this article is structured on the following methodology of analysis: first of all the pattern of value creation for private firms is shown making clear the meaning of value creation compared with firm’s strategic targets. Then the particular attributes of health companies and the meaning that value creation can undertake in these circumstances are analysed. If the creation of health value can become the strategic target of a health company, it is essential a valuation of the “key variables” marking out the way to create value. At last the change of classical instruments of management and administration control are described. To create health value is the real strategic target of health companies. After years of prevailing or exclusive orientation to efficiency, now managerial instruments rediscover the efficacy and the quality of medical treatments as “key variables” to program and control. Old management tools, such as the budget or the reporting, can become an excellent support for every operator, first of all the medical class that, because of various motives, was (and is) particularly refractory to these instruments. The pattern of value creation can become the philosophy which has to inspire all the health management instruments, and the common language for all the cultures and the professions inside the health companies. Concluding, the pattern of value creation can be an interesting proposal to innovate control systems of health companies and to put an end to the impasse of most of the health management’s applications, but, it required a new co-operation between managers and medical class. Only if the medical class will accept valuation and measurement systems of activity, the value creation will stop to be just a theory and will become a reality