Farmeconomia. Health economics and therapeutic pathways
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Percorsi diagnostico-terapeutici nella gestione dei pazienti affetti da polmonite acquisita in comunità
Full text linkCommunity-Acquired Pneumonia (CAP) is one of the major cause of death due to infectious diseases in developed countries. In Italy, about 18% of the patients with CAP are hospitalized, accounting for an annual health-care cost of more than 1.000 billion Lire. Overall, CAP represents an heavy burden to the society and the National Health-Care System. The managed-care of patients with CAP should be committed to find a balance between the individual health-care needs and the more general claims of a fair utilization and an overall efficiency of the healthcare system. The comprehensive strategy of care should consider many decision nodes and the outcomes related with each different options. The diagnostic procedures (physical examination, chest radiography, microbiology, laboratory) should be oriented to obtain a robust differential diagnosis and to estimate the risk of mortality. Prediction rule are now available that help physicians to make more rational decisions about hospitalization for patients with pneumonia. The selection of antibiotic in the absence of an etiologic diagnosis is based on the epidemiological settings, the severity of the illness and other clinical conditions of the patients. Non concordant therapeutic recommendations are provided by the published guidelines. Decisions to be taken during the follow-up concern the switch therapy and the early discharge options, as soon as the patient stabilizes, or the admission to ICU in case of worsening. The length of hospital stay depends on the time to stability and the risk of mortality. However, socio-cultural factors and availability of outpatient care programs could facilitate the early discharge of patients and help to decrease the health-care costs of CAP patients. The results of the present review can be used as a background to implement a general decision model suitable to performe pharmacoeconomic analysis of the CAP therapy
La profilassi antibiotica in chirurgia e la sua valutazione economica
No full textSurgical wound infections (SWIs) are a subset of hospital acquired infections (HAIs), associated – though not to the highest frequency – to the highest cost share within HAIs. On these grounds, an economic approach to their entity (incidence and costs) and to the clinical means (surgical prophylaxis) for their containment is attempted in this article. In particular, a simple model is reported to evaluate the best effectiveness of alternative regimens, based on the following equation: Diff Cost = Cost SWI x Diff WIR. Where Diff Cost = difference in the costs of the prophylactic regimens in comparison. Cost SWI = cost per wound infection. Diff Wir = difference in the efficacy of regimens, measured as the difference in Wound Infection Rate. Such equation computes points of indifference, that is points where the difference in efficacy is balanced by the difference in cost between two treatments. At a bit more sophisticated level, this model can be used by adding some stochastic components (confidence intervals). This article collects a group of case-studies, relative to which the model is applied and discussed
I costi di struttura dei servizi neurologici in Italia
Full text linkThe present study aimed to evaluate the mean unit cost of neurological services, broken down by type of output: hospital day of stay, day hospital day and outpatient consultation. The analysis concerned five neurological services (four hospital wards and one clinic), located in the North and Centre of Italy, selected among the 16 participants of the EPICOS (Epilepsy Costs) 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 neurological 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 neurological pathology considered. Personnel was the most relevant component of total cost, accounting for 76% for outpatient services, 66% for admissions and 54% for day hospital. The estimated unit cost was L.395,000 for a hospital day of stay, L.527,000 for a day hospital day, and L.89,000 for an outpatient consultation
Creazione di valore sanitario e sistemi di finanziamento: il caso del dipartimento di salute mentale
Full text linkHealth-value adding is the new priority and a watchword for all clinicians and health service workers. The creation of health-value requires a team work involving different actors: A. the clinical staff, whose task consists in the creation of treatment models and in their formalization into guidelines and protocols; B. the managers, since effective clinical and therapeutic practices must go along with coherent organizational models and valuable control instruments; C. the public institutions responsible for the definition of health policy guidelines: among these, a prioritary role is played by funding methods, which can affect significantly the results of health-value adding initiatives. This work aims at studying the relationships between funding methods and health-value creation, with particular reference to mental health services. Particular relevance is given to the funding of mental health departments, with a view to putting aside the shortcomings of the current models and proposing the DRG as an alternative funding method for mental health services. The procedures for patients classification and evaluation envisaged in the psychiatric DRG can assist health service managers in evaluating the outcomes and the patients’ health conditions. In other words, the issues concerning funding and management evaluation will be articulated in the same language: this, in turn, will eliminate the lack of integration which can be presently identified as the main fault of most funding methods, and improve the degree of coherence among resource allocation, activities and results. The case of mental health services can therefore be taken as an example of successful and effective cooperation among management, health policy and clinical staff
Le analisi costo della malattia e costo efficacia in farmacoeconomia. Ambiti di applicabilità, problemi, prospettive
Full text linkAim of the paper is to compare and evaluate some of the main features of two different tecniques of economic analyses: cost of illness e and cost-effectiveness. The former is not so widely used in pharmacoeconomics, while the latter is dominant. Although their theory has recently much progressed, their practice is still hindered by some unresolved questions, to which the paper also addressess
Analisi comparativa del mercato dei dispositivi per incontinenza in cinque paesi europei
Full text linkThe aim of the paper is to compare and valutate the market of the incontinence devices in five European countries: Italy, France, Germany, U.K. and Denmark. We chose incontinence devices because they are strictly connected with the development of the home delivery. France, Germany and U.K. has been analysed for their politic and territorial importance, while Denmark has been considered for its home assistance system. A common pattern has been applied in every country: first of all there is a general outline of the legislative aspect of the incontinence devices, then the study presents prescription procedure and the different models of distribution. Finally, it shows the competitive systems of the pharmaceuticals industry in every single country. The necessary information has been gathered through relevant literature and interviews with the area operators. The incontinence devices are repayable in all the studied countries, except from France. Every country has different health system (Italy, U.K and Denmark had a public health system; France and Germany has a mutualist health system). There isn’t an evident correlation between the type of the health system and the market of the incontinence devices