518 research outputs found
L’utilizzo di modelli decisionali per le valutazioni economiche dei farmaci in Italia: stato dell’arte e prospettive future
No full textTo appraise the methodological quality of the Italian pharmaco -
economic models.
Background: In most of the developed countries the institution of HTA
agencies has been one of the major concerns in order to support the decisions
for reimbursement of new drugs. Italy is experiencing a remarkable lack in
this field.
Design: 18 Italian models published between 1998 and 2005 selected using
EMBASE and MEDLINE search engines. Inclusion criteria: (a) Italian
nationality of the first author, (b) Italian baseline population. Studies were
appraised using the checklist developed by Philips et al. (2004).
Results: Although the alternatives and the basic framework of the
pharmacoeconomic models are usually well defined and specified, the studies
present a lack of data about treatment effects, utilities, analysis of uncertainty,
considerations about heterogeneity and generalisability of results.
Conclusion: Despite the high level of competence of the authors, the
pharmacoeconomic models quality is largely affected by the scarce interest
of Italian institutions for the use of ICER-based criteria, in favour of a priceminimization
one. The institutional use of ICER-based criteria should be
strongly recommended for a rational resource use in healthcare
MSC898732 Appendix - Supplemental material for Economic evaluation of colorectal cancer screening programs: Affordability for the health service
No full textSupplemental material, MSC898732 Appendix for Economic evaluation of colorectal cancer screening programs: Affordability for the health service by Silvia Coretti, Matteo Ruggeri, Rossella Dibidino, Lara Gitto, Andrea Marcellusi, Francesco Saverio Mennini and Americo Cicchetti in Journal of Medical Screening</p
Using randomized controlled trials to ask questions regarding developmental psychopathology: A tribute to Dante Cicchetti
No full textThis article was originally published in Development and Psychopathology. The version of record is available at: https://doi.org/10.1017/S0954579424000245. © The Author(s), 2024. Published by Cambridge University PressDante Cicchetti, the architect of developmental psychopathology, has influenced so many of us in profound ways. One of his many contributions was in demonstrating the power of randomized controlled trials (RCTs) to study the effects of Child–Parent Psychotherapy (CPP). These RCTs have shed light on causal mechanisms in development. Following Cicchetti and colleagues’ work, we designed a brief home visiting program, Attachment and Biobehavioral Catch-up (ABC), to help parents respond in sensitive, nurturing ways, so as to enhance children’s attachment and self-regulatory capabilities. In the current study, we assessed adolescents’ reports of the closeness of their relationships with their mothers 12 years after their mothers completed the intervention. A total of 142 adolescents participated (47 randomized to ABC, 45 randomized to a control intervention, and 50 from a low-risk comparison group). Adolescents whose mothers had been randomized to ABC reported closer relationships with their mothers than adolescents randomized to the control condition, with significant differences seen on approval, support, companionship, and emotional support subscales. Consistent with Cicchetti et al.’s work, these results provide powerful evidence of the long-term effects of an early parenting intervention.This research was supported by National Institute of Mental Health grant R01MH074374 to the last author. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors thank the children and families who participated in the research. The authors also gratefully acknowledge the support of child protection agencies in Philadelphia. The authors have declared that they have no competing or potential conflicts of interest
Il manoscritto autografo delle «Grandezas de Madrid» di Alonso Remón
No full textL’articolo costituisce un primo assedio al manoscritto IT VIT-163 della Biblioteca del Centre de Documentació i Museu de les Arts Escèniques dell’Institut del Teatre di Barcellona che tramanda la commedia autografa, a tutt’oggi inedita, Grandezas de Madrid (1606) del frate mercedario Alonso Remón, autore di numerose opere a carattere morale e religioso, ma che fu anche abile drammaturgo, degno della stima di notevoli esponenti del panorama letterario aureo, quali Lope de Vega, Miguel de Cervantes e Francisco de Quevedo. In vista dell’edizione critica, l’obiettivo è quello di individuare e ricostruire il processo di creazione e l’usus corrigendi di Remón e, contestualmente, di distinguere eventuali successivi interventi di mani estranee alla composizione dell’opera.The article constitutes a first study of the manuscript IT VIT-163 of the Library of the Centre de Documentació i Museu de les Arts Escèniques of the Institut del Teatre of Barcelona which contains the autograph comedy, still unpublished, Grandezas de Madrid (1606) by the Mercedarian friar Alonso Remón, author of numerous moral and religious works, but who was also a skilled playwright, worthy of the esteem of notable exponents of the Literary Golden Age, such as Lope de Vega, Miguel de Cervantes and Francisco de Quevedo. In view of the critical edition, the aim is to identify and reconstruct Remón’s process of creation and his usus corrigendi and, contextually, to distinguish any subsequent interventions by extraneous hands to the composition of the work
Linking the Price of Cancer Drug Treatments to Their Clinical Value
No full textBACKGROUND AND OBJECTIVE:
Appropriate pricing of medications is one of the ultimate goals for decision makers, but reliable data on the risk/benefit ratio are often lacking when a Marketing Authorization Application is submitted. Here we propose a method to consistently evaluate price adequacy, which we applied to six anticancer medications approved in Italy in recent years.
METHODS:
We obtained ratios of cost per survival per day (cost/survival/day) by dividing the total costs of evaluated medications for the median survival gain in days. Each cost/survival/day corresponds to a crude score, with 0 assigned to a cost/survival/day ≥€586. The maximum price considered as adequate was €91 cost/survival/day (score 75) while a score of 100 corresponded to a cost/survival/day ≤€11, based on the thresholds set by the British National Health System (NHS) and the "willingness-to-pay" of the Italian NHS. Crude scores were then adjusted using correction factors for efficacy, safety, quality of life, and prevalence of disease.
RESULTS:
None of the analyzed medications (abiraterone, afatinib, aflibercept, bevacizumab, dabrafenib, and ipilimumab) achieved a final score of 75, corresponding to adequate pricing. The final score for afatinib was the highest with 55 points. Prices of all the other drugs resulted in being inadequate, with negative final scores for bevacizumab, dabrafenib, and ipilimumab.
CONCLUSIONS:
This method may be considered a tool for the evaluation of appropriateness of price proposed at negotiation and could represent a reliable resource for decision-making. Furthermore, this analysis suggests that most recently approved cancer drugs in Italy do not fulfill price adequacy
A Microwave Imaging System for the Detection of Targets Hidden behind Dielectric Walls
No full textIn this work, a prototype of microwave imaging system for through-the-wall monitoring is presented. The system can operate remotely, as well as by using antennas directly in contact with the wall. For the remote modality, ad-hoc wide-band antennas have been designed and integrated into an efficient measurement system, able to acquire the scattered-field data. Such measurements are processed by a novel hybrid inversion procedure able to create an image of the inspected scenario. For the proximity modality, a Bessel beam launcher is specifically designed, realized and tested to provide a focused near-field with enhanced penetration capabilities. Preliminary results are provided for assessing the capabilities of the system
Indicatori di monitoraggio del contagio
No full textNell’ambito del presente capitolo vengono mostrati gli indica-
tori di monitoraggio e contagio. I primi casi di infezione di SARS-
CoV-2 in Italia sono stati individuati a fine febbraio 2020 nei co-
muni di Codogno (Lombardia) e Vo Euganeo (Veneto). Il 9 mar-
zo, l’intero territorio italiano è stato sottoposto alla misura del
lockdown per limitare la diffusione dell’epidemia, che due giorni
dopo veniva dichiarata pandemica dalla World Health Organiza-
tion. I principali indicatori presi in considerazione per monitorare
l’andamento dei contagi sono stati l’incidenza e la prevalenza dei
casi estratti grazie ai dati pubblicati quotidianamente dalla Prote-
zione Civile. Per riepilogare gli andamenti generali dei valori re-
gistrati – che hanno subito delle fisiologiche oscillazioni legate
essenzialmente al flusso dei dati – il calcolo è stato raffinato tra-
mite una media mobile
Campagna vaccinale anti COVID-19
No full textIl 27 dicembre 2020 è iniziata in Italia la campagna vaccinale
anti-Covid-19; con una latenza di circa 20 giorni (dovuta alla pro-
grammazione del ciclo vaccinale) inizia anche la somministrazio-
ne delle seconde dosi, che segue a distanza l’andamento della
somministrazione delle prime dosi. Dopo un periodo di stallo alla
fine di gennaio, la somministrazione giornaliera dei vaccini cresce
fino all’estate del 2021, arrivando a dei picchi nei mesi di giugno
e luglio 2021 e aggiungendo poi a settembre la somministrazione
delle terze dosi
Copertura vaccinale antinfluenzale e assenteismo per malattia negli Operatori Sanitari di un Policlinico Universitario Italiano
No full textINTRODUZIONELa vaccinazione antinfluenzale annuale degli Operatori Sanitari (OS) è raccomandata per prevenire l’influenza ed evitarne la trasmissione ai pazienti fragili. Nel periodo influenzale epidemico, l’assenza dal lavoro per malattia degli OS, inoltre, può generare inefficienze organizzative su qualità e continuità delle cure prestate ai pazienti. Nel nostro Policlinico Universitario, la copertura vaccinale antinfluenzale tra gli OS nella stagione 2016-17 è risultata intorno al 9%. Per tale motivo, durante la stagione 2017-18 sono state adottate diverse strategie per aumentare la copertura. Obiettivo del presente studio è quello di valutare l’efficacia di queste strategie integrate e analizzare, inoltre, l’impatto della vaccinazione sull’assenteismo per malattia degli OS nel periodo epidemico.MATERIALI E METODIDurante la stagione influenzale 2017-18, in circa metà delle Unità Operative della Fondazione Policlinico Universitario “A. Gemelli” IRCCS (FPG) sono stati attuati interventi formativi “peer” (academic detailing) e sessioni di vaccinazione on-site per aumentare conoscenze, attitudini e tasso di copertura vaccinale antinfluenzale tra gli OS.Al termine della stagione 2017-18, è stato realizzato uno studio trasversale al fine di analizzare la copertura vaccinale antinfluenzale tra gli OS della FPG. Dati socio-demografici e occupazionali (età, genere, vaccinazione antinfluenzale nella precedente stagione 2016-17, professione e Unità Operativa di afferenza) sono stati forniti dal Servizio di Medicina Preventiva e dalla Direzione Risorse Umane; quest’ultima ha fornito anche il numero di giornate di malattia usufruite dagli OS nel corso del periodo epidemico (42° settimana 2017 – 17° settimana 2018).RISULTATILo studio ha incluso 4111 OS della FPG. Il tasso di vaccinazione antinfluenzale è aumentato dall’8.7% del 2016-17 al 13% del 2017-18 (+48.5%, p<0.0001). L’analisi multivariata ha evidenziato che, al termine della stagione 2017-18, la copertura era più elevata tra gli OS coinvolti nell’intervento formativo e vaccinale on-site (OR 2.7; 95% CI 2.2-3.4), medici, più anziani e precedentemente vaccinati. Il genere, invece, non sembrerebbe influenzare la copertura vaccinale. La media delle giornate di malattia usufruite nel periodo epidemico dagli OS vaccinati è risultata significativamente più bassa rispetto a quella degli OS non vaccinati nella campagna 2017-18 (rispettivamente 1.3±4.6 e 3.2±10.3; p<0.001). Questi risultati hanno carattere preliminare.CONCLUSIONIL’intervento formativo “peer” e la vaccinazione on-site si sono dimostrati efficaci nell’aumentare la copertura vaccinale antinfluenzale tra gli OS della FPG. Variabili socio-demografiche e occupazionali possono influenzare significativamente l’attitudine degli OS alla vaccinazione. La vaccinazione antinfluenzale, infine, sembrerebbe ridurre in maniera significativa l’assenteismo per malattia degli OS nel periodo epidemico
The “triangular model” applied to drug eluting stents (DES)
No full textObjective: The work intends to assess, within an HTA process, the ethical consequences of
implementing DES by the “triangular model”.
Methods: The work is conducted with reference to the National Library of Medicine data.
Results: The European Network for Health Technology Assessment (EUNetHTA) has assessed,
within an HTA process, the ethical consequences of implementing DES by Core model (EUNetHTA,
2007), a catalogue of questions, primarily based on Björn Hoffman’s (2005).
Nevertheless, the methodological approaches for integrating ethical analysis into HTA are various.
Amongst them, there is the “triangular model”, that is centred on a substantial conception of human
person (Sgreccia, 2007). Its methodology comprises three steps of analysis:
1. data collection, i.e. an in-depth study of all facts/data, including qualitative and relational ones;
2. anthropological aspects, i.e. the analysis of eventual values at stake, related to human life, integrity
and dignity;
3. ethical-normative evaluation, i.e. the practical choices that should be made.
Moreover, this model presumes a normative framework, that consists of four operative criteria:
1. the defence of physical human life;
2. freedom-responsibility;
3. therapeutic criterion;
4. sociality-subsidiarity.
Conclusions: The “triangular model” on Drug Eluting Stents (DES) could be applied as possible
alternative approach for integrating ethical analysis into HTA
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