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A hypothetical road map to reduce acid related diseases costs management
No full textIn the last few years the containment of healthcare costs has become a key point in many education and research programs. In relation to this issue, the management of acid related diseases is one of the most important problems, because of the high prevalence of underlying diseases. Indeed a current question is: are acid related diseases better managed by empiric treatment or by a diagnostic approach? To address this question we analysed the outcome of 182 patients with dyspepsia and/or gastro-oesophageal reflux disease (GERD) in primary care, over a period of 12 months, in the Campania region (southern Italy). Ninety-eight patients were treated since the beginning (therapeutic group; median age 49; males 50) and 84 underwent a diagnostic approach (diagnostic group; median age 50; males 44). After 12 months the direct management costs (consultations, diagnostic procedures, drugs) were calculated for both groups. Obviously, for patients in the diagnostic group there were higher management costs than for other patients (268€/year vs. 156€/year on average). An intriguing finding was the role of diagnostic procedures in providing additional information to determine therapy. In our study we analysed the diagnostic procedures defined as “not useful”, i.e., procedures that did not provide additional information to help us decide on therapy changes, whether the prescription had been prescribed only on the basis of the symptoms (therapeutic group) or it had only been hypothesized before the diagnostic approach (diagnostic group). This analysis was conducted on 84 of the patients in the diagnostic group and 20 of those in the therapeutic group in whom the practitioner had decided to perform a diagnostic procedure after starting treatment. The diagnostic procedure prevalently performed in all patients was endoscopy with urease test to search Helicobacter pylori infection; some patients had already undergone non-invasive H. pylori testing (fecal or breath test) before endoscopy. Eleven patients with dyspepsia were also investigated by abdominal sonography. The diagnostic criteria influencing therapy and disease management were presence of organic disease (severe esophagitis, duodenal or gastric ulcers, neoplasia, etc.) and H. pylori infection. The results showed that the diagnostic procedures did not modify the prescribed or hypothesized therapy and clinical management in 75% (21/28) of patients with GERD, 52% (26/50) with dyspepsia and 58% (15/26) with both GERD and dyspepsia. Based on these results, we tried to estimate a possible decrease in healthcare costs in the Campania region if diagnostic procedures, not leading to therapy changes, were eliminated from the outcome of acid related diseases. The analysis was performed considering that, in Campania, the estimated prevalence of clinically relevant (more than two symptomatic episodes/week) acid related diseases is 1.2% for GERD, 2.2% for dyspepsia and 5.5% for both GERD and dyspepsia [1] and [2]. Moreover using another analysis we found that the practitioner chooses the diagnostic approach for GERD, dyspepsia and dyspepsia-GERD in 27%, 38% and 39%, respectively [3]. Based on these estimates and on the increased cost management of diagnostic approaches calculated with our analysis, the cost/year of “not useful” diagnostic procedures in Campania could be of about 2.64, 4.16 and 10.73 million euros for GERD, dyspepsia and dyspepsia-GERD, respectively (see Table 1). Although the concept of “not useful” diagnostic procedure is debatable, the results of this analysis further suggest to address more attention to the improvement of education for disease management with the aim to contain healthcare costs
Notification of undesirable effects of cosmetics and toiletries
No full textAn undesirable effect (UE) of a cosmetic product is a harmful reaction attributable to its normal or reasonably foreseeable use. However, the knowledge of UEs, at the population level, is limited by the absence of formal and reliable cosmetovigilance systems, which nevertheless are characterized by underreporting. To test the feasibility of the collection of UEs in our territory we have carried out a pilot project aimed to assess either the notification procedures or the validation/evaluation of the collected forms in our territory. As reporting categories, we have chosen dermatologists and community pharmacists who were asked to notify UEs to cosmetics through a reporting form we have set up. During the period July 2006-December 2007, we have registered 76 reporting forms. Dermatologists who have sent 47 reporting forms represented the main reporting category, followed by community pharmacists (15 reports), other health professionals (9 reports) and consumers (5 reports). Several drawbacks, mainly represented by the incompleteness and inaccuracy of the filled in forms, affected the validation process. Thus, on receipt, we could validate only 34 forms and only after a careful check with each single reporter, we could include in the study other 36 forms. The validation of the collected reports has stressed the importance of a well-structured reporting form, an easy access to notification procedures as well as education and training programme. The evaluation of the validated forms has revealed the need of a controlled term vocabulary for the classification of the observed events and diagnosis, especially with regard to cutaneous reactions that represented almost the totality of the reported events (95.7%). Among the events (n = 45) reported by dermatologists, 22 were diagnosed as allergic contact dermatitis (ACD) and 18 as irritant contact dermatitis (ICD). Facial care products (19.7%), followed by body care products (16.9%), perfumes (12.7%) and eye care products (11.3%) were the cosmetics mainly suspected to be responsible for the observed events. Correspondingly, face (n = 37), including periorbital and perioral area, forehead, ocular mucous membrane and lips, followed by entire body (n = 9) were the body sites reported as more involved. In conclusions, our experience allowed us to identify the main pitfalls of the system we have experienced. These are setting/formulation of the reporting form, notification step, description of the event and diagnosis. A careful settlement of these aspects could substantially contribute to the establishment of an efficient reporting system, although the bias due to underreporting is difficult to eliminate. © 2008 Elsevier Ltd. All rights reserved
La gestione della malattia acido correlata nella medicina di primo livello. Sinergie di utilizzo degli archivi informatizzati per l’informatizzati per l’informazione e la formazione e la formazione professione.
No full textImaging tests in staging and surveillance of early breast cancer in Italy. changes in routine clinical practice and costs implications
No full textProton pump inhibitors market in primary care setting.
No full textOBJECTIVES:
In some European Union countries in recent years
the use of proton pump inhibitors (PPIs) has greatly increased. In
march 2006 in Italy lansoprazole came off patent and became a
relatively cheap treatment. Several national and regional mea-
sures to rationalise PPIs spending growth were taken to promote
the choice of less expensive PPI, lansoprazole, regardless of his
antisecretory potency. The goal of this study was to compare
general practitioners’prescription (GPs) of different PPIs and
explore how GPs PPI prescribing changes following the loss of
lansoprazole patent.
METHODS:
We extracted all records of PPI
prescribing within a General Practitioner Research Database of
99 GPs located in Naples, Italy, and analysed them using
Microsoft SQL Server 2005. All records for patients who had
been prescribed a PPI were divided into calendar years from 2005
to 2007 (the year prior to and following lansoprazole generic).
PPI consumption were quantified using Defined Daily Dose
system (DDD).
RESULTS:
The total volume of PPI’s prescribing
increased steadily over the 3 years. The proportion of defined
daily doses accounted for by lansoprazole was 11.8% in 2005
rising to 35.9% in 2007. The contribution of omeprazole, the
most often PPI prescribed, to total PPIs prescriptions decreased
from 43.0% to 22.7% in the same period, while esomeprazole
contribution remained costant. Following the loss of patent, new
lansoprazole prescriptions increased substantially; 32.7% of sub-
jects switched from another PPI to lansoprazole.
CONCLU-
SIONS:
To reduce costs GPs have been coming under pressure
encouraging the prescription of a cheaper drug. The wide variation in PPI prescribing suggests that the choice of PPI by GPs was
distorted by the effect of lansoprazole “liberalization
Gastroesophageal reflux disease (GERD) cost of care: Role of naive and relapsed symptoms in general practice
No full textImpact of comorbidity on the risk and cost of hospitalization in HIV- infected patients: real-world data from Abruzzo Region
Full text linkBackground: Due to the success of antiretroviral therapy, human immunodeficiency virus (HIV) infection has been transformed into a lifelong condition. In Italy, little is known about the impact of comorbidities (CMs) on the risk of hospitalization and related costs for people who live with HIV (PWLHIV). The objective of the study was to quantify the risk of hospitalization and costs associated with CMs in an Italian cohort of PWLHIV.Methods: The study population included subjects aged >= 18 years with HIV infection, identified in the Abruzzo's hospital discharge database among files stored from 2004 until 2013 and then followed up until December 2015. Patients' CMs (Charlson Comorbidity Index [CCI)] were extracted from International Classification of Diseases, Ninth Revision, Clinical Modification codes in the hospital discharge abstracts. Poisson regression was used to compare the incidence rate of hospital admissions in patients with and without each CM class. Incidence rate ratios (IRRs) with 95% confidence intervals (CIs) were adjusted for age, sex and the other CMs. A generalized linear model under gamma distribution was used to estimate adjusted mean hospital costs. Costs were derived from official Italian Diagnosis-related group (DRG) based reimbursements.Results: Among 1,026 HIV patients identified (mean age 47 years), 30% had at least one CM and 14.5% underwent hospital admission during the follow-up period. The risk of acute hospitalization significantly increased among patients with hepatitis C virus (HCV) coinfection (adjusted IRR 1.98; 95% CI: 1.59-2.47), renal (adjusted IRR 2.27; 95% CI: 1.45-3.56), liver (adjusted IRR 2.21; 1.57-3.13) and chronic pulmonary CMs (adjusted IRR 2.31; 1.63-3.32). Adjusted mean hospital costs were (sic) 2,494 in patients without CMs and (sic) 4,422 and (sic 9,734 in those with CCI=1 or CCI >= 2, respectively.Conclusion: The presence of renal, liver and chronic pulmonary CMs, as well as HCV coinfection doubled the risk of hospitalization in the PWLHIV cohort. A CCI >= 2 is associated with a fourfold increase in hospitalization costs. Our study provides new evidence that CMs in PWLHIV increase the risk of hospitalization and local health service facilities
Influence of generic drugs on proton pump inhibitor prescription in primary care.
No full textOBJECTIVES: The aim of this study is to evaluate general practitioners’ prescription (GPs) of different Proton Pump Inhibitors (PPIs) in the period between 2005 to 2008. METHODS: Analysis has been performed on a database of 99 medical practitioners that have managed an average of 150.000 inhabitants. We evaluate the PPIs prescriptions from January 2005 to December 2008. Evaluations performed are the following:1) PPI prescription (total and separately for lansoprazole, esomeprazole, pantoprazole,rabeprazole, and omeprazole); 2) prevalence of the reimbursement purpose (Gastroprotection—G; Acid-Related Disease—ARD); 3) prevalence of patients with ARD categorized on the basis of PPI prescriptions as drugs box/year (1–3 short treatment— ST; 4–11 long treatment—LT; >12 very long treatment—VLT). Data were expressed as Compound Annual Growth Rate (CAGR). RESULTS: The total volume of PPI’s prescribing increased progressively over the 4 years (CAGR +15%). The growth for each molecule was: L +42%; E +11%; P +16; R +3%; O 1%. The reimbursement purpose was significantly higher for G (CAGR +41%) than for ARD (CAGR +6%; p < 0.01). We found an increase of ARD patients with VLT with a significant highest CAGR (ST +3.9%, LT +4.8%, VLT +7.4%; p < 0.01). PPI prescription showed a highest CAGR for L in all patients (27%), while the lowest one was for O in VLT patients (-9%). CONCLUSIONS: Generic PPIs has unexpectedly increased the prescription of whole drug class during the period 2005–2008. We observed a marked increase in a very long duration PPI treatment for ARD that caused a relevant resource consumption. Our data suggest that the appropriateness of PPI prescription after generic PPI introduction should be carefully monitored to distinguish between costeffective from cost-ineffective PPI treatment
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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