323,007 research outputs found
Economic evaluation of screening programs for hepatitis C virus infection: evidence from literature
No full textSilvia Coretti,1 Federica Romano,1 Valentina Orlando,2 Paola Codella,1 Sabrina Prete,1 Eugenio Di Brino,1 Matteo Ruggeri1 1Post-Graduate School of Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy; 2Center of Pharmacoeconomics (CIRFF), Department of Pharmacy, Federico II University, Naples, Italy Background: Hepatitis C is a liver infection caused by hepatitis C virus. Its main complications are cirrhosis and liver cancer. According to the World Health Organization (WHO), more than 185 million people worldwide are infected with hepatitis C virus and, of these, 350,000 die every year. Due to the high disease prevalence and the existence of effective (and expensive) medical treatments able to dramatically change the prognosis, early detection programs can potentially prevent the development of serious chronic conditions, improve health, and save resources. Objective: To summarize the available evidence on the cost-effectiveness of screening programs for hepatitis C. Methods: A literature search was performed on PubMed and Scopus search engines. Trip database was queried to identify reports produced by the major Health Technology Assessment (HTA) agencies. Three reviewers dealt with study selection and data extraction blindly. Results: Ten papers eventually met the inclusion criteria. In studies focusing on asymptomatic cohorts of individuals at general risk the cost/quality adjusted life year of screening programs ranged between US 50,000/quality adjusted life year gained, while in those focusing on specific risk factors the incremental cost-effectiveness ratio ranged between 128,424/quality adjusted life year gained. Age of the target population and disease prevalence were the main cost-effectiveness drivers. Conclusion: Our results suggest that, especially in the long run, screening programs represent a cost-effective strategy for the management of hepatitis C. Keywords: hepatitis C, screening, early detection, cost-effectivenes
Fluctuation relations for dissipative systems in constant external magnetic field: Theory and molecular dynamics simulations
No full textWe illustrate how, contrary to common belief, transient Fluctuation Relations (FRs) for systems in constant external magnetic field hold without the inversion of the field. Building on previous work providing generalized time-reversal symmetries for systems in parallel external magnetic and electric fields, we observe that the standard proof of these important nonequilibrium properties can be fully reinstated in the presence of net dissipation. This generalizes recent results for the FRs in orthogonal fields-an interesting but less commonly investigated geometry-and enables direct comparison with existing literature. We also present for the first time a numerical demonstration of the validity of the transient FRs with nonzero magnetic field via nonequilibrium molecular dynamics simulations of a realistic model of liquid NaCl
Fluctuation relations for systems in a constant magnetic field
No full textThe validity of the fluctuation relations (FRs) for systems in a constant magnetic field is investigated. Recently introduced time-reversal symmetries that hold in the presence of static electric and magnetic fields and of deterministic thermostats are used to prove the transient FRs without invoking, as commonly done, inversion of the magnetic field. Steady-state FRs are also derived, under the t-mixing condition. These results extend the predictive power of important statistical mechanics relations. We illustrate this via the nonlinear response for the cumulants of the dissipation, showing how the alternative FRs enable one to determine analytically null cumulants also for systems in a single magnetic field
Doctors commitment and long-term effectiveness for cost containment policies: lesson learned from biosimilar drugs
No full textEnrica Menditto,1 Valentina Orlando,1 Silvia Coretti,2 Daria Putignano,1 Denise Fiorentino,1 Matteo Ruggeri2 1CIRFF, Center of Pharmacoeconomics, Federico II University of Naples, Naples, 2Postgraduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, School of Economics, Rome, Italy Background: Agency is a pervasive feature of the health care market, with doctors acting as agents for both patients and the health care system. In a context of scarce resources, doctors are required to take opportunity cost into account when prescribing treatments, while cost containment policies cannot overlook their active role in determining health care resource allocation. This paper addresses this issue, investigating the effects of cost containment measures in the market of biosimilar drugs that represent a viable and cost-saving strategy for the reduction of health care expenditure. The analysis focuses on a particular region in Italy, where several timely policies to incentivize biosimilar prescribing were launched. Methods: Drugs were identified by the anatomical therapeutic chemical classification system. Information about biosimilar drugs and their originator biological products was extracted from the IMS Health regional database. Drug consumption was expressed in terms of counting units, while expenditure was evaluated in Euro (€).The market penetration of biosimilars was analyzed by year and quarterly. Results: In the Campania region of Italy, the effects of cost containment policies, launched between 2009 and 2013, showed the prescription of biosimilars strongly increasing in 2010 until prescribing levels reached and exceeded the market share of the reference biological products in 2012. After a slight reduction, a plateau was observed at the beginning of 2013. At the same time, the use of the originator products had been decreasing until the first quarter of 2011. However, after a 1-year plateau, this trend was reversed, with a new increase in the consumption of the originators observed. Conclusion: Results show that the cost containment policies, applied to cut health expenditure "to cure and not to care", did not produce the cultural change necessary to make these policies effective in the long run. Therefore, top-down policies for cost containment are not successful; rather, a bottom-up approach based on consensus among professionals should become the preferred option. Keywords: cost containment policy, biosimilar drugs, health care expenditure, policy makin
Erratum: Fluctuation relations for systems in a constant magnetic field (Physical Review E (2020) 102 (030101R) DOI: 10.1103/PhysRevE.102.030101)
No full textErratum. After the publication of this paper, we found an inconsequential mistake in the derivation of the dissipation function for the Nosé-Hoover thermostatted system, Eq. (17) of the original paper. A complete and correct derivation for O(0)(X) is now reported in Appendix B of Ref. [1], where, in particular, it is shown that (Formula Presented) (Figure Presented)
The social cost of major depression. A systematic review
No full textMajor depression (MD) is a major cause of disability and a significant public health problem due to strong physical and
mental impairment, possible complications for patients (including suicides), serious social and working problems to the
patient and his/her family. We provide an overview of the social cost of Major depression worldwide. We conducted a
systematic literature review. Two search engines were queried. Screening of records and summary of evidence was
performed by two researchers blindly. The review was conducted in accordance with the standards of the PRISMA
guidelines.
Twenty studies met the inclusion criteria. Despite the heterogeneity in terms of population, setting and estimation
techniques, the studies showed that the largest share of the burden of disease is represented by indirect costs. Among
direct healthcare costs, inpatient care represents the most significant item, followed by outpatient care. The average total
direct cost of depression ranges between €508 and €24 069, depending on the jurisdiction where the analysis was run and
the range of cost items included. Indirect costs range between €1963 and €27 364.
Evidence on the cost of MD in some countries is currently lacking. A deeper understanding of the drivers of the economic
burden of disease is a crucial starting point for studies concerned with the cost-effectiveness of new treatment strategies
The minimum clinically important difference for EQ-5D index: A critical review
No full textThe European Quality of Life-5 Dimensions Questionnaire (EQ-5D) is the most common instrument to value health outcomes under the patient's perspective. Several studies have investigated whether observed changes are meaningful to patients, using a variety of approaches to estimate the minimum clinically important difference (MCID). This study provides an overview of the state of art of the estimation of the MCID for the three-level EQ-5D index based on the UK scoring algorithm, critically assessing the available evidence. The interest in estimation of MCID for the EQ-5D has been increasing in recent years. However, some additional standardization in the estimation procedures may be of value, in order to enhance the ability to make comparisons across measures and disease areas. Further methodological research might also contribute to reducing gaps between theory and practice. © 2014 Informa UK Ltd
Assessing the ethics of prison policies to ensure human rights compliance: Suicides and self-inflicted critical events in Italian prisons
No full textConsidering self-inflicted critical events (suicides, attempted suicides, self-harm acts, hunger strikes) in Italian prisons as indicators of the respect of inmates’ human rights, this study examines their relationship with the characteristics of the Italian prison system between 2016 and 2021, using a unique prison-level dataset covering the 188 national prisons. Both individual panel regressions and seemingly unrelated regressions show that reducing prison overcrowding reduces critical events. The same result is achieved by increasing mandatory treatments (restraint acts) performed discretionally by prison staff. Because the former policy is politically sensitive and difficult/costly to implement, policymakers may prefer to rely on the latter as a “death-avoidance strategy”, despite the greater likelihood of violating inmates’ human rights. These findings may help explain the increasing use of acts of restraint in Italian prisons in recent times
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