1,721,003 research outputs found
The social cost of major depression. A systematic review
Full text linkMajor 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
COST-EFFECTIVENESS ANALYSIS of HERPES ZOSTER VACCINATION in Italian ELDERLY PERSONS
No full textObjectives: Herpes zoster (HZ) is characterized by a painful skin rash. Its main complication is postherpetic neuralgia (PHN), pain persisting or occurring after the rash onset. HZ treatment aims to reduce acute pain, impede the onset complications, and disease progression. The aim of this study was to assess the cost-effectiveness of HZ vaccination compared with no vaccination strategy, within the Italian context. Methods: The natural history of HZ and PHN was mapped through a Markov model with lifetime horizon. A population of patients aged between 60 and 79 years was hypothesized. Third party payer (Italian National Health Service, I-NHS) and societal perspectives were adopted. Data were derived from literature. Results and Conclusions: The incremental cost-effectiveness ratio of the vaccination equaled EUR 11,943 per quality-adjusted life-year (QALY) under the I-NHS perspective and EUR 11,248 per QALY under the societal perspective. Considering a cost-effectiveness threshold of EUR 30,000/QALY, the multi-way sensitivity analysis showed that vaccination is cost-effective regardless of the perspective adopted, in 99 percent of simulations
Non-malleable Encryption: Simpler, Shorter, Stronger
No full textOne approach toward basing public-key encryption (PKE) schemes on weak and credible assumptions is to build “stronger” or more general schemes generically from “weaker” or more restricted ones. One particular line of work in this context was initiated by Myers and Shelat (FOCS ’09) and continued by Hohenberger, Lewko, and Waters (Eurocrypt ’12), who provide constructions of multi-bit CCA-secure PKE from single-bit CCA-secure PKE. It is well known that encrypting each bit of a plaintext string independently is not CCA-secure—the resulting scheme is malleable. We therefore investigate whether this malleability can be dealt with using the conceptually simple approach of applying a suitable non-malleable code (Dziembowski et al., ICS ’10) to the plaintext and subsequently encrypting the resulting codeword bit by bit. We find that an attacker’s ability to ask multiple decryption queries requires that the underlying code be continuously non-malleable (Faust et al., TCC ’14). Since, as we show, this flavor of non-malleability can only be achieved if the code is allowed to “self-destruct,” the resulting scheme inherits this property and therefore only achieves a weaker variant of CCA security. We formalize this new notion of so-called indistinguishability under self-destruct attacks (IND-SDA) as CCA security with the restriction that the decryption oracle stops working once the attacker submits an invalid ciphertext. We first show that the above approach based on non-malleable codes yields a solution to the problem of domain extension for IND-SDA-secure PKE, provided that the underlying code is continuously non-malleable against (a reduced form of) bit-wise tampering. Then, we prove that the code of Dziembowski et al. is actually already continuously non-malleable against bit-wise tampering. We further investigate the notion of security under self-destruct attacks and combine IND-SDA security with non-malleability under chosen-ciphertext attacks (NM-CPA) to obtain the strictly stronger notion of non-malleability under self-destruct attacks (NM-SDA). We show that NM-SDA security can be obtained from basic IND-CPA security by means of a black-box construction based on the seminal work by Choi et al. (TCC ’08). Finally, we provide a domain extension technique for building a multi-bit NM-SDA scheme from a single-bit NM-SDA scheme. To achieve this goal, we define and construct a novel type of continuous non-malleable code, called secret-state NMC, since, as we show, standard continuous NMCs are insufficient for the natural “encode-then-encrypt-bit-by-bit” approach to work
Economic assessment of an anti-HCV screening program in Italy
No full textBackground The progression of hepatitis C virus (HCV) disease usually occurs over a 10-year period. HCV-related complications as well as the highly debilitating effects on patients represent a significant item of expenditure for the National Health Service. Early detection of HCV infection is an excellent opportunity to improve patients' quality of life and to rationalize resource allocation. Objective The aim of this study was to provide a cost-effectiveness evaluation of an anti-HCV screening program in the Italian National Health Service perspective. Methods We built a Markov model made up of two arms. The ''Test Strategy'' arm involves a screening program based on the enzyme immunoassay for detection of antibodies as first-level test and the research of HCV RNA as second-level detection; patients with positive test results are treated with peg-interferon alfa in combination with ribavirine. Parameters were derived from the literature and validated through experts' opinion. Costs and benefits were discounted by 3.5%. Results were expressed as cost/quality- adjusted life-year (QALY) gained through the screening program compared with the treatment of symptomatic patients. Deterministic and probabilistic sensitivity analysis was performed. Results The incremental cost-effectiveness ratio of the ''Test Strategy'' is €5171/QALY, definitively below the cost/QALY of other approved treatments in Italy. Model results turned out as sensitive to the age of the target population, the prevalence of HCV infection, and the time horizon adopted. Conclusions The anti-HCV screening program is a valid health-related investment improving patients' quality of life and survival with an acceptable expenditure increase for the National Health Service. © 2013 International Society for Pharmacoeconomics and Outcomes Research (ISPOR)
Money back guarantee? A cost–benefit framework of performance-based agreements (PBAs) for the reimbursement of pharmaceuticals
No full textThe aim of this paper is to provide an empirical framework based on a
discrete-time Markov chain to assess the costs and benefts of Performance Based
Agreements (PBAs) for the reimbursement of pharmaceuticals. We provide an
empirical testing using a case study referring to a treatment recently approved for
reimbursement in Italy. The implementation of this framework is challenging for the
agencies dealing with pricing and reimbursement decisions given the uncertainty
associated with the treatment efectiveness and safety. On the other hand, empirical
evidence shows that the awareness of the expected costs associated with diferent
reimbursement schemes is necessary to inform decision-makers
Rate-optimizing compilers for continuously non-malleable codes
No full textWe study the rate of so-called continuously non-malleable codes, which allow to encode a message in such a way that (possibly adaptive) continuous tampering attacks on the codeword yield a decoded value that is unrelated to the original message. Our results are as follows: For the case of bit-wise independent tampering, we establish the existence of rate-one continuously non-malleable codes with information-theoretic security, in the plain model.For the case of split-state tampering, we establish the existence of rate-one continuously non-malleable codes with computational security, in the (non-programmable) random oracle model. We further exhibit a rate-1/2 code and a rate-one code in the common reference string model, but the latter only withstands non-adaptive tampering. It is well known that computational security is inherent for achieving continuous non-malleability in the split-state model (even in the presence of non-adaptive tampering). Continuously non-malleable codes are useful for protecting arbitrary cryptographic primitives against related-key attacks, as well as for constructing non-malleable public-key encryption schemes. Our results directly improve the efficiency of these applications
Economic Analysis and Budget Impact of Tenofovir and Entecavir in the First-Line Treatment of Hepatitis B Virus in Italy
No full textBackground: Chronic hepatitis B is a common, progressive disease, particularly when viral replication is detected. Oral antivirals can suppress viral replication and prevent or delay the development of cirrhosis and liver-related complications. The treatments of chronic hepatitis B cannot totally cure the disease but can prevent its progression to hepatocellular carcinoma, decreasing the levels of both morbidity and mortality. To date, there are several therapies indicated by the international guidelines as first-line treatments for the management of hepatitis B; two of the most effective are those based on either tenofovir or entecavir. Objective: The aim of this study is to evaluate the cost-effectiveness of tenofovir and entecavir in the treatment of naïve patients with chronic hepatitis B. The two treatments are compared with the “no treatment” and to one another. Methods: The cost-effectiveness analysis was conducted using a Markov model; patients entered one of the following health states: chronic hepatitis, cirrhosis (compensated or decompensated), hepatocellular carcinoma, liver transplantation or death. The analysis was carried out from the perspective of the Italian National Health Service by considering a life-time horizon with cycles lasting 1 year and with costs and QALYs (quality-adjusted life years) discounted at a rate of 3.5%. The results of the model were analysed in terms of incremental cost-effectiveness ratio (ICER). Results: ICERs for tenofovir and entecavir emerging from the comparison versus “no treatment” were equal to €10,274.73 and €16,300.44 per QALY gained, respectively, on the life-time horizon. Tenofovir was dominant in the direct comparison with entecavir, indicating more QALYs and a lower consumption of resources. The Monte Carlo simulation demonstrated that in 97% (tenofovir) and in 85% (entecavir) of the scenarios performed, the cost per QALY fell below the threshold of €30,000/QALY. The budget impact analysis showed savings for tenofovir amounting to 33% compared to entecavir in the first year on treatment and to 31% in following years. Conclusions: Entecavir and tenofovir are recommended for the treatment of patients with chronic Hepatitis B in the Italian Health System. In particular, tenofovir appeared to be the more cost-effective drug for the management of chronic hepatitis B virus (HBV) infections. These results could help decision makers and clinicians to address their decision when choosing a first-line treatment for the management of people affected by chronic HBV
Preventing mobility disability in Europe: a health economics perspective from the SPRINTT study
No full textIn a global context of population aging, gaining better knowledge of the mechanisms leading to loss of autonomy has become a major objective, notably with the aim of implementing effective preventive health policies. The concept of frailty, originally introduced in gerontology and geriatrics as a precursor state to functional dependency, appears as a useful tool in this specific context. The “Sarcopenia and Physical fRailty IN older people: multi-componenT Treatment strategies” (SPRINTT) project will provide a unique opportunity to explore health economics issues associated with frailty. In terms of health economics, the loss of autonomy approach retained here focuses on the economic and social causes and consequences of the onset of frailty in older adults, and examines the challenges not only in terms of health system efficiency but also in terms of social protection
Hardening subnational budget constraints via administrative subordination: The Italian experience of recovery plans in regional health services
No full textSince 2007, Italian regions running large deficits underwent recovery plans (Piani di Rientro) imposed by the central government. The goal was twofold: regions were asked (i) to restore a balanced budget and (ii) to continue supply the set of services defined by the constitution. We investigate whether recovery plans have reached their objectives. Our evidence suggests that recovery plans have proved to be an effective mechanism to eliminate subnational governments deficits. We also do not find any significant effects on health care utilization and on citizens' health. Overall, spending efficiency has likely improved
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