1,720,969 research outputs found
Hospital-Based Health Technology Assessment: analisi della letteratura internazionale (2008-2019)
No full textThe process of health technology assessment has been a priority for health policies for several years. Nevertheless, a number of issues have not been disentangled yet, in particular with regard to its application at hospital level. This work attempts to shed light on Hospital-Based HTA through a systematic analysis of the academic literature. By doing this, our work allows to identify: i) the objectives pursued by HB-HTA; ii) the approaches adopted when performing HB-HTA, including the technologies assessed, the stakeholders involved and the aspects included in the evaluation. A managerial perspective could help decision-makers at selecting technological innovations that are not only effective in a clinical perspective, but also viable in economic and organizational terms for healthcare organizations. Moreover, it may support the achievement of strategic objec- tives and sustainable development in the long term
Un supporto alla governance pubblica : performance e accountability delle società partecipate
Full text linkCorporate social responsibility and firm value: Do firm size and age matter? Empirical evidence from European listed companies
No full textWhile the current empirical literature has focused predominantly on the direct relationship between corporate social responsibility (CSR) and firm value, in this paper, we aim to explore firm-level moderators that may contribute to disentangling this relationship. Based on a dataset of Western European listed companies, we use a moderation analysis of panel data to examine whether firm size and age drive the impact of CSR on firm value. Our estimations show that the relationship between CSR and firm value is moderated by firm size and age so that it is negatively impacted when small and/or young companies are considered. This finding seems to be consistent with the view that CSR initiatives could be ineffective in smaller and younger companies due to their lack of financial resources, experience, reputation, etc. Implications for firms are also discussed
Cost-utility analysis of esketamine for patients with treatment resistant depression in Italy
Full text linkAIM: Major depressive disorder is considered one of the most frequent diseases in the general population, and treatment resistant depression (TRD) represents the subset with more significant clinical and social impact. Large, robust phase III studies have shown safety and efficacy of esketamine nasal spray plus SSRI/SNRI antidepressants (ADs) compared to SSRI/SNRI plus placebo nasal spray in patients with TRD. The main aim of this study was to perform a cost-utility analysis comparing esketamine plus ADs with ADs alone in TRD patients, from the societal perspective in Italy. A secondary analysis focused on the National Healthcare Service (NHS) perspective.
METHODS: A Markov multistate model has been developed to estimate quality adjusted life years and economic outcomes of both treatment strategies over 5 years considering the initiation of esketamine in the different treatment lines, from 3 to 5 (3L-5L). The model has been populated with data from literature and real-world evidences. The analysis from the societal perspective considered direct healthcare costs and patients’ productivity losses. In addition to the incremental cost-utility ratio (ICUR), the incremental net monetary benefit (INMB) has been calculated as (incremental benefit × WTP) – incremental cost and by applying a willingness-to-pay (WTP) of 50,000€/QALY. Deterministic and probabilistic sensitivity analyses have been performed to assess the robustness of the model results.
RESULTS: From the societal perspective the ICUR ranged between 16,314€ and 22,133€ per QALY according to the different treatment lines, while it was over the threshold of 100,000€/QALY for the NHS perspective. The INMB was positive and ranged from 2,259€ to 2,744€ across treatment lines in the societal perspective; the INMB begins to occur earlier as moving towards subsequent lines of treatment (3.9 years for 3L, 3.6 years for 4L and 3.5 years for 5L). The analyses showed also that the advantage in terms of incremental NMB is maintained for a wide range of societal preferences expressed by WTP thresholds, and in particular for values above 22,200€, 16,400€ and 17,100€ for 3L, 4L and 5L, respectively.
CONCLUSION: The study showed that esketamine may be a cost-effective opportunity from the societal perspective for the management of patients with treatment resistant depression. In the future, data collected from observational studies or registries, which can include the collection of productivity losses and also costs sustained by the patients, will be able to provide further evidence in order to improve the reliability of the model results
Applicazione e potenziamento del PIP (Pandemic Influenza Preparedness Framework) in ambito OMS: un’arma in più per affrontare le fasi successive al picco da Covid-19
No full textPandemic Influenza Preparedness (PIP) Framework, developed by the World Health Organization, is the only existing framework to face a global pan- demic crisis. It is aimed to define a line of intervention which overcomes charac- teristics of health systems and allows the Member States at accessing to vaccines and other benefits. Besides reviewing its evolution, this article attempts to explore whether – and how – PIP could support future political and economic challenges engendered by Covid-19. In the absence of a new global agreement, PIP may represent the first outline of a framework for reacting to the present pandemic crisis. Moreover, a revised and more robust version of PIP may increase preparedness to future health crises
Value-Based Healthcare Paradigm for Healthcare Sustainability
No full textHealthcare represents a paramount issue in the current debate around sustainability. Developing sustainable practices within health systems is fundamen- tal not only to guarantee the right of care, but also to enhance the growth of a country. The widespread dissemination of innovation, on the one hand, could represent a way for providing a better service, in terms of quality and access. On the other hand, it is severely undermining the sustainability of health organisations due to high costs and magnitude on existing organisational arrangements. Among the various research strands aimed to identify theoretical framework to face the various challenges, Value-Based Healthcare is largely considered as the blueprint for promoting sustainable management approaches in healthcare. This paradigm stresses the importance to deliver care towards enhanced value for the patient, which could be measured through the ratio between outcomes and costs.
This chapter has a twofold aim. First of all, it is aimed at exploring the concept of Value-Based Healthcare to realise the state-of-art and to identify main issues and open questions around the drivers of value in health. Besides, it attempts to under- stand whether this approach could effectively contribute to the attainment of sus- tainable development goals. To do that, an in-depth explanation of the concepts of outcome and cost in healthcare has been carried out.
At the end of the analysis, principles of Value-Based Healthcare seem to be usefulness to cope with the need of improved practices. The focus on the value of patient, instead, allows to foster behaviours that could support the achievement of sustainable goals aimed to provide better and more accessible infrastructures. Within this complex mosaic, accounting could represent the common language to orient health management towards a higher sustainable value for the patient
Higher Sustainability and Lower Opportunistic Behaviour in Healthcare: A New Framework for Performing Hospital-Based Health Technology Assessment. Sustainability
Full text linkInnovative health technology deployment represents the primary challenge within the sustainability of public health systems. On one hand, new technologies may potentially improve access to care and the quality of services. On the other hand, their rapid evolution and broad implications on existing procedures increase the risk to adopt technologies that are not value for money. As a consequence, Health Technology Assessment (HTA) is a critical process at each level of the National Health System. Focusing on the organisational level, this paper explores the current practices of Hospital-Based HTA (HB-HTA) in terms of management, control and behaviours of various actors involved. Among several tasks, decision-makers are appointed at managing the conflict of interest around health technology development, that could pave the way for corruption or other misleading behaviours. Accordingly, the purpose of the study is proposing a new strategic framework, named Health Technology Balanced Assessment (HTBA), to foster hospital-based health technology management aimed to align strategy and actions. The conceptual model is developed on three perspectives (clinical, economic and organisational) to make the actors involved in the assessment (clinicians, health professionals, hospital managers and patients) aware of the impact of new technology on the value chain. Besides supporting the decision-making process, such a tool represents support for the internal control system as a whole. By promoting structured evaluation, it increases transparency and accountability of public health organisations. Moreover, in the long run, the framework proposed will be useful to reach selected United Nations Sustainable Development Goals (UN SDGs) to enhance the quality of healthcare in the future
Accountability for climate change: a research synthesis through the lenses of the integrated thinking approach
Full text linkPurpose – The increasing responsibility of organisations towards society and the environment has inverted the relationship between accounting and accountability, leading to accountability-based accounting systems. This study aims to explore the debate on accountability for climate change within the integrating thinking (IT) perspective. Ascertaining the most significant trends in the debate around purposes and performance that characterise climate mitigation engagement and their connections, the study would explore if and to what extent organisations are tackling climate actions.
Design/methodology/approach – A narrative review of the extensive academic literature developed from the Kyoto Protocol to date was performed. After selecting a representative sample, papers were analysed with the support of a new analytical framework that involves three dimensions – answerability, enforcement and outcome – and governance schemes that emerge from the involvement of the private and public sector and civil society. With the support of NVivo software, themes arisen were analysed and coded. Key items were labelled, creating specific nodes and synthesised into the proposed framework.
Findings – A “silo approach” largely characterises the debate on accountability for climate change. The most significant reasons behind the shortcomings of extant climate actions may be retrieved firstly in the weakness of the motivations that guide organisations to operate in a climate-friendly way.
Social implications – This study underlines the need for a 360° integrated approach for strategically tackling climate actions.
Originality/value – This study would represent a further step towards an integrated approach for studying organisations behaviours in the “climate war”, embracing the connectivity between purposes and outcomes, capitals and the relationships amongst the various stakeholders
Environmental Auditing in Rural Areas: Current Patterns and Future Challenges in Central Asia
Full text linkEnvironmental audit (EA) is a systematic process of collecting and objectively evaluating information, whether certain environmental activities are in compliance with audit standards, criteria, and control systems. Due to the former use of the Soviet Union regime, Central Asia, with vast resources and a growing population, is still confronting a number of environmental issues. The increasing number of businesses in Central Asian countries has an impact on the local environment and the population’s health. As a response, EA is one of the instruments that businesses may use to improve their environmental performance, protect nature, and ensure public-health safety. This paper, after providing a scoping review concerning the academic literature, investigates, by using secondary data, the current trends and challenges in practical application of EAs in five Central Asian countries. Our findings point out a list of shortcomings in applying the EA tools in Central Asia, which mainly derive from implementation, legislative, and resource gaps. Thus, the road towards a concrete implementation of EA is still far from being achieved. The study ends with some pieces of advice for EA policy makers and opens up avenues for future research, which can also be applied outside Central Asia
Designing the Function of Health Technology Assessment as a Support for Hospital Management
No full textInvestment in Health Technologies (HTs) is one of the crucial points for hospital managers. It affects the goals and strategic orientation of the whole Health Organization. Decision-making regarding the employment of new technologies involves, prevalently, the hospital level, which directly concerns the healthcare delivery process and its design.
Hospital-Based Health Technology Assessment (HB-HTA) is aimed at selecting the portfolio of new HTs that provides the best balance between competing targets, namely, cost containment and quality improvement. This objective is achievable by thinking about how to improve the service delivered, through the use of innovative cost-effective HT.
Accordingly, the HTA role deals with the operational modalities of hospital departments, and it is strictly related to outcomes desired and in respect to budgets.
This evaluative process should be coherent with specific health organization necessities given that each one is concerned with its own geographic area, its own specific patients’ epidemiology, the social environment, and financial resources’ availability. However, HTA is usually run by practitioners whose competences contemplate mainly clinical and technical aspects; hence, the absence of a focus on performance management (PM) represents the main weakness of this function.
Thus, starting from the current body of literature in the fields of PM and HT management, this work theoretically identifies how to design an HB-HTA func- tion and which the main relevant evaluation perspectives are. By explaining the implementation stages, it will be shown how HTA at the hospital level should be
able to combine the different perspectives of business performance (financial and nonfinancial) with clinical needs
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