1,721,165 research outputs found
Analisi di budget impact sull’utilizzo di paracalcitolo nel trattamento dell’iperparatiroidismo secondario associato a malattia renale cronica
Full text linkOBJECTIVE: Evaluation of the budget impact of the use of paricalcitol (compared to alternative treatment) for secondary
hyperparathyroidism (SHPT) in patients with chronic kidney disease (CKD) when used at two different timing of therapy.
METHODS: Two Markov models related to a different timing of treatment have been developed: the intermediate stage of
chronic kidney disease (CKD3) and the dialysis stage. The analysis was conducted with the perspective of the Italian National
Health System and over a 5-year time horizon. The clinical and economic data used in the model were derived from
the literature and other assumptions were made based on the opinion of clinical experts. Univariate sensitivity analysis was
conducted to test the robustness of the results.
RESULTS: The base case shows that starting paricalcitol treatment from the dialysis stage (considering 13,311
possible candidates) is associated with a reduction in direct costs from € 1,782,921,351 to € 1,622,357,209
over 5 years. Furthermore, considering a collective of 1,000 subjects eligible and starting treatment with paricalcitol
since the intermediate stages of the CKD, is associated with an overall cost saving of € 1,197,500.
DISCUSSION AND CONCLUSIONS: Paricalcitol is expected to be cost-saving in patients with SHPT in Italy considering
both the therapeutic indications of the drug. Moreover, despite the higher cost of using paricalcitol in pre-dialysis stage, an
early treatment of SHPT determine an overall decrease in direct medical costs
The cost-effectiveness of drug therapies to treat secondary hyperparathyroidism in renal failure: a focus on evidence regarding paricalcitol and cinacalcet
No full textThe present review aims to assess the state-of-the-art regarding cost-effectiveness of therapy for secondary hyperparathyroidism in order to identify the best treatment and review methodological issues. PubMed and the Cochrane Library were searched to identify papers performing comparative analysis of costs and effects of treatment for secondary hyperparathyroidism in adult patients. Among the 66 papers identified, only 10 were included in the analysis. Treatment strategies evaluated in the selected papers were: cinacalcet in addition to vitamin D and phosphate binders versus vitamin D and phosphate binders only (seven papers), paricalcitol versus non-selective vitamin D (two papers), early and late introduction of cinacalcet in addition to vitamin D and phosphate binders (one paper) and paricalcitol versus cinacalcet (one paper). The high degree of heterogeneity among alternative treatments and methodological limits related to cost items considered, resource valuation methods and so on, make it unfeasible to reach a definite conclusion regarding cost-effectiveness but allow for future research opportunities
Budget impact analysis of the use of extended half-life recombinant factor VIII (Efmoroctog alfa) for the treatment of congenital haemophilia A: The Italian national health system perspective
No full text
Triglyceride-glucose index predicts outcome in patients with chronic coronary syndrome independently of other risk factors and myocardial ischaemia
Full text linkAIMS: The triglyceride-glucose (TyG) index, a surrogate marker of insulin resistance (IR), is a prognostic risk factor in the general population. We aimed to assess whether it is an independent predictor of outcome also in patients with chronic coronary syndrome (CCS). METHODS AND RESULTS: TyG index was evaluated in 1097 consecutive patients (75% men, median age 72 years) with known (26%) or suspected coronary artery disease (CAD), undergoing stress-rest myocardial perfusion scintigraphy, and coronary angiography and followed up for a median of 4.5 years. Moderate/severe perfusion abnormalities during stress (summed stress score >7) were documented in 60% of patients, obstructive CAD in 74%, and 36% underwent early revascularization. TyG index was 8.9 (median, interquartile interval 8.6–9.2). Cardiac death or myocardial infarction occurred in 103 patients and all-cause death in 65. After correction for clinical risk factors, LV function and common bio-humoral variables, TyG index (HR 2.42, 95% CI 1.57–3.72, P < 0.001), and moderate/severe stress perfusion abnormalities (hazard ratio (HR) 2.17, 95% confidence interval (CI) 1.25–3.77, P < 0.001) independently predicted cardiac events. TyG index (HR 3.64, 95%CI 2.22–5.96, P < 0.001) and high-sensitivity C-reactive protein (HR 1.11, 95% CI 1.04–1.19, P = 0.002) independently predicted all-cause death. CONCLUSION: In patients with CCS, the TyG index identifies a cardiometabolic profile associated with an additional risk of cardiac events, over the presence of myocardial ischaemia and independently of other clinical, common bio-humoral or imaging risk determinants
Budget impact analysis of the use of extended half-life recombinant factor VIII (efmoroctocog alfa) for the treatment of congenital haemophilia a: The Italian National Health System perspective
No full textBackground: Congenital haemophilia A (HA) is a rare, inherited, life-long bleeding disorder characterised by prolonged or spontaneous bleeding due to the lack of clotting factor VIII (FVIII) in the body. Treatment for HA involves FVIII replacement therapy and poses great economic burden to National Health Systems and to society. Availability of novel products as extended half-life clotting factor products might change treatment approches and their economic evaluation is essential for an informed treatment choice. Accordingly the objective of the present work is to analyse the economic impact of using efmoroctocog alfa (recombinant factor VIII-Fc fusion protein, rFVIIIFc) for the treatment of children and adults with severe congenital haemophilia A (HA). Methods: A budget impact analysis was performed to estimate the economic impact of the introduction of rFVIIIFc in the market-mix of products for the treatment of HA. The analysis condidered a 3-year time horizon and the Italian National Health System (INHS) perspective. The model estimated drug costs associated with the treatment of HA in the current scenario - representing the marketplace forecast for the time period of interest assuming that rFVIIFc is not introduced - and a new scenario, assuming that rFVIIIFc is available in the market. The size of the target population was calculated using epidemiological national data. Univariate one-way sensitivity analyses and scenario analyses were performed. Results: Overall 3-year costs of treating the HA population in the current scenario were 555,277,691 Euro for the INHS. With the introduction of rFVIIIFc, the costs were reduced to 541,897,466 Euro suggesting potential savings to the INHS of 13,380,255 Euro. Results were consistent at variation of most of the model's parameters; only in case of lower dosage of conventional products and higher dosage of rFVIIIFc, costs for the INHS increased, in both cases, of about 20 million Euro. Conclusions: The use of rFVIIIFc for the treatment of HA has been recently approved by the Italian Medicines Agency (AIFA) and this is the first study estimating the financial impact of this new therapeutic alternative in the Italian context. The analysis suggests that rFVIIIFc use does not result in higher expenditure for the INHS
A budget impact analysis (BIA) of the use of paracalcitol for the treatment of a secondary hyperparathyroidism (SHPT) in end stage renal disease patients
No full textOBJECTIVES:
Budget impact analysis (BIA) of the use of paricalcitol versus alternative treatment for the management of secondary hyperparathyroidism (SHPT) in end stage renal disease patients.
METHODS:
A Markov model was used to simulate the evolution of end stage renal disease patients through transplant and death and to estimate associated direct health costs comparing the use of paracalcitol and cinacalcet plus low dose vitamin D over a 5-years horizon and using the Italian National Health System perspective. The model was developed using parameters from literature and assumption discussed with clinicians. National tariffs and costs from literature were used to value drug use, dialytic treatment, hospitalizations and transplant. One-way sensitivity analyses for model inputs were conducted. Costs and effects were discounted at 3% annum.
RESULTS:
Considering 13.311 candidate subjects for each treatment strategy, results from the model showed a decrease in direct healthcare costs from 1.782.921.351 Euro to 1.622.357.209 Euro in favour of paricalcitol over 5 years. Particularly, paricalcitol produced an overall saving in drug costs for more than 51 millions Euro while the other direct health costs related to dialysis, hospitalization and transplant were reduced by approximately 109 millions Euro.
CONCLUSIONS:
In light of the high economic burden of end stage renal disease mainly associated with dialysis and transplant the use of paricalcitol for the treatment of IPTS in these patients represents a valid alternative not only from a clinical point of view but also from an economic point of view
Towards Resilient Healthcare Systems: A Framework for Crisis Management
Full text linkThis study addresses the crucial need for resilient healthcare systems, highlighted by recent global health emergencies such as the Ebola and COVID-19 crises. It identifies a significant gap in the current literature: a lack of practical, actionable frameworks for healthcare resilience. To bridge this gap, the research introduces an innovative framework that blends theoretical resilience concepts with heuristic approaches. This framework, rooted in the principles of monitoring, anticipation, recognition, and learning, is designed to enhance the crisis management capabilities of healthcare systems. The methodology involves a comprehensive literature review, combined with heuristic methods, culminating in a framework that is both academically sound and practically applicable. This framework guides healthcare systems through various stages of crisis management, including data collection, situation analysis, risk anticipation, and response evaluation. It provides a holistic approach to enhancing resilience in healthcare settings. Overall, this paper makes a significant contribution to the field of healthcare system resilience, offering a strategic blueprint for improved crisis response and recovery. It marks an important advancement in aligning theoretical resilience concepts with practical implementation strategies, essential for tackling current and future healthcare challenges
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