1,721,128 research outputs found
Artificial Urinary Sphincters as a Treatment for Post-Prostatectomy Severe Urinary Incontinence in Italy: A Cost-Utility Analysis
Full text linkAbstract
Objective: This study aimed at evaluating the cost-utility of artificial urinary sphincter (AUS) in men affected by postprostatectomy severe urinary incontinence and identifying the most cost-effective alternative among the various devices analyzed in Italy.
Methods: A 5-year cycles Markov model was developed to simulate the disease evolution. The analysis compared conservative therapy, ZSI 375®, single-cuff (SC) AMS 800TM, and double-cuff (DC) AMS 800TM. A Probabilistic Sensitivity Analysis (PSA) was performed. One thousand Monte Carlo simulations were conducted to generate the Cost-Effectiveness Acceptability Curve for each intervention strategy. A sensitivity analysis on the price of the device was conducted.
Results: From the Italian National Health Service perspective, DC AMS 800TM was the most cost-effective alternative in comparison with conservative therapy, with an Incremental Cost-Effectiveness Ratio (ICER) value equal to € 12,893. From the NHS + patient perspective, both the AMS 800TM devices (SC and DC) were dominant in comparison with conservative therapy. From the societal perspective, ICER was dominant for all the alternatives considered in terms of cost-effectiveness. The PSA showed that DC AMS 800TM had a greater probability to be cost-effective with respect to the other strategies considered in the analysis. The sensitivity analysis on the price of the device showed that in all the cases analyzed the incremental cost per QALY gained would be below € 25,000.
Conclusions: This cost-utility analysis confirms that AUSs are cost-effective options in the Italian context with respect to conservative therapy. Among AUSs, DC AMS 800TM has the greatest probability to be cost-effective
Cost of illness probabilistic methodology to assess direct and indirect costs of HCV-related diseases in Italy [Costi diretti e indiretti assorbiti dalle patologie HCV-indotte in Italia: stima basata su una metodologia probabilistica di Cost of Illness]
No full textHuman papillomavirus in Italy: retrospective cohort analysis and preliminary vaccination effect from real-world data
Full text linkIntroduction The objective of this study was to estimate the lifetime risk of hospitalization associated with all major human papillomavirus (HPV)-related diseases in Italy. Moreover, a preliminary vaccination effect was also performed.Methods A retrospective, nonrandomized, observational study was developed based on patients hospitalized between 2006 and 2018 in Italy. All hospitalizations were identified through administrative archives, according to the International Classification of Diseases (ICD-9 CM). Information related to the hospital discharges of all accredited public and private hospitals, both for ordinary and day care regimes, was taken into account. We included hospitalizations related to resident patients presenting one of the ICD-9-CM codes as primary or secondary diagnosis: genital warts (GW); 'cervical intraepithelial neoplasia (CIN)' (067.32-067.33); 'condyloma acuminatum' (078.11); 'anal cancers' (AC) (154.2-154.8); oropharyngeal cancers (OC): 'oropharyngeal cancer'(146.0-146.9) and 'head, face and neck cancers' (171.0); genital cancers (GC): 'penis cancer' (187.1-187.9) and 'cervical cancer' (180.0-180.9). Data were stratified by birth year and divided into two groups: (a) cohort born before 1996 (not vaccinable) and (b) cohort born after 1997 (vaccinable-first cohort that could be vaccinated at the beginning of immunization schedule in girls since 2008 in Italy). Disease-specific hospitalization risks for both groups were estimated by sex, year and age.Results Epidemiological data demonstrate that the peak hospitalization risk occurred at 24-26 years of age for GW (both male and female); 33-41 and 47-54 years for AC males and females, respectively; 53-59 and 52-58 years for OC males and females, respectively; and 54-60 and 39-46 years for GC males and females, respectively. Focusing on GW and GC, vaccinable females demonstrate a significant reduction in hospitalization risks (- 54% on average) compared to nonvaccinable females until 21 years of age (maximum follow-up available for girls born after 1997). Comparing the same birth cohort of males, no differences in hospitalization risk were found.Conclusions These results support the importance of primary prevention strategies in Italy and suggest that increased VCRs and time of observation (genital cancers for which vaccination is highly effective, have a latency of some decades) will provide useful information for decision-makers
Costo-utilità di dalbavancina versus standard of care (SoC) in pazienti con ABSSSI non severa in Italia. (Cost-utility of dalbavancin in patients with non-severe ABSSSI in Italy).
No full textIntroduction: Acute Bacterial Skin and Skin Structure Infections (ABSSSIs) include all complicated skin and soft tissue infections. The aim of this study was to conduct a cost-utility analysis to compare dalbavancin with standard antibiotic therapies for the management of non-severe ABSSSIs from the National Health Service (NHS) perspective.
Methods: A probabilistic decision tree model was developed considering a 30-days follow-up to simulate the therapeutic pathway of a patient treated with dalbavancin or Standard of Care (SoC). The model considered three mutually exclusive health states: a) discharge of patients from the emergency department, b) discharge of patients after one night from admission, c) discharge after 24 or 36 hours from admission. A one-way deterministic sensitivity analysis and a probabilistic sensitivity analysis were conducted.
Results: The analysis showed that the use of dalbavancin in patients with non-severe ABSSSI compared to SoC could generate a reduction in costs (– € 291.6 per patient treated) and an increase in QALYs (+0.0018 per patient treated). In 99.7% of the simulations carried out, dalbavancin was dominant compared to the SoC. Considering a threshold for the willingness to pay of € 30,000 for QALY gained, the minimum level of efficacy of dalbavancin so that the treatment can be considered cost-effective compared to the SoC was equal to 69.4%.
Conclusions: The analysis showed that dalbavancin may represent a cost-effective option compared to SoC for the treatment of patients with non-severe ABSSSI
Economic Consequences of Anti-HCV Treatment of Patients Diagnosed Through Screening in Italy: A Prospective Modelling Analysis
Full text linkAim To evaluate the cost-consequences of the investment for anti-hepatitis C virus (HCV) treatment by the Italian National Health System (NHS) for patients who will be newly diagnosed through active HCV screening, implemented in Italy from 2020. Methods A previously published Markov model was used to estimate the disease complications avoided and the associated savings over 20 years to treat a standardised population of 10,000 HCV-infected patients diagnosed as a result of screening. Disease progression probabilities and fibrosis stage distribution were based on previously reported data in the literature. Real-life treatment effectiveness and medical expenses for disease management were estimated starting from a representative cohort of HCV-treated patients in Italy (Italian Platform for the Study of Viral Hepatitis Therapies). The breakeven point in time (BPT) was defined as the years required for the initial investment in treatment to be recovered in terms of cumulative costs saved. Results Over a 20-year time horizon, the treatment of 10,000 standardized patients diagnosed through active HCV screening results in 7769 avoided events of progression, which are associated with euro838.73 million net savings accrued by the Italian NHS. The initial investment in treatment is recouped in 4.3 years in the form of savings from disease complications avoided. Conclusion Investment in treatment of newly diagnosed patients will bring a significant reduction in disease complications, which is associated with great economic benefits. This type of action can reduce the infection rate as well as the clinical and economic disease burden of HCV in Italy
Impatto economico del regime di dosaggio Q6Wdi pembrolizumab nel melanoma avanzato o adiuvante
No full textDirect and indirect costs associated with respiratory allergic diseases in Italy. A probabilistic cost of illness study. [Costi diretti e indiretti associati a malattie allergiche respiratorie in Italia. Uno studio probabilistico di cost of illness]
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