50 research outputs found
23-valent pneumococcal vaccine failure in a patient who developed pneumonia: a case report
No full textWe report a clinical failure of a pneumococcal vaccine in a patient who developed pneumococcal pneumonia. In 2008, an 85-year-old Italian woman was admitted to the Respiratory Disease Unit of a hospital in Southern Italy. The 23-valent pneumococcal vaccine had been administered to the patient 50 days earlier. The chest x-ray disclosed a right basal bronchopneumonic focus. Streptococcus Pneumoniae serotype 19A, a strain included in the 23-valent pneumococcal vaccine, was isolated from the sputum. There is a need for more efficacious conjugated vaccines covering the majority of the pneumococcal serotypes that cause serious illness in older children and adults worldwide
Ultrasound screening for thyroid nodules and cancer in individuals with family history of thyroid cancer: a micro-costing approach
No full textPurpose: Screening programs that target healthy populations are an important tool for identifying unrecognized, asymptomatic disease. However, ultrasound screening for thyroid cancer has no obvious advantage in terms of cost-effectiveness in asymptomatic adults. There is far less consensus (and data) on the indications for screening in high-risk individuals. The aim of the study was to estimate the costs of ultrasound screening for individuals with first-degree family history of thyroid cancer. Methods: We conducted a prospective cross-sectional study from January 1, 2009 through December 31, 2018 in the Thyroid Cancer Outpatient Clinic of a large teaching hospital in Rome, Italy. We estimated the costs of an ultrasound screening protocol using the micro-costing bottom-up method. Results: For individuals without thyroid nodules, the screening examination had an estimated cost of €66.21 per screenee. For those found to have unsuspicious nodules, the estimated cost rose to €119.52 per screenee, owing to the addition of thyroid function tests. The estimated cost of screening for a subject with newly diagnosed nodules that were submitted to cytology was €259.89. The total cost of screening for the entire population of 1176 individuals was € 118,133.85. The total expenditure to confirm a single thyroid cancer diagnosis was €10,598.71. Conclusion: A sonographic screening implies a significant direct expenditure and is likely to detect a very large number of individuals with benign nodules (more than 45 asymptomatic individuals are diagnosed with a thyroid nodule for each newly detected cancer case), whose long-term follow-up will further increase healthcare costs
Cost-effectiveness of I-123-FP-CIT SPECT in the differential diagnosis of essential tremor and Parkinson's disease in Italy
No full textEconomic evaluation (Italian NHS perspective) modeling I-123-FP-CIT SPECT (DaTSCAN (R)) compared to clinical judgment alone for differentiating essential tremor (ET) from Parkinson's Disease (PD). A 5-year Markov model was Constructed to assess the cost-effectiveness of I-123-FP-CIT SPECT to differentiate ET from PD in patients referred to a movement disorder specialist in Italy. Published data and a double-round, Delphi panel of 12 specialists populated the model. Effectiveness was expressed as the projected Years on potentially beneficial therapy (PBTYs). Costs were expressed in Euros (2005 values). The model suggests that over 5 years. the "current" diagnostic pathway generated an average of 2.3 PBTYs/patient at an estimated cost of (sic)8.864. I-123-FP-CIT SPECT generated an average of 4.1 PBTYs/patient at an estimated cost of (sic)8,422, which represented an additional 1.8 PBTYs at a cost saving of (sic)442/patient ((sic)341 when discounted at 5%). The estimated cost-effectiveness of I-123-FP-CIT SPECT is under (sic)1,000 per PBTY gained when the underlying disease prevalence is high (55-70%), and cost-saving at prevalence under 55%. I-123-FP-CIT SPECT is likely to be regarded as economically advantageous to differentiate ET from PD, increasing tune on potentially beneficial therapy at a lower overall cost to the healthcare system
Costo-efficacia di rituximab nella terapia di mantenimento in soggetti affetti da linfoma non-Hodgkin follicolare refrattario
No full textObjectives: Cost-effectiveness of rituximab in maintenance treatment of refractory or relapsing follicular non-Hodgkin lymphoma
Scope of this analysis was to estimate the cost-effectiveness of rituximab maintenance (r-maintenance) therapy vs. observation, in relapsed/refractory follicular lymphoma patients following response to induction therapy with or without rituximab, based on data from a large multicenter study, in the Italian public payer's perspective.
Methods: This study models the impact of r-maintenance vs. observation using a 15 years, health-state transition model. All patients entered the model following response to chemotherapy with or without rituximab as induction therapy (progression-free health state, PFHS). On the basis of probability estimates derived from the clinical trial, the model simulates transitions of patients from PFHS to either progressed health state (PHS) or death. Progression-free survival (PFS) and overall survival (OS) following r-maintenance are extrapolated from 2-year Kaplan-Meier curves from the study data (median trial follow-up 31 months) using a Weibull distribution (in the basecase PFS and OS clinical benefit is assumed to last 5 years). Quality of life utility values for the health states in the model were derived from a study of 165 patients using the EQ-5D questionnaire. Direct medical costs (including drug acquisition plus administration and management of adverse events) are reported in 2006 Euros and are derived from expert opinion and published sources. Costs and outcomes were discounted at a rate of 3.5%. In order to address uncertainty in point estimates, one-way and probabilistic sensitivity analyses were also performed.
Results: The estimated lifetime incremental PFS is a 1.5 year increase for r-maintenance vs. observation (3.2 vs. 1.7 years). Overall survival analysis (based on 5 year extrapolation of the clinical benefit) yields an estimate of 5.9 life years (LY) for r-maintenance vs. 4.9 for observation (difference 0.99 LY gained). Total cost for r-maintenance is estimated as €26,027 vs. €16,146. R-maintenance results in a gain of 0.9 quality-adjusted life years (QALYs) [4.22 vs. 3.3] at an incremental cost of €9,881. The incremental cost-effectiveness ratio (ICER) of r-maintenance vs. observation is, therefore, estimated at €11,097/QALY gained. The ICER of r-maintenance is sensitive to the duration of treatment benefit and frequency of subsequent treatment; probabilistic sensitivity analysis shows that, over 2000 simulations, the cost/QALY never exceeds €14,000/QALY, a value well below commonly accepted cost-utility thresholds.
Conclusions: In patients with partial or complete response to induction therapy, r-maintenance improves overall survival and progression-free survival and produces more QALYs compared with observation alone, at an acceptable cost/LY and cost/QALY ratio. Maintenance therapy with rituximab is a cost-effective approach for the management of patients with refractory/relapsed follicular lymphoma
The BAD study: Social and economic burden of attention deficit and hyperactivity disorder (ADHD) in Italy
No full textAnalisi costo-efficacia di rituximab + CHOP versus CHOP in soggetti affetti da linfoma non Hodgkin aggressivo
No full textCost-effectiveness analysis of rituximab + CHOP versus CHOP in patients with aggressive Non-Hodgkin lymphoma
Objective: Aim of this study was to evaluate the cost-effectiveness of rituximab + CHOP (R-CHOP) versus CHOP alone, in Italian patients with aggressive Non-Hodgkin lymphoma (NHL), in the NHS' perspective. Design: The economic analysis is based on an existing Markov model which was developed to evaluate costs and effects for two hypothetical cohorts of patients aged ≥ 60 years or aged < 60 years respectively, over a time frame of 15 years after administration of chemotherapy. The model is based on five health states (start therapy, complete response, no response, progression, death) and combines efficacy data from published clinical trials (GELA-98-5) with costs of therapies and follow-up after chemotherapy, based on Italian treatment patterns. Costs and effects were discounted respectively at 6% and 1.5% per year. Extensive 1-way and Monte Carlo sensitivity analyses were conducted to test the robustness of results.
Results: For the two cohorts (age ≥ 60 or age < 60 years), incremental discounted survival gains with R-CHOP vs. CHOP were respectively 1.08 and 1.02 years per patient; incremental QALYs were 1.15 and 1.04 per patient; incremental cost/patient was €14 838 and €13 938; the incremental cost per life-year gained (cost/LYG) was therefore €13 732 and €13 717, while the incremental cost/QALY gained was €12 879 and €13 362.
Conclusions: The clinical advantage of R-CHOP is supported by values of incremental cost/LYG and cost/QALY gained, which are well below the thresholds commonly indicated both in the international and Italian literature. R-CHOP is a substantial improvement in the treatment of aggressive NHL, at a reasonable cost, in the perspective of the Italian NHS
Major complications have an impact on total annual medical cost of diabetes - Results of a database analysis
No full textBackground: Type 2 diabetes mellitus is a common, chronic, and costly disease, and its prevalence is increasing in major industrialized countries. Diabetes has indeed a high social impact mainly because of its chronic complications. objective: The aim of this study was to analyze the direct medical costs attributable to Type 2 diabetes mellitus and its determinants, as assessed in a diabetologic center (DC) in Italy. Methods: We conducted a retrospective longitudinal cost of care study; Type 2 diabetic patients who visited between January 2001 and August 2002 were randomly selected from the database of the DC of Portogruaro. Cost data collected included hospitalizations, visits, diagnostics, and pharmacological therapies and were quantified and analyzed in the perspective of the National Health Service (NHS). Results: Two hundred ninety-nine diabetic patients were extracted, with a mean/patient follow up of 476 days. Mean age was 67.5 years and males represented 67.2% of the sample. The average annual health care cost was found to be Euro 1909.67 per patient; pharmacological therapies accounted for the greatest proportion of direct medical costs (52%), followed by hospitalization (28%) and diagnostic exams (11%). Annual costs increased with the number of diabetes related comorbidities, from Euro 1039 to 3141 per patient in participants with none or more than two complications, respectively. Conclusion: Long-term complications carry a considerable impact on total annual medical cost. Our study demonstrates that an increase in the number of comorbidities is directly associated with an increase of Type 2 diabetes cost. Strategies aimed at preventing the onset of diabetic complications are likely to reduce medical costs in the long run, while improving patients' health. (c) 2006 Elsevier Inc. All rights reserved
Socioeconomic costs of digital ulcer treatment among patients with systemic sclerosis: A pilot observational study in Italy
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