1,720,963 research outputs found
Le patologie gastrointestinali dall epidemiologia all'intervento terapeutico nella pratica di medicina generale: analisi dei costi sanitari indotti
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Terapia delle patologie gastrointestinali: un compromesso tra indicazioni ministeriali, evidenze scientifiche e scelte gestionali del medico di medicina generale nell'ULSS 9 di Treviso
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COSTI E BISOGNI SANITARI DEGLI ANZIANI NON AUTOSUFFICIENTI PRESSO LE STRUTTURE RESIDENZIALI: STRATEGIE E INTERVENTI PER UNA POPOLAZIONE CHE INVECCHIA. FARMACOECONOMIA E PERCORSI TERAPEUTICI
No full textAnalisi delle prescrizioni farmaceutiche e dei costi del trattamento del carcinoma prostatico nell'ULSS 9 di Treviso
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A cost-analysis of hormone therapy in advanced prostate carcinoma: Evidence from Treviso, Italy
No full textObjective: In Italy, the standard curative treatment for prostate carcinoma with metastases is the androgen suppression therapy (AST). Recently, intermittent AST has been introduced for the treatment of androgen-responsive patients aged > 75 years in order to reduce the toxicity and cost of treatment, as well as to delay tumor progression. The purpose of this study was to perform a cost-analysis of standard AST, intermittent AST or bilateral surgical castration. Patients and setting: A total of 584 patients from the ULSS 9 (district of Treviso, Veneto, Italy) treated with AST, examined in 1999. Main outcome measures: Parameters adopted in this study were drug prescriptions, length of treatments, biochemical assays and costs of hospital stay. Results: The patients exposed to AST represented 0.33% of the whole male population of the district. Two hundred and sixty-one subjects were aged > 75 years. The largest proportion of the treated population was 78 years-old. Eighty patients had been receiving AST for more than 6 years, and during the year 1999 approximately 50% of them were not prostate-specific antigen (PSA)-tested. Cost-analysis: The yearly treatment cost for prostate cancer per patient was 3,823.46 as assessed in 1999. In order to reduce costs, three scenarios can be considered: a) with the cheapest AST drug (triptorelin, 11.25 mg), the estimated cost would be 3,495.09 patient/year, b) with surgical castration, the estimated cost would be lower (2,268.98 patient/year), and finally c) treatment with intermittent AST of patients > 75 years, previously treated with AST for at least 1 year, would cost 2,525.30 patient/year. Conclusions: In addition to its reduced toxicity, intermittent AST should be extensively considered for use because of the reduced cost of AST therapy, which would be similar to the cost of surgical castration
Le ragioni del mancato utilizzo dei farmaci oppioidi nel trattamento del dolore in Italia.
No full textOpioid prescription for terminally ill outpatients in a district of northern Italy: a retrospective survey
No full textA retrospective survey of the opioid prescriptions issued for cancer outpatients (2125) of the Treviso district (Veneto Region, northern Italy) during the time period 1993-2000 was carried out with the specific aims to establish the rate of opioid prescription and verify whether terminally ill outpatients (1697) who had died by the end of December 2000 received adequate opioid prescription, as compared with the Defined Daily Doses (DDDs) of opioids suggested by the World Health Organization (WHO) for a standard population. For both women and men, the maximum rate of opioid prescription was at the age of beyond 90 years. Men were more prescribed than women between 60 and 79 years of age, whereas women were more prescribed than men beyond 90 years. Opioid prescriptions concerned only morphine, buprenorphine, and pentazocine. The Anatomical Therapeutic Chemical (ATC)/DDDs analysis of opioid prescriptions indicated that total opioid use increased about 1.7-fold between 1993 and 1996, mainly because of an increase (55.4%) in morphine prescriptions. Afterwards, total opioid use remained stable, with an estimated mean annual value of 108.2 +/- 6.4 DDDs/million inhabitants/day.
Considering terminally ill outpatients who had died by the end of December 2000, oral morphine turned out to be the most commonly prescribed opioid (64% of patients) and, among the three opioids, pentazocine was more prescribed to older patients. From the comparison between the number of "expected opioid DDDs" (i.e. days for which patients should have been prescribed opioids at the WHO recommended DDDs) and the number of prescribed opioid DDDs (i.e. days for which patients had been offered adequate opioid treatment) for individual patients, it could be estimated that only 38.1% of opioid prescriptions were adequate and a mean of 55.8 DDDs of opioids per patient were not prescribed. The opioid prescription inadequacy increased with the length of time from first prescription to patient death.
In addition, a questionnaire investigation, conducted in 2001 among general practitioners of the Treviso district to evaluate their attitudes toward opioid prescribing, evidenced insufficient knowledge of general practitioners in theory and use of opioid analgesics in cancer pain management. A total of 104 (32.5%) general practitioners responded and most of them feared opioid side effects, such as respiratory depression (49.6%), constipation (41.7%), and addiction (8.7%). Furthermore, many of the respondents considered opioids capable of reducing the patient length of life (22.2%) and inappropriate to treat pediatric patients (50.6%). About 44% of the respondents experienced external pressure by relatives of patients against opioid prescription and a majority of them (58.2%) considered the recently revised Italian legislation on opioid prescription ineffective for improving their prescribing pattern.
In conclusion, present data show that the vast majority of terminally ill cancer outpatients in the Treviso district received inadequate opioid prescriptions in relation to either drug daily dosage or therapy duration. Misconceptions of general practitioners of the district about opioids could contribute to the inappropriate use of these analgesics in cancer pain management. As far as we know, the ATC/DDD methodology for the opioid prescription analysis used in this survey has not been applied before. (C) 2003 Elsevier Science Ltd. All rights reserved
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