Andrea Belisari

Italian population-based values of EQ-5D health states

OBJECTIVE To estimate a value set for the calculation of Italian-specific quality-adjusted life years (QALYs), based on preferences elicited on EuroQol five-dimensional (EQ-5D) questionnaire health states using the time trade-off technique. METHODS The revised standard Measurement and Valuation of Health protocol was followed. Twenty-five health states, divided into three groups and given to 450 subjects, were selected to obtain 300 observations per state. Subjects aged 18 to 75 years were recruited to be representative of the Italian general adult population for age, sex, and geographical distribution. To improve efficiency, face-to-face interviews were conducted by using the Computer Assisted Personal Interviewing approach. Several random effects regression models were tested to predict the full set of EQ-5D questionnaire health states. Model selection was based on logical consistency of the estimates, sign and magnitude of the regression coefficients, goodness of fit, and parsimony. RESULTS The model that satisfied the criteria of logical consistency and was more efficient includes 10 main effect dummy variables for the EQ-5D questionnaire domain levels and the D1 interaction term, which accounts for the number of dimensions at levels 2 or 3 beyond the first. This model has an R(2) of 0.389 and a mean absolute error of 0.03, which are comparable to or better than those of models used in other countries. The utility estimates after state 11111 range from 0.92 (21111) to -0.38 (33333). Italian utility estimates are higher than those estimated in the United Kingdom and Spain and used so far to assess QALYs and conduct cost-utility evaluations in Italy. CONCLUSIONS A specific value set is now available to calculate QALYs for the conduction of health economic studies targeted at the Italian health care system.

Cost and quality of life in patients with severe chronic hand eczema refractory to standard therapy with topical potent corticosteroids

Little is known about the socio‐economic burden of severe chronic hand eczema in patients refractory to treatment with potent corticosteroids.

Clinical epidemiology of hand eczema in patients accessing dermatological reference centres: results from Italy

Data on the epidemiological impact and clinical characteristics of chronic hand eczema in Southern Europe are lacking.

Cost-Benefit Analysis of Amtolmetin-Guacil

ObjectiveTo assess the economic profile of amtolmetin-guacil (AMG).DesignThe analytical framework of this study was a cost-benefit analysis.SettingUsing published trials focusing on the gastrointestinal tolerability of AMG versus other nonsteroidal anti-inflammatory drugs (NSAIDs), we assessed the economic profile of AMG in comparison with tolmetin, indomethacin, diclofenac and piroxicam.PatientsNSAID users from published randomised controlled trials (RCTs) and meta-analyses used for the present evaluation.InterventionsAMG vs piroxicam, AMG vs diclofenac, AMG vs indomethacin, AMG vs tolmetin.Main Outcome MeasuresThe cost of NSAIDs in managing gastrointestinal lesions was considered. According to the cost-benefit analysis design, the effect was expressed as net cost or benefit consequent to the use of AMG vs other NSAIDs.ResultsThe cost of managing gastrointestinal lesions has been estimated to range between L879 400 (EUR454) and L9 176 600 (EUR4740) [year of costing 2000], depending on the grade of severity considered. Compared with tolmetin, the net benefit of using AMG ranged (over 90 days) from a maximum of L4 243 530 (EUR2190) to a minimum of L793 246 (EUR410). With indomethacin, benefits ranged after 30 days from L6 064 058 (EU3132) to L2 026 644 (EUR1046). Similarly, compared with diclofenac, the savings were (over 28 to 30 days) between L3 301 962 (EUR1705) and L736 938 (EUR380). When compared with piroxicam, after 14 days savings reached a minimum of L290 229 (EUR150) and a maximum of L2 178 944 (EUR1077) [year of costing 2000].ConclusionsAlthough further research is needed, from this study AMG appears to have a desirable economic profile compared with the other NSAIDs investigated in this study.

Economic impact of the use of Hyalubrix® in the treatment of hip osteoarthritis in Italy

The present study aims at evaluating the economic impact of the use of hyaluronic acid (Hyalubrix®60/HyalOne) as an alternative to surgery in the treatment of hip osteoarthritis, consistently with the therapeutic protocol envisaged in the Ortobrix study. To quantify the cost and efficacy of the treatment options under evaluation, the perspective of both the Italian NHS and the Society was considered. To this end, a decision analysis model was created over a 4-year period, to quantify the cost of treatments, procedures and adverse events, as well as the benefits expressed as survival rates and reduced lost workdays. The results show that, since the treatment with Hyalubrix® enables to avoid or delay the need for Total Hip Replacement (THR) surgery, it is possible to reduce mortality, adverse events and total costs. Hyalubrix®, given in the hip by ultrasound-guided intra-articular injection as an alternative to surgery is the most favourable option, helping preserve the survival rate over a 4-year period, of approximately 1 in 100 patients considered candidates for THR, preserve work capacity for a total differential amount of 500 days, and achieve considerable savings in economic terms, of approximately 550,000 € and 600,000€ euros from the NHS and the Societal perspectives, respectively.

PSS3 EPIDEMIOLOGY, COSTS AND QUALITY OF LIFE IN PATIENT WITH SEVERE CHRONIC HAND ECZEMA

PND47 APPLICATION OF THE KANO METHODOLOGY FOR EVALUATING MIGRAINE TREATMENT EXPECTATIONS AMONG PATIENTS TREATED BY NEUROLOGISTS IN SPAIN: THE MIGREXX STUDY Matias J, Nocea G, Caloto T Hospital Universitario San Carlos, Madrid, Spain; Merck Sharp & Dohme, SA, Madrid, Spain OBJECTIVES: To classify the characteristics and properties of the pharmacological treatments among migraine patients treated by neurologists in Spain. Patients are becoming increasingly implicated in treatment decisions. Expectations in relation to therapy largely condition satisfaction with the results obtained. METHODS: Multicenter, cross-sectional study in adult patients with at least one prescription of antimigraine drugs within the last year. The protocol was approved by the CREC of La Princesa University Hospital (Madrid). Sociodemographic, and clinical characteristics of patients, as well as questions regarding their expectations with regard to migraine treatments and evaluation of the importance of their attributes are documented. Using a treatment expectations questionnaire and applying Kano methodology, sixteen treatment attributes were classifi ed as: Must-be, One-dimensional, Attractive, Indifferent, Reverse or Questionable. Patients were required to give informed consent. RESULTS: 68 neurologists included 174 patients diagnosed with migraine (mean age 39 years; 75% women). None of the attributes were considered “Must-be”. The attributes considered by most patients to be “One-dimensional” were the absence of long-term adverse effects (55%), to allow work/study activities (50%), to allow social and family relationship (50%), achievement of symptoms relief (47%) and pain relief (44.3%). The attributes considered “Attractive” by most patients were: achievement of rapid symptoms and pain relief (54%), and achievement of total disappearance of the pain (53.4%). The attributes that led to a greater dissatisfaction were the occurrence of long-term adverse effects, not to allow work activity or studies and not to achieve pain relief. The three attributes that led to a greater satisfaction were achievement of total disappearance of the symptoms and the pain, and rapid pain relief. CONCLUSIONS: The expectations regarding a medical treatment signifi cantly infl uence the satisfaction reached with the outcome of such treatment. a better knowledge of patient’s expectations can lead to a greater satisfaction associated with treatment outcomes.

Valutazione economica del lansoprazolo nel trattamento dei pazienti affetti da reflusso esofageo

SummaryObjective To investigate the cost effectiveness ratio of different patterns of GORD management in Italy. Design Cost effectiveness analysis based on a semi-markov model approach, and expressed as cost per relapse-free-patient and cost per avoided relapse. Costs were derived from Italian NHS tariffs, which is the perspective of analysis, while effectiveness was assessed through the literature. Setting Italian inpatient and outpatient clinics. Patients and participants An expert panel of 5 gastroenterologists, assessing patients with GORD Savary-Miller stages II, III, IV after the first acute episode of oesophagitis. Interventions 1) No pharmacological maintainance, 2) lansoprazole 15 mg once daily, 3) lansoprazole 30 mg once daily. Main outcome measures and results The total cost of care was 1.43, 1.22 and 1.79 billions Lire in the cohort of 1) no pharmacological maintainance, 2) lansoprazole 15 mg once daily, 3) lansoprazole 30 mg once daily respectively. No pharmacological maintainance alternative is dominated by lansoprazole 15 mg, which is both more effective and less expensive and is therefore the reference therapy. Incremental cost per relapse-free-patient and per avoided relapse of 30 mg vs 15 mg are 5.5 and 12.6 millions Lire. Conclusion No pharmacological maintainance is inefficient. Lansoprazole 30 mg alternative is both more costly and effective compared to lansoprazole 15 mg. Lansoprazole 15 mg is, in our study, the reference therapy.