Dante Cornago

Direct Cost of Medical Management of Epilepsy among Adults in Italy: A Prospective Cost-of-Illness Study (EPICOS)

Summary:  Purpose: To investigate the costs of epilepsy from a nationwide survey comparing adult patients included in different prognostic categories.

Direct medical costs unequivocally related to diabetes in Italian specialized centers.

This study estimated the resource utilization and direct medical costs in Italian diabetes centers (DCs). Hospital admissions for major chronic complications were not considered since DCs deliver primary care and follow up only complications unequivocally related to diabetes-acute complications and diabetic foot. The multicenter, prospective, observational study involving 31 Italian DCs included a total of 1,910 patients classified into eight prognostic groups by type of diabetes (types 1 and 2), metabolic control (HbA1c >7.5%, HbA1c ≤7.5%) and age (≤60, >60). The average total cost of type 1 diabetes per patient per year ranged from € 762 in group 2 (age ≤60, HbA1c >7.5%) to € 1,060 in group 4 (age >60, HbA1c >7.5%), and that the cost of type 2 diabetes from € 423 in group 5 (age ≤60, HbA1c ≤7.5%) to € 613 in group 8 (age >60, HbA1c >7.5%). The study brought to light the wide variability in the single cost components across clinically defined groups of patients. The cost of diabetes management in the strict sense was significantly affected by the type of diabetes and metabolic control.

Economic evaluations in Italy: a review of the literature.

OBJECTIVES To review the economic evaluations (EEs) done in Italy by Italian authors, following a common scheme to allow some comparisons of the studies selected and with the international reviews. METHODS We selected all the original studies published by Italian authors (in Italian or English) in national and international journals. The period considered was January 1994 to December 2001. Both full and partial economic evaluations were included. Three international databases were interrogated: MEDLINE, Embase, and HealthStar; further articles were added from the internal database of our center (CESAV), which also classifies Italian local publications and journals specialized in health economics. RESULTS A total of ninety-nine studies were reviewed. More than half of the fifty-seven full EEs focused on drugs as type of intervention (n = 38), followed by diagnostic screening (n = 7). The NHS viewpoint was the most used (n = 55 studies), followed by that of society (n = 27) and hospitals (n = 12). Sixty-eight studies only analyzed direct costs and twenty-nine included both direct and indirect costs. Twenty-five of the thirty-eight pharmacoeconomic full EEs were sponsored by companies. In sixteen of the twenty-five sponsored studies, the sponsors products were the dominant alternative. CONCLUSIONS The review showed that, in Italy, like elsewhere, there is a gap between theory and practice in EEs, and sponsors can considerably affect the results of EEs.

Pharmacoeconomic studies in Italy: a critical review of the literature

To assess the state of pharmacoeconomics in Italy we reviewed all the original studies published by Italian authors in national and international journals from January 1994 to December 2003. We selected 70 articles and broadly assessed 92 economic evaluations (EEs) since some articles contained multiple analyses. We adopted common analysis criteria to allow methodological comparison of the studies. The variables investigated can be grouped into three categories: general methods, costs, and consequences. To further assess the quality of the EEs, we decided to rank them according to criteria of both clinical and economic good practice. Then, to complete our critical evaluation, we analysed whether sponsorship might have somehow affected the results. Our analysis seems to support the widespread scepticism of the Italian NHS decision-makers towards pharmacoeconomic studies, whose results seem to be biased by flawed methods and sponsors’ interference with results.

Medical Costs of Chronic Musculoskeletal Pain in Italy

AbstractBackground and objectives: Musculoskeletal system problems are responsible for more than two-thirds of painful conditions in primary care. However, only one published study, conducted in Finland, has analysed the costs of managing musculoskeletal pain as a whole in primary care. This study analysed the costs of diagnosing and treating chronic musculoskeletal pain in primary care in Italy. A secondary aim of the study was to assess the impact of different drug treatment patterns on medical costs associated with musculoskeletal pain. Methods: Chronic pain of musculoskeletal origin was defined as continuous or recurrent pain persisting over 3 months with involvement of the musculoskeletal system, i.e. arising from primary musculoskeletal disorders or from the late consequences of external events (injuries, medical care or surgery). A total of 52 general practitioners (GPs) recruited 581 patients. We focussed on the differences between patients treated (410) and not treated (171) with drugs. Within the treated group, we also analysed subgroups given non-selective NSAID-based therapy (subgroup A, 169 patients) or cyclo-oxygenase-2 (COX-2) inhibitor-based therapy (subgroup B, 52 patients). Results: The annual average cost of treating a patient with chronic musculoskeletal pain was €212.60. Hospital admissions and GP consultations were the largest cost components, both accounting for around a quarter of the total cost. Not surprisingly, the treated group included older patients, who had more co-morbidities and more severe pain. This was associated with annual costs more than four times those of untreated patients (€274.50 vs €63.90, respectively). Subgroups A and B did not differ with respect to major demographic and clinical variables except in relation to mean age (63 vs 70 years, respectively; p = 0.037). They had similar per-patient costs (€186.20 vs €172.90), although these totals comprised a different mix of components. Conclusion: The analysis showed that the annual average cost of treatment of chronic musculoskeletal pain in Italy varied considerably depending on whether drug treatment was used. COX-2 inhibitors and traditional NSAIDs had similar per-patient costs, although this similarity stemmed from a different mix of components.

A comparative analysis of domiciliary oxygen therapy in five European countries

This comparative study analyses the domestic market of domiciliary oxygen therapy in five European countries (Denmark, France, Germany, Italy, and the UK) according to a common checklist of subjects. Domestic legislation, prescription procedures, delivery, and the market situation concerning oxygen therapy were considered. The analysis involved (i) reviewing the literature on oxygen therapy in national and international journals, and (ii) interviewing a selected expert panel of market operators in each country (composed of at least one civil servant, one physician, one distributor, and one oxygen manufacturer). The analysis did not find any specific relationship between the health care system framework and the oxygen therapy market, except for a greater inclination towards home care in national health services. In all these countries oxygen therapy is reimbursed, but the type of supply and its diffusion differ widely. The spread of domiciliary care has undermined the traditional role of pharmacies in the oxygen distribution chain in all countries except Italy. The study did not help identify any specific country that can be considered a benchmark for oxygen therapy, each one dealing with oxygen therapy in a different way. An economic evaluation of the different supply modalities could help improve decision making by public authorities.

Pharmaceutical policy in Italy

or as a published lecture, review, or thesis); that it is not under consideration elsewhere; that its publication has been approved by all co authors, if any, as well as by the respon sible authorities at the institute where the work has been carried out; that, if and when the manuscript is accepted for publication, the authors agree to automatic transfer of the copyright to the publisher; that the manu script will not be published elsewhere in any language without the written consent of the copyright holders; that written permission of the copyright holder is obtained by the authors for material used from other copy righted sources; and that any costs asso ciated with obtaining this permission are the authors’ responsibility. Transfer of copyright to Springer-Verlag becomes effective if and when the article is accepted for publication. The copyright covers the exclusive right (for U.S. government employees: to the extent transferable) to reproduce and distribute the article, including reprints, translations, pho to graphic reproductions, microform, elec tro nic form (off line, online) or other re pro duc tions of similar nature.

Il costo medio per tipologia di prestazione nei centri trasfusionali

In Italy the collection, validation and separation of blood and its derivatives for transfusional interventions are carried out by some 380 transfusional centers (TCs), mainly located within greater health care structures. The aim of the CORSA (Costi Raccolta Sangue) study was to furnish an estimate of the mean cost of the main transfusional services on a sample of the Italian TCs. Of the centers contacted, only 13,3% were able to deliver the unit costs necessary to perform the full-cost, fully-allocated analysis conducted. Of the three services examined (apheresis of plasma and platelets, whole blood collection), the selective collection of thrombocytes resulted the most expensive, as opposed to whole blood collection. The mean cost of a erythrocyte, plasma and platelet unit resulted of 17,7, 21,6 and 89,8 •, respectively, although the variation among centers was substantial. To main conclusions can be drawn by the CORSA study. First, the very low percentage of TCs able to provide the necessary data for a complete economical analysis highlights an important delay in the modernizing process of health care management, started in 1992 with the aim to ameliorate resource allocation. Second, the study was not able to establish a relationship between production volume and production cost, indicating the absence of scale economy features in transfusional processes.

Efficienza tecnologica e produttiva delle strutture trasfusionali in Italia

In all the developed countries the methods of blood collection and production are relevant subjects for the pharmacoeconomics studies, because of their health and economic implications related to the health policies in this area. The “blood market” rappresents an area where the sanitary items, the economic items and also the ethic items must be broached at the same time; therefore it can be considered emblematic. By this situation arises Progetto CO.R.SA. (COsti Raccolta SAngue), a project for estimating productivity and cost for a representive sample of italian trasfusional structure (ST). The study is supported by Societa Italiana di Medicina Trasfusionale e Immunoematologia (SIMTI). In Italy there are about 380 ST, but only 30 ST resulted suitable for the study. The analysis investigates six rates concerning: a) wastes; b) technological efficiency; c) personnel productivity. The present work describes only the informations on ST organization and production, delaying the results about costs to a specific further report.

Il mercato dei dispositivi per stomia in cinque paesi europei: lezioni per l’Italia

Aim of the present study is to analyze the international market of the ostomy devices in Italy, France, Germany, U.K. and Denmark. The ostomy systems are technologically mature devices, and the more interesting market developments are about innovative modality of distribution and patients technical support, like home distribution. For every country it has been applied a common pattern, based on four aspect of the ostomy devices market: 1. the legislative aspect; 2. the prescription procedure; 3. the different models of distribution; 4. the competitive systems of pharmaceutical industry. All the data in this study has been galthered through relevant literature and interviews with the area operators. The ostomy devices are repayable against medical prescription in all the studied countries; significant legislative differences are registered in the repayment prices determination. For all the studied countries, in the decisional process related to the choice of one or another device, the essential role is played by the ostomy hospital nurse, that advises the patient immediately after the surgery. Finally, the more significant examples to innovate purchase and distribution process of ostomy devices in Italy comes from Denmark and U.K., where the home distribution is already available and it is working.