F. Fusco

Comparing the performance of the standard EQ-5D 3L with the new version EQ-5D 5L in patients with chronic hepatic diseases

PurposeTo assess the performance of the EQ-5D-5L version compared with the standard EQ-5D-3L in a clinical setting targeted at patients with chronic hepatic diseases (CHDs).MethodsWe introduced the 5L descriptive system into a cost-of-illness study involving patients with different CHDs. The patients completed a questionnaire including the two versions of the EQ-5D, together with other questions related to their condition. We tested the feasibility, the level of inconsistency, the redistribution properties among consistent responses, the ceiling effect, the discriminative power, and the convergent validity of the 5L compared with the 3L system.ResultsA total of 1,088 valid patients were recruited: 62xa0% male, 19–89 (medianxa0=xa059) years old. Patients had chronic hepatitis from HCV (31.8xa0%) or HBV infections (29.3xa0%) or other causes (7.8xa0%), 20.4xa0% had cirrhosis, 11.9xa0% underwent liver transplantation, and 7.8xa0% had hepatic carcinoma. Less than 1xa0% of EQ-5D-5L were returned blank, and 1.6xa0% or less of missing values were calculated on the dimensions of the partially completed questionnaires. The proportion and weight of inconsistent responses (i.e., 3L responses that were at least two levels away from the 5L responses) was 2.9xa0% and 1.2 on average, respectively. Regarding redistribution, 57–65xa0% of the patients answering level 2 with the 3L version redistributed their responses to levels 2 or 4 with the 5L version. A relative 7xa0% reduction of the ceiling effect was found. Furthermore, the absolute informativity increased but the relative informativity slightly decreased in every domain, and the convergent validity with the VAS improved.ConclusionsIn a clinical setting involving CHD patients, the EQ-5D-5L was shown to be feasible and with promising levels of performance. Our findings suggest that the 5L performs better in at least some of the properties analyzed, and encourage further research to also test other psychometric properties of this new version of the EQ-5D.

The societal burden of chronic liver diseases: results from the COME study

Objective Chronic liver diseases (CLDs) impose a significant socioeconomic burden on patients and the healthcare system, but to what extent remains underexplored. We estimated costs and health-related-quality-of-life (HRQoL) among patients with CLDs at different stages and with different aetiologies. Design A cost-of-illness study was conducted. Direct costs, productivity loss and HRQoL were estimated in patients with chronic hepatitis, cirrhosis hepatocellular carcinoma (HCC) or where orthotopic liver transplantation (OLT) had been performed, for hepatitis C virus (HCV) infection, hepatitis B virus (HBV) infection, or in those with liver disease from other causes. Patients were retrospectively observed for 6u2005months. The societal perspective was adopted to calculate costs. Results In total, 1088 valid patients (median age=59.5u2005years, 60% men) were enrolled. 61% had chronic hepatitis, 20% cirrhosis, 8% HCC and 12% underwent OLT. HCV infection was identified in 52% and HBV infection in 29% of the patients. Adjusted mean direct costs increased from <€200/patient-month in HCV-infected patients with hepatitis to >€3000/patient-month in HBV infected patients with OLT. Antiviral treatment was the cost driver in patients with hepatitis, while hospital costs were the driver in the other subgroups. Absenteeism increased from HBV-infected patients with hepatitis (0.7u2005day/patient-month) to patients with OLT with other aetiologies (3.7u2005days/patient-month). HRQoL was on average more compromised in cirrhosis and patients with HCC, than in hepatitis and patients with OLT. HBV-infected patients generated higher direct costs, patients with other aetiologies generated the highest productivity loss and HCV-infected patients reported the worst HRQoL levels. Conclusions The present study can be considered a benchmark for future research and to guide policies aimed at maximising the cost-effective of the interventions.

Telerehabilitation after total knee replacement in Italy: cost-effectiveness and cost-utility analysis of a mixed telerehabilitation-standard rehabilitation programme compared with usual care.

Objectives To assess cost-effectiveness and cost utility of telerehabilitation (TR) versus standard rehabilitation (SR) after total knee replacement (TKR). Design Markov decision modelling of cost-effectiveness and cost-utility analysis based on patient-level and secondary data sources employing Italian National Health Service (NHS; Ita-NHS) and Society perspectives. Setting Primary care units (PCUs) in Italy. Participants Patients discharged after TKR. Interventions Mixed SR-TR service (10 face-to-face sessions and 10 telesessions) versus SR (20 face-to-face sessions) Primary and secondary outcome measures The incremental cost per additional knee flexion range of motion (ROM) and per QALY gained by SR-TR compared with SR. Second, we considered the probability of being cost-effective and the probability of being more effective and less expensive. Results TR appears to be the cost-effective in the base case and in all of the considered scenarios, but is no longer more effective and less expensive if transportation costs are excluded. Comparing SR-TR with SR, the incremental cost-effectiveness ratio (ICER) adopting the Ita-NHS perspective for the base case was −€117/ROM gained. The cost-effectiveness probability for SR-TR was 0.98 (ceiling ratio: €50/ROM), while the joint probability of being more effective and less expensive was 0.87. Assuming that TR would increase health-related quality of life (HRQOL) utilities by 2.5%, the ICER adopting Ita-NHS perspective is −€960/QALY (cost-effectiveness probability: 1; ceiling ratio: €30u2005000/QALY). All the performed sensitivity analyses did not change the conclusions, but if transportation costs were excluded, the probability for SR-TR of being more clinically effective and less expensive reduced to 0.56. Conclusions The analysis suggested SR-TR to be cost-effective, even less expensive and more effective if the PCUs provide ambulance transportations. However, the uncertainty related to TR costs, HRQOL and long-term clinical outcomes raises important topics for future research, which should be addressed to confirm our estimates. Trial registration number ISRCTN45837371.

Interactive Business Models for Telerehabilitation after Total Knee Replacement

To date Total Knee Replacement (TKR) is one of the most performed procedures in Italy; likewise, rehabilitation after TKR accounts for 182 million of euro each year. The deployment of ICT was able to increase the efficiency in several areas, but in healthcare sector still fails to be widely adopted. According to management literature, business modelling is crucial for a product success and the stakeholder engagement is valuable as well. In this direction, we designed 4 telerehabilitation business/governance models through brainstorming session and developed them interviewing a large sample of the stakeholders involved into the telehealth arena. Whereas the decision makers highlighted the need of gradual changes in healthcare, the preliminary results showed the interest in exploring innovative governance pathways able to directly involve the patients in the healing process and reduce waiting lists over the regional healthcare service. Future research aims to capture the others stakeholders perspectives.

Interactive Business Models for Telerehabilitation after Total Knee Replacement - Preliminary Results from Tuscany.

To date Total Knee Replacement (TKR) is one of the most performed procedures in Italy; likewise, rehabilitation after TKR accounts for 182 million of euro each year. The deployment of ICT was able to increase the efficiency in several areas, but in healthcare sector still fails to be widely adopted. According to management literature, business modelling is crucial for a product success and the stakeholder engagement is valuable as well. In this direction, we designed 4 telerehabilitation business/governance models through brainstorming session and developed them interviewing a large sample of the stakeholders involved into the telehealth arena. Whereas the decision makers highlighted the need of gradual changes in healthcare, the preliminary results showed the interest in exploring innovative governance pathways able to directly involve the patients in the healing process and reduce waiting lists over the regional healthcare service. Future research aims to capture the others stakeholders perspectives.

Approaching 2014: Is Telemedicine Assessed from The Social Perspective? A Brief 2013 Systematic Review

Recent reviews in Telemedicine (TM) detected methodological flaws in economic assessment. Our brief review addresses the perspective adoption problem, investigating to what extent adopting a broader point of view could have an impact on TM economic studies and consequential diffusion. Out of 486 articles found, 15 studies were selected for full-text assessment. Most of them showed an improvement in methodology if compared with the past TM economic evaluations. However, only 4 papers reported data from the social perspective and among them 3 presented productivity loss. Although some positive results in economic evaluation were observed, to date it is not clear to what extent TM is paid for by third parties or has to be paid by the patients. Keywords-economic evaluation perspective; cost-effectiveness; cost-utility; review;