Fabrizio Tediosi

Costs of diabetes. A methodological analysis of the literature.

AbstractObjective: To review studies on the costs of diabetes and its complications through a scheme designed specifically for assessing the quality of cost-of-illness (COI) studies. Design and Setting: The methodology of COI studies in diabetes was analysed in order to assess the significance of quantitative results. The scheme adopted 7 items identified as the main points for discussing the methodological choices governing the results. We also used a checklist based on questions related to the 7 items. Main outcome measures and results: The answers showed that many studies appear not to give technical details, so it is hard to understand themethod.Methodological choices varied widely between the studies. This is probably due to the lack of consensus on the methodology of COI studies. Based on the findings of this review, we suggest also some specific points that could help produce more reliable results on the costs of diabetes. Conclusions: Clearly, a general consensus on COI studies is still remote, making the value of any comparison of results questionable.

The Cost of Urinary Incontinence in Italian Women A Cross-Sectional Study

AbstractObjective: To offer cost estimates of urinary incontinence (UI) in the general population based on prospectively collected data. Design: We analysed individual costs in a sample of women with UI who were identified in the framework of a cross-sectional study on the prevalence of UI in women aged >40 years. Setting: Six areas in Italy. Intervention: Home interview. Patients and participants: Women were identified among the patients registered with a network of general practitioners operating in each area using computer-generated random number lists. Results: A total of 2767 women were identified. Of these, 408 (14.7%) reported UI during the year before the interview and 229 underwent a detailed interview on UI-related costs. On the basis of this information, we estimated the direct costs associated with UI from the perspective of the Italian National Health Service (INHS). The lifetime cost per patient of diagnosis was 80 131 Italian lire (L) (exchange rate:

Cost Analysis of Dialysis Modalities in Italy

US1 = L1618). Consultations accounted for only 20% of the diagnostic cost, diagnostic tests for 36% and hospital admissions for diagnostic procedures accounted for 44%. The diagnosis cost estimate seems low, partly because several women did not request either consultations or diagnostic tests (the overall rate per patient was 0.76 for consultations and 0.39 for diagnostic tests). The only appreciable treatment cost, according to the INHS perspective, was for diapers. The annual cost per patient for diapers was L255 519. The prevalence of UI in women aged >40 years in Italy is estimated in the study at 9.3%. Thus, combining this information with the cost estimates, the annual treatment cost of UI in Italian women aged >40 years is L351 800 billion, considering diapers and drugs only. Conclusion: This study has estimated the individual cost of UI in the general population. These figures may be useful when designing economic evaluations of UI.

Cost of schizophrenia studies: a methodological review

This study analyses management and costs of dialysis in the Italian National Health Service (NHS). Information on efficacy and health-related quality of life (HRQOL) based on the existing literature also is presented. The clinical differences between the dialysis modalities seem to be related to their appropriateness to specific patient groups. Efficacy rates are similar and the only differences are in complications and HRQOL. Traditional haemodialysis (THD) can be done by Italian patients in dialysis centres or in hospital. High-flux haemodialysis (HFHD) is generally only done in hospital. Peritoneal dialysis (PD) is usually done at home. The cost analysis was performed on a sample of Italian dialysis centres and hospitals, according to the full cost method. As expected, HFHD was more expensive than THD and PD, but no marked differences emerged among the different HFHD modalities. THD modalities in dialysis centres were less costly than in hospitals. Automated PD (APD) was much more expensive (almost twice) than continuous ambulatory PD (CAPD), the cheapest method in absolute terms. This study confirms that dialysis is costly and that it is very difficult to assess the cost-effectiveness of the different approaches. Although this study has limits, it should provide sufficient analytical information to local healthcare managers for more rational allocation of financial resources to dialysis services.

A comparative analysis of domiciliary oxygen therapy in five European countries

The paper first analyses the key points of COI study methodology trying to identify the most appropriate choices. Secondly, following the key methodological points defined, it reviews a sample of studies on the economic costs associated with schizophrenia.The COI studies analyzed here confirm that schizophrenia is a costly illness, and that indirect costs account for a large share of total costs. In all the studies considered, hospitalization accounted for a large part of direct costs. Pharmacological therapy only marginally affected direct costs, and thus the total cost of schizophrenia. The review showed also that COI studies adopted widely different approaches to estimate the costs of schizophrenia. To increase the credibility of COI studies closer agreement among researchers on methodological principles would be desirable.

Costi diretti della schizofrenia nei dipartimenti di salute mentale italiani

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.

I costi del piede diabetico in Italia: dati dal progetto RECORD

SummaryObjectiveTo estimate resource utilisation and direct costs of treatment for patients with schizophrenia in Italian Community Mental Health Centers (CMHCs).DesignMulticentre, retrospective observational study. CMHCs recruited all patients who attended a follow-up consultation during the period September to December 1998. At enrolment, psychiatrists completed a questionnaire on consumption of resources in the 2 months before recruitment.Setting14 CMHCs.PerspectiveItalian National Health Service (INHS).Patients702 patients with a diagnosis of schizophrenia or other psychotic disorders, defined according to the Diagnostic and Statistical Manual of Mental Disorders-fourth edition. These patients had been followed by the CMHCs for at least 2 years and attended a follow-up consultation either during the period September to December 1998 or on randomly selected days during this period. Patients were classified into seven groups according to their diagnosis.ResultsThe mean direct cost of patients with schizophrenia in the 2-month observation period was 2 234 475 Italian lire [L.] (1 154.01 Euro; EUR); direct costs ranged from L. 1 545 818 to L. 2 775 658 (EUR798.35 to EUR1 433.51) by prognostic group. There was wide variability for prognostic groups in the impact of most cost components on total cost. Admissions accounted for between 11.4 and 56.3% of the total cost, daycare centre days for between 11.3 and 35.5%, home visits for 7.8 to 16.4%, and day-hospital days for 5.4 to 32.8%. Antipsychotics and anxiolytics were the most prescribed drugs and also the most costly.ConclusionsDespite the limitations of the study related to the short period considered, we believe this study offers some interesting information on the burden of schizophrenia, a disease for which its cost has received limited attention so far in Italy.

A comparative analysis of generics markets in five European countries

SummaryObjectiveTo describe resource utilisation patterns among patients with diabetic foot and to estimate direct costs of diabetic foot treatment according to the Italian NHS perspective.DesignMulticenter, retrospective observational study lasting two months.Setting35 centres for diabetic care in Italy.InterventionQuestionnaire.Patients and participants139 patients with diabetic foot.ResultsThe per patient average cost on two months of observation was estimated at Lit. 148,845 for day-hospital and outpatient care. Day-hospital — which includes diagnostic tests and medications — represented 67% of total costs, while medications and diagnostic tests performed in ambulatory setting accounted, respectively, for 21% and 12%.The per patient average cost of the pharmaceutical therapy — included those not reimbursed by the NHS — was Lit. 101,334. Thus the total cost per patient was Lit. 250,179, 86% of which borne by the NHS.ConclusionThis article presents some preliminary information on the economic burden of diabetic foot in Italy. It confirms that diabetic foot is a relevant complication also in terms of health care resource consumption and consequent direct costs.