I. Palla

Economic evaluation of da Vinci-assisted robotic surgery: a systematic review

BackgroundHealth technology assessment (HTA) is frequently used when a new and expensive technology is being introduced into clinical practice. This certainly is the case with the da Vinci surgical robot, with costs ranging from

Health Technology Assessment of Belimumab: A New Monoclonal Antibody for the Treatment of Systemic Lupus Erythematosus

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Assessment of the Economic Impact of Belimumab for the Treatment of Systemic Lupus Erythematosus in the Italian Setting: A Cost-Effectiveness Analysis

2.5 million for each unit. This systematic review documents major variability in the reported cost evaluation studies of da Vinci robot-assisted operations compared with those performed by the direct manual laparoscopic approach.MethodsPublished studies in the English language related to the period 2000–2010 were searched using economic and clinical electronic databases.ResultsAll 11 reports included some form of cost analysis, which made it possible for the authors to extract information on certain specific economic outcomes: operating room time, hospital stay, and total costs. With the exception of two studies, the reported operating room time was higher with the robotic approach than with manual laparoscopic surgery, and the hospital stay was the same for the two techniques. Robotic surgery is significantly more expensive if the purchase and maintenance costs of the robot system are included in the total costs. Only 3 of the 11 publications included these costs.ConclusionsThe disadvantage of robotic surgery is its higher costs related to purchase and maintenance of technology and its longer operating room time. However, emerging evidence shows that operating room time decreases with experience using the robot. From the HTA viewpoint, the result of this review is that the jury still is out on the HTA of da Vinci-assisted robotic surgery.

Il PDTA del paziente con adenocarcinoma gastrico: analisi organizzativa di cinque centri del Veneto

Objective. Systemic lupus erythematosus (SLE) is treated with anti-inflammatory and immunosuppressive drugs and off-label biologics. Belimumab is the first biologic approved after 50 years as an add-on therapy for active disease. This paper summarizes a health technology assessment performed in Italy. Methods. SLE epidemiology and burden were assessed using the best published international and national evidences and efficacy and safety of belimumab were synthesized using clinical data. A cost-effectiveness analysis was performed by a lifetime microsimulation model comparing belimumab to standard of care (SoC). Organizational and ethical implications were discussed. Results. Literature review showed that SLE affects 47 per 100,000 people for a total of 28,500 patients in Italy, 50% of whom are affected by active form of the disease despite SoC. These patients, if autoantibodies and anti-dsDNA positive with low complement, are eligible for belimumab. SLE determines work disability and a 2–5-fold increase in mortality. Belimumab with SoC may prevent 4,742 flares in three years being cost-effective with an incremental cost-effectiveness ratio of €32,859 per quality adjusted life year gained. From the organizational perspective, the development of clear and comprehensive clinical pathways is crucial. Conclusions. The assessment supports the use of belimumab into the SLE treatment paradigm in Italy.

Clinical pathways in gastric cancer care

Objective The purpose of this analysis is to evaluate the cost-effectiveness of belimumab, a new biological treatment specifically developed for the treatment of Systemic Lupus Erythematosus (SLE), in the Italian setting. SLE is a chronic non-organ specific autoimmune disease characterized by a disregulation of the immune system that involves many organs and systems. Methods A cost-effectiveness micro-simulation model with a lifetime horizon originally developed for the UK was adapted to the Italian setting. The analysis compared Standard of Care (SoC) alone vs belimumab plus SoC from a National Healthcare Service (NHS) and societal perspective. Health-economic consequences of treatments and organ damage progression were calculated. When available, Italian data were used, otherwise UK costs were converted using Purchasing Power Parities (PPPs). Utility values were based on the EQ-5D™ assessments in the belimumab clinical trials (BLISS 52 and 76). Results were discounted with 3% for costs and effects. A maximum belimumab treatment duration of 6 years was assumed and wastage costs were considered. Results Cost per life year gained (Incremental Cost-Effectiveness Ratio, ICER) and cost per Quality Adjusted Life Year (QALY) (Incremental Cost-Utility Ratio, ICUR) were €22,990 and €32,859, respectively. These values reduced to €20,119 and €28,754, respectively, when indirect costs were included. Conclusions It may be concluded that in the Italian setting and according to the guidelines of the Italian Association of Health Economics (IAHE), belimumab was shown to be cost-effective, in terms of both ICER and ICUR, (€25–40,000/QALY).

Dentro, attraverso, oltre la crisi: il caso El.En

Il cancro gastrico e il quinto tumore per incidenza e la terza causa di morte a livello mondiale. Si tratta di una patologia maggiormente diffusa in Giappone e in Corea mentre in Europa l’incidenza varia notevolmente tra i Paesi. L’incidenza in Italia varia tra 10 e 20 casi su 100.000 abitanti. L’obiettivo principale del lavoro consiste nel disegnare un Percorso Diagnostico Terapeutico Assistenziale (PDTA) ottimizzato, che sia applicabile alla Rete Regionale Veneta, in grado di garantire al paziente una elevata qualita della prestazione assistenziale e al sistema sanitario un maggiore livello di efficienza sia organizzativa che economica. Il percorso ottimizzato e frutto dell’analisi organizzativa dei percorsi e delle criticita di cinque centri clinici veneti. Il PDTA ottimizzato definisce un modello strutturato di comunicazione nella fase della diagnosi e rafforza la gestione multidisciplinare del paziente con adenocarcinoma gastrico.

A systematic literature review of the economic impact of ankylosing spondylitis

The diagnostic–therapeutic pathways (DTPs) are emerging as useful instruments for clinical management of complex diseases as gastric cancer, whose treatment is challenging and requires a multidisciplinary approach. However, the DPTs of patients with gastric cancer are still not defined yet. The aim of this study was to define the optimal DPT to be applied for patients with gastric cancer in the Veneto region. Rather than defining the ideal DTPs a priori, we conducted a preliminary research by analyzing the differences in the actual DPTs for patients with gastric cancer among different hospitals (hub and spokes) in Veneto. Then, the final DPT was elaborated based on the current available best clinical evidences; however, also the areas of homogeneity among the actual DPTs of the included centers as well as the critical issues that had emerged by our preliminary analysis were taken into account for pathway design. High heterogeneity in actual DTPs of patients with gastric cancer was observed among the analyzed centres. Moreover, some of the major criticisms have been found at crucial points of the current pathways. Based on these data, a reference path that is applicable to the whole-regional health network was constructed. The reference DTP is focused on multidisciplinary team management of patients with gastric cancer. Clinical pathways are essential tools to properly manage complex diseases such as gastric cancer. As such, more efforts should be done to implement their use.

The economic impact of gout: a systematic literature review.

L’articolo - attraverso l’analisi delle strategie che El.En, una impresa high-tech nata nel 1981 come spin off della ricerca accademica, ha adottato per affrontare e gestire la crisi economica nel quinquennio 2007-11 - ha l’obiettivo di evidenziare e discutere alcuni elementi rilevanti presenti nella letteratura industriale e manageriale italiana in tema di competitivita della media impresa. Dall’analisi dell’esperienza El.En. - che ha saputo affrontare la crisi investendo in R&S, ponendo al centro l’innovazione, acquisendo imprese e perseguendo una strategia di internazionalizzazione compiuta - emergono interessanti spunti di ricerca per proseguire nella individuazione, approfondimento e sistematizzazione dei fattori di solidita e competitivita delle medie imprese nei settori high tech.