Maria Caterina Cavallo

Cost-Effectiveness and Cost-Utility of Beclomethasone/Formoterol versus Fluticasone Propionate/Salmeterol in Patients with Moderate to Severe Asthma

AbstractBackground: Asthma is a chronic disease characterized by acute symptomatic episodes with variable severity and duration. Pharmacological asthma management aims to achieve and maintain control without side effects, thus improving quality of life and reducing the economic impact. Recently, a clinical trial showed the non-inferiority of beclomethasone/formoterol (BDP/F) versus fluticasone propionate/salmeterol (FP/S) in adults with moderate to severe persistent asthma. However, this study did not provide evidence on costs and did not quantify quality-of-life parameters. Objective: The objective of the present study was to assess the cost effectiveness and cost utility of BDP/F versus FP/S in patients with moderate to severe asthma from the perspective of the Italian National Health Service (NHS). Methods: A Markov model (MM) was used, with five health states for the different levels of asthma control: successful control, sub-optimal control, outpatient-managed exacerbation, inpatient-managed exacerbation, and death. Model data were derived from the ICAT SE study and from expert panels. Three outcomes were considered: time spent in successful control state, costs and quality-adjusted life-years (QALYs). Results: The model shows that BDP/F treatment led to a slight increase of weeks in successful control compared with FP/S, with a lower cost. The probabilistic sensitivity analysis highlights that in 64% and 68% of the Monte Carlo simulations, BDP/F outperformed FP/S in terms of weeks in successful control and QALYs. Considering the expected cost of the two strategies, in 90% of simulations BDP/F was the least expensive choice. In particular, BDP/F was cost saving as compared with FP/S in about 63% and 59% of simulations as shown by the cost-utility and cost-effectiveness analysis, respectively. Conclusion: Overall, from the Italian NHS perspective, BDP/F treatment is associated with a reduction in cost and offers a slight increase of effectiveness in terms of weeks spent in successful control and QALYs.

Il costo del trattamento del carcinoma del colon retto in stadio avanzato

SummaryObjective The study aim was to: (i) estimate the direct and full costs of five chemotherapy regimens for the treatment of advanced colorectal cancer and (ii) compare the direct costs with the fees reimbursed by the National Health System to the local health providers. Design An observational, retrospective cost-analysis study. Data were obtained from a sample of 78 patients who underwent the following therapies: 24 were treated with the FU High dose regimen, 22 with the CPT 11 & raltitrexed, 19 with the Mayo Clinic 425, 8 with the Mayo Clinic 375 and 5 with the De Gramont scheme. The observation period was July–November 1999. Perspective and setting The study was set in an oncology unit of the Clinical Oncology Department of the National Institute for Cancer Research (Genova, Italy) and was conducted from the hospital perspective. Methods The records of 78 patients who had received, as first-line therapy, one of the five most frequently used regimens in the observed unit between July and September 1999 were analysed. Results A wide difference among monthly direct cost per patient was highlighted, the average increasing from Lit. 388,500 (Mayo Clinic 375) to Lit. 5,066,300 (CPT 11 & raltitrexed). All alternatives show a positive contribution to overhead with the only exception of the CPT 11 & raltitrexed group. Conclusions The analysis of the data shows that the Mayo Clinic 375 is the least costly among the chemotherapy regimens considered. Our results, however, do not imply that the cheapest treatment must always be the chosen one. Quantitative financial considerations should actually be integrated by qualitative considerations (such as quality of life aspects) on broadly intended outcomes.

Cost-utility of inhaled corticosteroids in patients with moderate-to-severe asthma.

Different inhaled corticosteroids can be used to treat asthma but their relative efficacy on quality of life and relative economic impact are mostly unknown. A decision model compared the cost–utility of beclomethasone, beclomethasone-extrafine, fluticasone and budesonide in adult patients with either moderate or severe persistent asthma. The patients’ health state was described by the Asthma Symptom Utility Index. Patients’ consumption of healthcare resources, according to the health state, was elicited by a Delphi Panel. Within 2 months, beclomethasone-extrafine prolonged quality-adjusted life by 0.5–2.3 days, as compared with the other inhaled corticosteroids, and reduced asthma-related per patient costs by €12–67.

Analisi dei costi della stimolazione cerebrale profonda (DBS) nella malattia di Parkinson: uno studio osservazionale su pazienti italiani

SummaryObjectiveAssess costs of deep brain stimulation versus traditional pharmacological therapy (levo-dopa) in patients affected by Parkinson’s disease from a social perspective.DesignA 16-month observational prospective study was undertaken. Patients were observed for 4 months before DBS procedure and 12 months afterwards. Clinical outcomes and resource consumption data were collected through specific questionnaires submitted to patients.Setting7 hospitals carrying out DBS intervention in 1998.Patients36 patients affected by Parkinson’s disease — eligible for DBS intervention — were enrolled in the study. After DBS intervention, 31 patients were observed for 6 months and 22 patients for 12 months.Main outcome measures and resultsTotal costs to society were significantly lower in both the 0–6 month and the 6–12 month period following DBS procedure than in the preceding 4 months. A 17 month period is needed to cover the costs of DBS (€ 20.033). Clinical symptoms assessed through the UPDRS scale and functional status measured with the Barthel Index were significantly improved after DBS.ConclusionsThe results show that, from a social perspective, DBS procedure is economically advantageous compared to traditional pharmacological therapy in patients affected by Parkinson’s disease who are eligible for the procedure.

Impatto economico della gestione degli eventi correlati all’apparato scheletrico (SREs) in pazienti con metastasi ossee da tumori solidi nelle regioni italiane

Le metastasi ossee sono frequentemente associate alla gestione di eventi correlati all’apparato scheletrico (Skeletal Related Events, SRE) quali fratture patologiche, compressione del midollo spinale, radioterapia ossea, chirurgia ossea. Tali eventi incrementano la morbilita nel paziente e la necessita di prestazioni sanitarie associate. A partire dai dati dello studio STARS - che ha rilevato i consumi di prestazioni di carattere sanitario in quattro Paesi europei tra cui l’Italia - si e stimato l’impatto economico sulle regioni italiane indotto dalla gestione degli SRE conseguenti a tumori della mammella, prostata e tumori solidi. Tale impatto e stato stimato in base all’ammontare tariffario a carico delle singole regioni per far fronte all’erogazione del mix di prestazioni richieste dalla gestione degli SRE come rilevate dallo studio STARS. L’impatto economico medio per la gestione degli SRE nelle regioni e risultato pari a circa 3.664 euro. Stimando 56.697 SRE annuali in Italia, l’impatto complessivo sui sistemi sanitari regionali risulta di circa 208 milioni di euro. Qualsiasi intervento in grado di ridurre la frequenza degli SRE e auspicabile per incrementare la qualita di vita dei pazienti e per diminuire l’impatto economico complessivo.