Monica Merito

Epidemiology and economic burden of herpes zoster and post-herpetic neuralgia in Italy: A retrospective, population-based study

BackgroundData on the epidemiology and cost of herpes zoster (HZ) and post-herpetic neuralgia (PHN) in Italy are limited. This retrospective, population-based study was designed to determine the incidence of HZ and the proportion developing PHN in Italy and the associated medical resource utilisation and costs. It focused primarily on immunocompetent patients aged ≥50 years who would be eligible for preventive vaccination.MethodData were extracted from a primary-care database and national hospital-discharge records covering four major regions in Italy for 2003-2005. Cases of HZ and PHN (1 and 3 months duration; PHN1 and PHN3) were identified by ICD9-CM codes and, additionally for PHN, prescription of neuropathic pain medication.ResultsOver 3 years, 5675 incident cases of HZ were documented in adults, of which 3620 occurred in immunocompetent patients aged ≥50 years (incidence of 6.31 per 1000 person-years [95% CI: 6.01-6.62]). Of the immunocompetent patients aged ≥50 years with HZ, 9.4% (95% CI: 8.2-10.7) and 7.2% (95% CI: 6.2-8.2) developed PHN1 and PHN3, respectively. Increasing age, female sex, and being immunologically compromised conferred increased risk for both HZ and PHN. Overall, about 1.3% of HZ and almost 2% of PHN cases required inpatient care, with 16.9% of all HZ-related hospitalisations due specifically to PHN. In patients aged ≥50 years, mean stay was 7.8 ± 5.4 days for HZ and 10.2 ± 8.6 days for PHN, and direct costs associated with inpatient care were more than 20 times outpatient costs per HZ case (mean ± SD: €2592 ± €1313 vs. €122.68 ± €97.51) and over 5 times more per episode of PHN (mean ± SD: €2806 ± €2641 vs. €446.10 ± €442.97). Total annual costs were €41.2 million, of which €28.2 million were direct costs and €13.0 million indirect costs.ConclusionsThis study, the largest to date on the epidemiology and economic impact of HZ and PHN in Italy, confirms the considerable disease and economic burden posed by HZ. As HZ and PHN disproportionately affect the elderly, without intervention this problem is likely to grow as the proportion of elderly in the Italian population continues to increase.

Cost-effectiveness of introducing the conjugated pneumococcal vaccine to routine free immunizations for infants in Lazio, Italy

OBJECTIVEnTo examine the health outcomes and costs of a hypothetical pneumococcal vaccination campaign among the general infant population in the Lazio region (Italy).nnnMETHODSnWe developed a model simulating direct medical costs and health outcomes of vaccinating infants with conjugated pneumococcal vaccine (PCV-7) compared to the costs (in and outpatient) of treating the disease, from a public health service perspective. According to vaccine trials outcomes, we considered vaccine effectiveness in preventing part of the invasive pneumococcal disease (IPD), pneumonia of any aetiology, and acute otitis moedia. Age-specific incidence, mortality and health care costs came from local surveillance and surveys; the vaccine costs euro40/dose. Annual budgetary impact and macro-health benefits were predicted for 2005-2014. Cost-effectiveness was expressed as net healthcare costs per disability-adjusted life-year (DALY) gained.nnnRESULTSnAfter 10 years, five cases of meningitis, 20 IPD, 933 pneumonia, 406 pneumonia-related hospitalisations, and 3160 otitis cases would be averted annually by vaccinating. The annual cost of vaccination would be euro4.9m, and annual costs averted would be euro1.4m. Additional healthcare costs of a mass vaccination would decrease over time from euro5.1m to euro3.5m per year. At baseline, net cost per averted DALY was euro18.0k, if health benefits are not discounted, and euro51.7k adopting a 3.5% discount rate; it was 12% lower with a hypothesis of high IPD incidence and 68% lower if the vaccine cost 50% less.nnnCONCLUSIONSnThe cost of the vaccine makes the campaign more expensive than todays recommended infant vaccinations. Nevertheless, the cost-effectiveness of introducing PCV-7 in Lazio compares favourably with previous estimates in similar countries.

Business Firms' Engagement in Community Projects. Empirical Evidence and Further Developments of the Research

At present, more and more commercial firms are getting involved, to various extents, in the Open Source (OS) movement. While several studies have examined incentives and business models of these OS-based software companies, very few works have investigated whether and how firms actively participate to open projects. This paper contributes to the literature by providing empirical evidence on the role and the activities of software houses in community developed projects. The research proposes an original methodology of large-scale primary data collection from OS project repositories and linked web sites. The findings show how different todays OS movement is from its origins and how important firm involvement has become.

Treatment patterns and associated costs for genital warts in Italy

ABSTRACT Objective: Genital warts are caused by human papillomavirus (HPV), principally types 6 and 11, and are highly contagious. This study assessed treatment patterns and costs of management of genital warts in Italy. Research design and methods: This was a retrospective, observational study conducted among gynaecologists, dermatologists, and specialists at sexually transmitted disease clinics in Italy. Resource-use data related to genital warts were collected for patients at risk in the age range 14–64 years examined during 2005. Unit costs were assigned to resource use to provide estimates of the direct, indirect and total costs per case of genital warts. Results: Twenty-eight investigators enrolled 341 patients aged 15–64 years, including 194 (56.9%), 81 (23.7%) and 66 (19.4%) patients with newly diagnosed, recurrent and resistant genital warts, respectively. Most patients (333/341; 97.7%) had at least one outpatient visit, while 43 (12.6%) patients were hospitalised, including 39 patients without an overnight stay (day-hospital cases, 11.4%). Self-applied medication was prescribed for 124 (36.4%) patients. Most outpatient cases (267/333; 80.2%) underwent an office-based procedure. Mean annual direct medical costs per patient, which were funded predominantly by the Italian National Health Service (there was some patient co-payment), were €242 for men and €332 for women. When productivity losses were included, mean total annual costs were €325 for men and €464 for women. Conclusions: This is the first study of treatment patterns and costs for genital warts in Italy. Treatment patterns differ in some respects from those observed in other European countries, but costs generally appear similar. Despite the limitations of physician selection bias and over-representation of North Italy in the patient sample, the findings of this study may be useful in estimating the cost-effectiveness of introducing a quadrivalent HPV vaccination programme in Italy.

Do incentives to industrial R&D enhance research productivity and firm growth? Evidence from the Italian case

This paper aims at contributing to the empirical literature about the impact of R&D subsidies on firm performances by providing recent micro-evidence from Italy. We focus on the last years of the Special Fund for Applied Research (FSRA), the main instrument of industrial research and innovation policy in Italy until 2000, and evaluate its effects on several dimensions of firm performance adopting a counterfactual approach. We controlled for the potential selection bias of public subsidies by combining a non parametric matching procedure with an auxiliary regression in order to account for systematic bias. Results show that the innovative performance improves only temporarily, and no significant differences between grant recipients and non-recipients emerge as far as labour productivity and sales growth are concerned. This evidence suggests that, in our sample of firms, public R&D subsidies were not able to produce any effect in the medium run on any of the outcome variables considered, casting some doubts on the overall efficacy of the public instrument.

The impact of new technologies in cervical cancer screening: Results of the recruitment phase of a large randomised controlled trial from a public health perspective †

The decision to introduce liquid‐based cytology (LBC) and HPV as screening tests involves criteria based on resource consumption. We used cross‐sectional data at recruitment from the NTCC trial [ISRCTN81678807] on 28,000 women aged 35–60, randomised to receive a conventional Pap test or LBC plus HPV. We computed the resources employed to detect a CIN2+ with different screening strategies. In order to result in the same overall cost per CIN2+ detected as screening by conventional cytology, the unit cost of LBC used alone should be less than that of a conventional Pap while its unit cost may be up to 20% higher if HPV‐triage for Atypical Squamous Cells of Undetermined Significance is applied together. With the same criterion the unit cost of HPV used alone may be about 20% higher than that of a Pap‐test using a 1 pg/ml cut‐off and over 40% higher using a 10 pg/ml cut‐off. If HPV testing is applied with cytology‐triage, a single HPV test may cost 20–30% more than a conventional Pap to result in the same overall cost per CIN2+ detected.

Comparing costs and effectiveness of different starting points for highly active antiretroviral therapy in HIV-positive patients

We evaluated the costs and effectiveness of starting highly active antiretroviral therapy (HAART) at different points during the course of HIV infection, defined on the basis of CD4 T-lymphocytes counts. The study considered 3,250 HAART-naive patients of the Italian Cohort Naive Antiretrovirals (ICONA), enrolled and followed between 1997 and 2002. In correspondence to the thresholds of 500, 350, and 200 CD4 cells/mm3, we selected immediate and deferred groups accounting for lead-time bias. The effects of immediate vs. deferred treatment on AIDS-free survival and direct health costs were estimated stratifying on the propensity score of immediate HAART initiation. The incremental cost-effectiveness ratio (ICER) and the cost-effectiveness acceptability curve were also obtained. Although immediate HAART initiation did not affect incidence AIDS and death at high CD4 levels, starting HAART with 200–349 CD4 cells/mm3 rather than deferring it below 200 CD4 cells/mm3, proved to be cost-effective.

PSK5 MANAGEMENT AND COST OF GENITAL WARTS IN ITALY

PSK5 MANAGEMENT AND COST OF GENITALWARTS IN ITALY Merito M, Largeron N,Trichard M, Cohet C, Boselli F, Mateeli A, Naldi L,Vittori G Informa S.r.l, Rome, Italy, sanofi pasteur MSD, Lyon, France, University of Modena and Reggio Emilia, Modena, Italy, University of Brescia, Brescia, Italy, CentroStudi GISED, Bergamo, Italy, Clinica Ginecologica, Rome, Italy OBJECTIVES: Human Genital warts (GW) are common and increasing in sexually active people. Ninety percent of GW are due to Human Papillomavirus (HPV) types 6 and 11. Current treatments can be long, painful, sometimes fail, and relapses are frequent. The objective of this study was to assess treatment patterns and costs associated with the treatment of GW in Italy. Such estimation is important to assess the cost-effectiveness of Gardasil®, the quadrivalent HPV vaccine (types 6, 11, 16 & 18). METHODS: A national retrospective observational study was designed to involve 40 investigators in public gynaecological, dermatological, and sexually transmitted disease centres, enrolling 360 patients aged 14–64 years, with newly diagnosed or recurrent GW. Investigators documented medical resource utilisation and absence from work for the treatment of GW and related complications in 2005 (physician visits, diagnostic tests, medications, office-based treatments, hospitalisations, days off work). Annual direct medical costs per patient were estimated along with productivity losses from the societal perspective. RESULTS: A total of 28 investigators enrolled 341 patients (189 men and 152 women); 8 patients were admitted directly to day-hospital and 333 (97.7%) had at least one investigator visit (on average 3.4 visits); 267 outpatient cases (80.2%) underwent at least one office-based procedure. 124 patients (36.4%) were prescribed a self-applied therapy. 39 cases (11.4%) were admitted to day-hospital. 47 patients (13.8%) reported a medical complication related to GW treatment. Mean annual direct medical costs per patient were €242 for men and €332 for women. Mean costs per patient including productivity losses were €325 and €464 for men and women, respectively. CONCLUSION: This study is the first to identify therapeutic patterns and costs of GW in Italy. Treatment costs are in line with recent European estimates, whereas a wider use of office-based procedures instead of self-applied therapies was found.

Firms' Participation in Open Source Projects: Empirical Evidence and Research Agenda

The Open Source (OS) software has progressively gained economic importance in recent years, and more and more commercial firms are getting involved, to various extents, in the OS movement. While a number of studies have investigated motivations and business models of OS-based software companies, very few works have examined whether and how firms actively participate to open projects. This paper contributes to the literature by providing empirical evidence on the role and the activities of software houses in community developed projects. The research also proposes an original methodology of large-scale primary data collection from OS project repositories and linked Web sites. The findings show how different todays OS movement is from its origins and how important firm involvement has become, not only numerically but also for the deepness of its impact on community projects. Finally, further research developments are suggested.

Do Incentives to Industrial R&D Enhance Research Productivity and Firm Growth? Evidence from the Italian Case

This paper aims at contributing to the empirical literature about the impact of R&D subsidies on firm performances by providing recent micro-evidence from Italy. We focus on the last years of the Special Fund for Applied Research (FSRA), the main instrument of industrial research and innovation policy in Italy until 2000, and evaluate its effects on several dimensions of firm performance adopting a counterfactual approach. We controlled for the potential selection bias of public subsidies by combining a non parametric matching procedure with an auxiliary regression in order to account for systematic bias. Results show that the innovative performance improves only temporarily, and no significant differences between grant recipients and non-recipients emerge as far as labour productivity and sales growth are concerned. This evidence suggests that, in our sample of firms, public R&D subsidies were not able to produce any effect in the medium run on any of the outcome variables considered, casting some doubts on the overall efficacy of the public instrument.