Paolo Sciattella

Treatment plan comparison in acute and chronic respiratory tract diseases: an observational study of doxophylline vs. theophylline

ABSTRACT Background: The main objective of this article is to estimate the global cost related to the use of the two drugs (associated drugs, specialist visits, hospital admissions, plasma drug monitoring). Methods: The drug prescriptions were extracted from the Information System of the Pharmaceutical Prescriptions of the Marche Region for each ATC code in the years 2008–2012 and the number of patients per year and other outcomes measure were obtained. Results: 13,574 patients were treated with theophylline and 19,426 patients with doxophylline. The number of patients treated was approximately 5,000 per year. Co-prescription with other drugs, use of corticosteroids, mean number of visits and hospital admissions (per 100 patients) were lower for doxophylline vs theophylline (1.55vs5.50, 0.3vs0.7, 2.05vs3.73 and 1.57vs3.3 respectively). The annual mean cost per patient was €187.4 for those treated with doxophylline and €513.5 for theophylline. Conclusions: In our study, doxophylline resulted to be associated with a reduction of the overall cost.

Burden of Disease of Human Papillomavirus (HPV): Hospitalizations in the Marche and Veneto Regions. An observational study

Background and ObjectivesHPV (human papillomavirus) is the virus most often responsible for sexually transmitted infections. The burden of HPV-related diseases on hospital resources represents a major public health problem. The aim of this study was to assess the economic burden of HPV-related diseases (anal cancer, genital cancer, genital warts, oropharyngeal cancer) on hospital resources in two Italian regions.MethodsA retrospective, non-randomized, observational study was developed in the Marche and Veneto Regions, based on patients receiving hospitalization between 2008 and 2011. All hospitalizations were identified through administrative archives, according to the International Classification of Diseases (ICD-9 CM) to which a defined tariff was assigned.ResultsWe identified 5299 hospitalized patients in Veneto and 1735 in the Marche Region. The mean annual hospitalization rate was 49.44 per 100,000 individuals in Veneto and 48.41 in Marche. The total mean annual cost attributable to HPV-related diseases was €5.78 (SD 0.80) million in Veneto and €2.24 (SD 0.17) million in Marche. Costs associated with genital cancer amounted to €1.61 million in Veneto and €1.06 million in Marche (28% and 47% of the total mean annual cost, respectively). Oropharyngeal cancer accounted for 36% in Veneto (€2.08 million) and 28% in Marche (€632,645). Hospitalization costs related to anal cancer were €882,567 in Veneto and €377,719 in Marche; genital warts accounted for €1.19 million in Veneto and €171,406 in Marche. Finally, the mean cost per patient was €4364 in Veneto and €5176 in Marche.ConclusionsThe present work estimated the cost of HPV-related diseases for hospitalized patients in two Italian regions. The considerable estimated annual economic burden is a powerful driver for the governance of the public health sector.

Cost of Poor Adherence to Anti-Hypertensive Therapy in Europe

Background: The financial burden for EU health systems associated with cardiovascular disease has been estimated to be nearly € 110 billion in 2006, corresponding to 10% of total healthcare expenditure across EU or a mean € 223 annual cost per capita. The main purpose of this study is to estimate the costs related to hypertension and the economic impact of increasing adherence to anti-hypertensive therapy in 5 European countries (Italy, Germany, France, Spain and England). Methods: A probabilistic prevalence-based decision tree model was developed to estimate the direct costs of cardiovascular disease related to hypertension (CV defined as: stroke, heart attack, kidney disease, heart failure) in 5 European countries. Our model considered adherence to hypertension treatment as a main driver of blood pressure control (BP

Economic evaluation of spondyloarthritis: economic impact of diagnostic delay in Italy

Background and aim Spondyloarthritis (SpA) is a disease that normally affects the axial skeleton. It progressively leads to overall stiffness up to severe postural deformity of rachis and functional impotence. The objective of the study was to quantify, through an economic model, the impact of specialized testing and pharmacological treatments carried out by the National Health Service (NHS) in normal clinical practice, before the patient is diagnosed with SpA in Italy. In line with the analysis objective, the chosen perspective is that of the NHS. Method The study was conducted by analyzing the Health Search Database – IMS Health Longitudinal Patient Database, from which newly diagnosed SpA patients were identified over the period 1 January 2007 to 31 December 2013. The use of specialist health care services and pharmacological treatments provided to the patients before the final SpA diagnosis were estimated. Results Through a retrospective analysis of the Health Search Database, 1,084 subjects (aged 25–45 years) were identified. These patients produced an expense of approximately €153,000 in the 3 years prior to a confirmed SpA diagnosis, in terms of specialist check-ups and drugs, presumably not appropriately used due to a lack of diagnosis. If we assume that the Health Search Database is a representative sample of the Italian population, it may be estimated that, in the 3 years prior to SpA diagnosis, over €5.4 million was largely unduly spent in Italy to examine and manage 38,232 newly diagnosed SpA patients, between 2010 and 2013. Conclusion The costs due to the delay in SpA diagnosis were quantified for the first time in Italy. For this reason, this work represents a contribution for national and regional decision makers to understand the current clinical practice and the economic consequences of a diagnostic delay in the short and medium term.

Reply to comment on Cost of poor adherence to anti-hypertensive therapy in five European country.

We wish to thank the Editor for giving us the opportunity to respond to the points raised by Prof. Afschin Gandjour, who has questioned the repeatability of the results based on the input data listed in the publication. Prof. Gandjour illustrates his point of view suggesting two steps to estimate the net cost of making one additional patient adherent to blood pressure (BP) treatment. Our model is based on the decision tree described in Fig. 1 of the article [1], which we used alongside the data reported in Tables 1 and 2 of the article to populate the model and simulate the results. For example, consider the case of a diagnosed female in Italy. Figure 1 summarizes the decision tree for an Italian subject who has an adherence equal to 41.5 % (red cell in the figure). Event probabilities (light green cell) were reported considering the data in Table 1 of our article [1], while probability transitions for the controlled and uncontrolled state (light blue cell) were extrapolated from Table 2 of our article [1]. Applying these parameters to the population estimated in Italy (yellow cell), we estimated the number of events for each sex and disease state (Fig. 2). Finally, subjects were multiplied by €280 and events were multiplied by €3.393 (Table 3 of the article) assuming that all patients diagnosed were treated, with the only difference being that some patients had lower adherence (\80 %) than others. Applying the same methods to consider a scenario with increasing adherence for diagnosed subjects, we estimated the costs after 10 years in case of adherence equal to 70 % (red cell in Fig. 3). Table 1 summarizes the results for male and female diagnosed subjects in Italy considering the simulation previously described. Total costs reported in Table 1 are available in Table 4 of our article [1]. Regarding the first point commented on by Prof. Gandjour, the ‘‘transparency and repeatability of the results,’’ we hope that Figs. 1, 2 and 3 clarify the method This reply refers to the article available at doi:10.1007/s10198-015-0713-x.