Silvia Coretti

The minimum clinically important difference for EQ-5D index: a critical review

The European Quality of Life-5 Dimensions Questionnaire (EQ-5D) is the most common instrument to value health outcomes under the patient’s perspective. Several studies have investigated whether observed changes are meaningful to patients, using a variety of approaches to estimate the minimum clinically important difference (MCID). This study provides an overview of the state of art of the estimation of the MCID for the three-level EQ-5D index based on the UK scoring algorithm, critically assessing the available evidence. The interest in estimation of MCID for the EQ-5D has been increasing in recent years. However, some additional standardization in the estimation procedures may be of value, in order to enhance the ability to make comparisons across measures and disease areas. Further methodological research might also contribute to reducing gaps between theory and practice.

COST-EFFECTIVENESS ANALYSIS OF HERPES ZOSTER VACCINATION IN ITALIAN ELDERLY PERSONS.

OBJECTIVES Herpes zoster (HZ) is characterized by a painful skin rash. Its main complication is postherpetic neuralgia (PHN), pain persisting or occurring after the rash onset. HZ treatment aims to reduce acute pain, impede the onset complications, and disease progression. The aim of this study was to assess the cost-effectiveness of HZ vaccination compared with no vaccination strategy, within the Italian context. METHODS The natural history of HZ and PHN was mapped through a Markov model with lifetime horizon. A population of patients aged between 60 and 79 years was hypothesized. Third party payer (Italian National Health Service, I-NHS) and societal perspectives were adopted. Data were derived from literature. RESULTS AND CONCLUSIONS The incremental cost-effectiveness ratio of the vaccination equaled EUR 11,943 per quality-adjusted life-year (QALY) under the I-NHS perspective and EUR 11,248 per QALY under the societal perspective. Considering a cost-effectiveness threshold of EUR 30,000/QALY, the multi-way sensitivity analysis showed that vaccination is cost-effective regardless of the perspective adopted, in 99 percent of simulations.

Reconfiguring health workforce: a case-based comparative study explaining the increasingly diverse professional roles in Europe

BackgroundOver the past decade the healthcare workforce has diversified in several directions with formalised roles for health care assistants, specialised roles for nurses and technicians, advanced roles for physician associates and nurse practitioners and new professions for new services, such as case managers. Hence the composition of health care teams has become increasingly diverse. The exact extent of this diversity is unknown across the different countries of Europe, as are the drivers of this change.The research questions guiding this study were: What extended professional roles are emerging on health care teams? How are extended professional roles created? What main drivers explain the observed differences, if any, in extended roles in and between countries?MethodsWe performed a case-based comparison of the extended roles in care pathways for breast cancer, heart disease and type 2 diabetes. We conducted 16 case studies in eight European countries, including in total 160 interviews with physicians, nurses and other health care professionals in new roles and 600+ hours of observation in health care clinics.ResultsThe results show a relatively diverse composition of roles in the three care pathways. We identified specialised roles for physicians, extended roles for nurses and technicians, and independent roles for advanced nurse practitioners and physician associates. The development of extended roles depends upon the willingness of physicians to delegate tasks, developments in medical technology and service (re)design. Academic training and setting a formal scope of practice for new roles have less impact upon the development of new roles. While specialised roles focus particularly on a well-specified technical or clinical domain, the generic roles concentrate on organising and integrating care and cure.ConclusionThere are considerable differences in the number and kind of extended roles between both countries and care pathways. The main drivers for new roles reside in the technological development of medical treatment and the need for more generic competencies. Extended roles develop in two directions: 1) specialised roles and 2) generic roles.

Economic evaluation of screening programs for hepatitis C virus infection: evidence from literature

Background Hepatitis C is a liver infection caused by hepatitis C virus. Its main complications are cirrhosis and liver cancer. According to the World Health Organization (WHO), more than 185 million people worldwide are infected with hepatitis C virus and, of these, 350,000 die every year. Due to the high disease prevalence and the existence of effective (and expensive) medical treatments able to dramatically change the prognosis, early detection programs can potentially prevent the development of serious chronic conditions, improve health, and save resources. Objective To summarize the available evidence on the cost-effectiveness of screening programs for hepatitis C. Methods A literature search was performed on PubMed and Scopus search engines. Trip database was queried to identify reports produced by the major Health Technology Assessment (HTA) agencies. Three reviewers dealt with study selection and data extraction blindly. Results Ten papers eventually met the inclusion criteria. In studies focusing on asymptomatic cohorts of individuals at general risk the cost/quality adjusted life year of screening programs ranged between US

Use of robot-specific resources and operating room times: the case of Telelap Alf-X robotic hysterectomy

4,200 and

Valutazione economica di un programma di screening anti-HCV in Italia

50,000/quality adjusted life year gained, while in those focusing on specific risk factors the incremental cost-effectiveness ratio ranged between

Preventing mobility disability in Europe: a health economics perspective from the SPRINTT study

848 and

Investigating the Generalizability of Economic Evaluations Conducted in Italy: A Critical Review

128,424/quality adjusted life year gained. Age of the target population and disease prevalence were the main cost-effectiveness drivers. Conclusion Our results suggest that, especially in the long run, screening programs represent a cost-effective strategy for the management of hepatitis C.

Economic assessment of eltrombopag in the treatment of thrombocytopenia

The aim of this study was to identify, quantify and evaluate the use of robotic materials and operating theatre times in Telelap ALF‐X robotic hysterectomy.

Doctors commitment and long-term effectiveness for cost containment policies: lesson learned from biosimilar drugs

BackgroundThe progression of hepatitis C (HCV) is usually developed over a ten-year-period. A high percentage of patients with chronic HCV contracts cirrhosis. The probability of developing liver cancer from chronic HCV over one year is 5%. These complications as well as the highly debilitating effects on patients, represent a significant item of expenditure for the National Health Service (NHS). Within the high risk population, the prevalence of the disease is 9–10% and is characterized, in the Italian scenario, by a high North-South gradient. Early detection of HCV is an excellent opportunity to improve patients’ QOL and to rationalize resource allocation, since the disease is characterized by a long preclinical phase, by the availability of treatments that can improve the prognosis and, moreover, by a high prevalence in the target population.ObjectivesThe aim of this study is to provide a cost-effectiveness evaluation of an anti-HCV screening program in the Italian NHS perspective.MethodsWe built a Markov model made up of two arms. The ‘Test Strategy’ arm involves a screening program based on the enzyme immunoassay for detection of antibodies (EIA) as first level test and the research of HCV virus RNA as second level positive patients are treated with Peg-interferon alpha 1a or Peg-interferon alpha 2b, both in combination with ribavirin. Parameters included in the model were derived from the literature and validated using experts’ opinions. Resource consumption was estimated in the Italian NHS perspective. Both costs and benefits were discounted at a 3.5% rate. Results were considered in terms of incremental cost per gained QALY by means of the screening program in comparison to no screening protocol. We performed a one-way and a multivariate sensitivity analysis to explore the effects of the key parameters variations on the model’s results.ResultsThe ‘Test Strategy’ ICER is €4,008.97/QALY. This value is acceptable, being lower than the threshold adopted by NICE. According to Montecarlo simulation results, the ICER remains below £40,000/QALY in 99% of scenarios.ConclusionThe anti-HCV screening program represents a valid health-related investment for high risk populations, as it improves patients’ QOL and survival in view of an acceptable expenditure increase for NHS.