Simone Gerzeli

Poor control increases the economic cost of asthma. A multicentre population-based study.

Background/Aims: Up to now, few cost-of-illness (COI) studies have estimated the cost of adult asthma at an individual level on general population samples. We sought to evaluate the cost of current asthma from the societal perspective in young Italian adults and the determinants of cost variation. Methods: In 2000, a COI study was carried out in the frame of the Italian Study on Asthma in Young Adults on 527 current asthmatics (20–44 years) screened out of 15,591 subjects from the general population in seven centres. Detailed information about direct medical expenditures (DMEs) and indirect costs due to asthma was collected at an individual level over the past 12 months. Results: The mean annual cost per patient was EUR 741 (95% CI: 599–884). DMEs represented 42.8% of the total cost, whereas the remaining 57.2% was indirect costs. The largest component of DMEs was medication costs (47.3%; 23.0% was due to hospitalization). The mean annual cost per patient ranged from EUR 379 (95% CI: 216–541)for well-controlled asthmatics to EUR 1,341 (95% CI: 978–1,706) for poorly controlled cases that accounted for 46.2% of the total cost. Poor control, coexisting chronic cough and phlegm, and low socio-economic status were significantly associated with high DMEs and indirect costs. Conclusions: In Italy, asthma-related costs were substantial even in unselected patients and were largely driven by indirect costs. Since about half of the total cost was due to a limited proportion of poorly controlled asthmatics, interventions aimed at these high-cost patients could reduce the economic burden of the disease.

The costs of multiple sclerosis: a cross-sectional, multicenter cost-of-illness study in Italy

Objectives To estimate the socio-economic impact of multiple sclerosis (MS) in Italy. Methods Outpatients with MS were enrolled at 44 centres across Italy. Socio-demographic, clinical and resource utilization data were collected using a validated questionnaire. Each patient completed a weekly diary of expenses due to MS over a three-month period. Direct health care costs and indirect costs (lack of productivity for the patient and for caregivers) were assessed for the whole population and were compared among five groups, categorised by disease severity (EDSS score). An analysis of variance was carried out on socio-demographic variables. Results For the total population of 566 patients, the mean direct cost over three months was ITL 2,134,000, the mean indirect cost was ITL 7,775,000. Costs were significantly higher for male patients (p < 0.05) and showed a significant increase with increasing age (p < 0.0005), disease duration (p < 0.0005) and disease severity (p < 0.0005). Costs for patients in a progressive phase were significantly higher (p < 0.0005). There were no significant geographical differences among the regions of Italy. Conclusions This study confirms that MS represents a high economic burden, with indirect costs greatly exceeding direct costs. Unpaid caregivers remain the culturally accepted mode of care for MS patients in Italy and this study illustrates the impact of their loss of earnings. As costs increase with disease progression, these findings suggest that treatment efforts should focus on patients in the early stages of MS, in order to slow down disease progression.

Direct and indirect costs of schizophrenia in community psychiatric services in Italy: The GISIES study

Abstract Backround: The present work is a cost-of-illness (COI) study that aims at assessing total direct and indirect costs of schizophrenic patients in community psychiatric services in Italy and identifying the variables that influence costs. Methods: A retrospective prevalence-based multi-centre COI study, was designed. Ten community mental health centres (CMHC) were involved and 100 patients were recruited. Data on patients’ costs were gathered through specifically designed instruments. Results: More than half total direct costs was attributed to CMHC interventions. The yearly average costs of schizophrenia per patient amounted to nearly ITL 50 million: 30% for direct costs and 70% for indirect costs. Conclusion: CMHCs tend to manage long-term ill patients by adopting a strong community-based system of care. Schizophrenia is correlated to loss of working days and lack of well-being. From the results of this study, it might be argued that the de-institutionalisation programme has produced ‘spillovers’ in terms of families’ greater involvement in patients management.

The economic burden of stroke in Italy. The EcLIPSE Study: Economic Longitudinal Incidence-based Project for Stroke Evaluation.

Stroke is the second most common cause of death in the world. The aim of this study is to estimate stroke’s direct costs and productivity losses in Italy from a societal perspective and to explain cost variability. A prospective observational multicentre cost of illness study was designed. Four hundred and forty-nine consecutive patients admitted because of acute first-ever stroke in 11 Italian hospitals were enrolled. Costs and outcomes were assessed at patients’ enrolment, and at 3, 6 and 12 months after discharge. Overall, social costs in the first six months following the attack were € 11 600 per patient; 53% of this was health care costs, 39% non-health care costs and the remaining 8% productivity losses. Age, level of disability and type of hospital ward were the most significant predictors of six-month social costs. The acute phase counted for more than 50% of total health care costs, leaving the remaining 50% to the post-acute phase, indicating that follow-up should be on the agenda of policy makers also.

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.

The costs of pharmacological treatment for major depression. The Italian Prospective Multicentre Observational Incidence-Based Study.

AbstractObjective: To describe the pharmacological treatment for major depression under the conditions of routine Italian public mental health facilities, assess its costs, and study its main predictors according to a societal perspective. Design: This was a prospective multicentre observational study designed to evaluate the economics of treatment of major depression using a specifically designed 65-item questionnaire. Data on drug consumption were collected in a section of the questionnaire and are presented here. Patients and participants: 60 mental health facilities were selected and 556 patients were enrolled and followed up for 15 months. Results: Pharmacological treatment appears to be the most common treatment for major depression. 98% of patients were prescribed an antidepressant. Selective serotonin reuptake inhibitors (SSRIs) were the most prescribed antidepressants. Patients treated with SSRIs suffered from less severe depression than those treated with tricyclic antidepressants. Benzodiazepines were prescribed for 84% of patients enrolled. The total drug cost was 1 120 000 Italian lire (

The clinical and economic efficacy of HAART: a shift from inpatient medical to outpatient pharmaceutical care for HIV/AIDS patients in Northeastern Italy

US707) per patient (1995 values). Less than 20% of this cost was borne by the ItalianNational Health Service, as the majority of drugs used were not reimbursed. Conclusions: The costs of the most widespread approach to treating major depression (pharmacological treatment) are not currently covered by the Italian NationalHealth Service. Prescribing of drugs seems to diverge from the standards of treatment indicated by the Italian Drug Committee.

Obesity nutritional aspects and life style from a survey on a sample of primary school pupils in the Pavia province (Northern Italy)

This study describes epidemiological, clinical and economic impact of the HIV epidemic in Italy prior to and after the introduction of HAART. A prospective, observational, multi-center design was applied using data collected on an AIDS cohort from 1994 and updated data from a comparable cohort in 1998. Mortality and direct medical costs were measured in 251 AIDS patients in 1994 and 77 AIDS patients in 1998. A considerable difference was observed in mortality (33.9% in 1994 vs. 3.9% in 1998). The numbers of hospital admissions were 1.9 in 1994 and 0.8 in 1998; average length of stay was 31.4 days in 1994 and 12.6 days in 1998. The cost per patient per year was 17,250 Euros in 1994 and 11,465 Euros in 1998. The comparison of two cohorts between time periods has enabled changes in costs and outcomes to be linked to the introduction of HAART in 1997. In conclusion, after the introduction of HAART hospital-based provision shifted from an inpatient-based to an outpatient-based service with major focus on pharmaceutical care.

Informative Sources for the Evaluation of the University Education Effectiveness in Italy

Background : The increased risk of chronic diseases requires effective strategies to promote health, facilitating the adoption of proper life styles from childhood. In order to do that, the local health authority in Pavia has undertaken a pilot study with the aim of estimating the level of overweight and obese children in primary schools and of identifying the life styles that entail health risks. Methods : A cross-sectional study based on a sample of 460 children in their last year of primary school in the Province of Pavia was performed. Pupils were classified by Body Mass Index, and a face-to-face questionnaire about children’s use of time was administered. A multiple logistic regression analysis has been applied in order to identify risks or preventive health factors linked to physical activity and eating habits. Results : 12.6% of the children were obese and 26.3% overweight, with the percentage of obesity nearly double in those who do not practice organized sports activities at least once a week, in those who don’t have breakfast in the morning and in those who don’t spend their free time in movement games. From a multiple logistic regression it results that the risk of being obese is twice and three times higher for the children living respectively in medium and small towns than for the ones living in large towns. Conclusions : In the Province of Pavia the prevalence of overweight and obese 10-year-old children exceed the data reported in recent studies all over Italy. The life styles that entail obesity risks are significantly linked both to eating habits and to physical activity: living in middle- and small sized towns and not having breakfast before going to school emerge as risk factors, while practicing movement games in the free time after school appears to be a protecting factor.

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

The evaluation of the effectiveness of a study programme refers to its outcomes, and may be measured with the level of satisfaction of the programme objectives. In an educational programme, we can recognize three macro objectives referred to students: i) the formation of specific competences; ii) general competences and individual cultural development; iii) capability in finding a suitable job.