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Campbell WA, Chick JFB, Shin DS, Makary MS. Value of interventional radiology and their contributions to modern medical systems. FRONTIERS IN RADIOLOGY 2024; 4:1403761. [PMID: 39086502 PMCID: PMC11288872 DOI: 10.3389/fradi.2024.1403761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 06/25/2024] [Indexed: 08/02/2024]
Abstract
Interventional radiology (IR) is a unique specialty that incorporates a diverse set of skills ranging from imaging, procedures, consultation, and patient management. Understanding how IR generates value to the healthcare system is important to review from various perspectives. IR specialists need to understand how to meet demands from various stakeholders to expand their practice improving patient care. Thus, this review discusses the domains of value contributed to medical systems and outlines the parameters of success. IR benefits five distinct parties: patients, practitioners, payers, employers, and innovators. Value to patients and providers is delivered through a wide set of diagnostic and therapeutic interventions. Payers and hospital systems financially benefit from the reduced cost in medical management secondary to fast patient recovery, outpatient procedures, fewer complications, and the prestige of offering diverse expertise for complex patients. Lastly, IR is a field of rapid innovation implementing new procedural technology and techniques. Overall, IR must actively advocate for further growth and influence in the medical field as their value continues to expand in multiple domains. Despite being a nascent specialty, IR has become indispensable to modern medical practice.
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Affiliation(s)
- Warren A. Campbell
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Virginia, Charlottesville, VA, United States
| | - Jeffrey F. B. Chick
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Washington, Seattle, WA, United States
| | - David S. Shin
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Southern California, Los Angeles, CA, United States
| | - Mina S. Makary
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
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Georgiou IT, Pappa ED, Coclami TE, Kelessis NG. Stereotactic vs open biopsy for non-palpable breast lesions. Their impact on short term quality of life. PSYCHOL HEALTH MED 2021; 28:1126-1132. [PMID: 34933617 DOI: 10.1080/13548506.2021.2019806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Stereotactic biopsy and open biopsy represent useful diagnostic tools of breast lesions. However, both affect the Quality of Life (QoL) in various degrees. We conducted this prospective longitudinal comparative study in order, first to access the impact of these techniques on short-term QoL and second to compare and critically discuss our results with those of literature review. Group A (58 patients) underwent vacuum-assisted stereotactic biopsy and Group B (46 patients) underwent open biopsy. The Health-Related Quality of Life (HRQol) was estimated using the European Quality of Life scale (EuroQol) and the SF-36 (The 36-Item Short-Form Health Status Survey) questionnaires. The stereotactic breast biopsy seems to be more accepted from the patients as it affects quality of life to a lesser extent than open breast biopsy. This difference is mainly attributable to a reduction of physical discomfort and pain.
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Affiliation(s)
- Irini T Georgiou
- Department of Radiology, Saint-Savvas Anticancer Hospital, Athens, Greece
| | - Evelina D Pappa
- Faculty of Social Sciences, Hellenic Open University, Patras, Greece
| | | | - Nickos G Kelessis
- Dir. Surgical Oncology Department, "Metropolitan" Gen. Hospital, Athens, Greece
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Pistolese CA, Perretta T, Claroni G, Anemona L, Servadei F, Collura A, Censi M, Materazzo M, Pellicciaro M, Lamacchia F, Vanni G. A Prospective Evaluation of Tru-Cut Biopsy and Fine-needle Aspiration Cytology in Male Breast Cancer Detection. In Vivo 2021; 34:3431-3439. [PMID: 33144451 DOI: 10.21873/invivo.12182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Male breast-cancer (MBC) is often diagnosed late. Our purpose was to evaluate fine-needle aspiration cytology (FNAC) versus Tru-Cut biopsy (TCNB) in MBC diagnosis. PATIENTS AND METHODS Men with suspicious breast lesions were prospectively enrolled; 54 met the inclusion criteria and underwent FNAC and TCNB. FNAC, TCNB and gold-standard results were compared. RESULTS Unsatisfactory results were 11.1% after FNAC and none after TCNB (p=0.027). After gold-standard evaluation, the diagnosis of FNAC and TCNB was confirmed, respectively, in 63.0% and 98.1% and changed in 37.0% and 1.9% (p<0.001). The malignancy rate after FNAC, TCNB and surgery were, respectively, 25.9%, 33.3% and 35.1% (FNAC vs. TCNB p=0.5276, FNAC vs. surgery p=0.404; TCNB vs. surgery p=1). Among invasive carcinomas, 93.8% were identified by FNAC vs. 87.5% by TCNB (p=1); all ductal carcinoma in situ (DCIS) were detected after TCNB and none after FNAC (p=0.1). CONCLUSION FNAC leads to a significantly higher number of inadequate samplings and seems to be subject to increased DCIS misdiagnoses. TCNB correlated better to the final histological report.
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Affiliation(s)
- Chiara Adriana Pistolese
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Tommaso Perretta
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Giulia Claroni
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Lucia Anemona
- Anatomic Pathology, Department of Experimental Medicine, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Francesca Servadei
- Anatomic Pathology, Department of Experimental Medicine, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Alberto Collura
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Michela Censi
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Marco Materazzo
- Breast Unit-Department of Surgical Science, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Marco Pellicciaro
- Breast Unit-Department of Surgical Science, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Feliciana Lamacchia
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Gianluca Vanni
- Breast Unit-Department of Surgical Science, Policlinico Tor Vergata (PTV) University, Rome, Italy
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Whitworth P, Hogan A, Ferko N, Son D, Wang F, Xiong Y, Suri H, Barclay B. Reduced Hospital Costs for Ultrasound-guided Vacuum-assisted Excision Compared with Open Surgery in Patients with Benign Breast Masses and High-risk Lesions. JOURNAL OF BREAST IMAGING 2020; 2:452-461. [PMID: 38424905 DOI: 10.1093/jbi/wbaa055] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Indexed: 03/02/2024]
Abstract
OBJECTIVE Benign breast masses represent a substantial proportion of breast cancer screening results and may require multiple follow-up visits and biopsy. Even with a preceding benign core biopsy, benign masses have been excised via open surgery for a variety of reasons. This study compared the procedural costs of US-guided vacuum-assisted excision (US-VAE) versus open surgical excisions for benign breast masses and high-risk lesions (HRL). METHODS In this retrospective cohort study, female outpatients receiving US-VAE or open excision of benign breast masses between 2015 and 2018 were identified within the Premier Healthcare Database. A secondary analysis was conducted for patients with HRLs. Propensity score matching and multivariate regression adjusted for patient demographics, encounter level covariates, and hospital characteristics. The total procedural costs were reported from a hospital perspective. RESULTS A total of 33 724 patients underwent excisions for benign breast masses (8481 US-VAE and 25 242 open surgery). Procedural costs were significantly lower in unmatched patients who received US-VAE ($1350) versus open surgery ($3045) (P < 0.0001). After matching, a total of 5499 discharges were included in each group, with similar findings for US-VAE ($1348) versus open surgery ($3101) (P < 0.0001). A secondary analysis of matched HRL patients (41 discharges in each group) also showed significantly lower procedural costs with US-VAE ($1620) versus open surgery ($3870) (P < 0.0001). CONCLUSION Among patients with benign breast masses or HRLs, US-VAE was associated with significantly lower procedural costs versus open surgery. If excision is performed and expected clinical outcomes are equal, US-VAE is preferable to reduce costs without compromising the quality of care.
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Affiliation(s)
| | | | | | | | - Faye Wang
- Becton, Dickinson and Company, Tempe, AZ
| | - Yan Xiong
- Becton, Dickinson and Company, Franklin Lakes, NJ
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Tsai HY, Huang ST, Chao MF, Kan JY, Hsu JS, Hou MF, Chiu HC. Cost-effectiveness of stereotactic vacuum-assisted biopsy for nonpalpable breast lesions. Eur J Radiol 2020; 127:108982. [PMID: 32334370 DOI: 10.1016/j.ejrad.2020.108982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 03/26/2020] [Accepted: 03/29/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE To examine the potential cost-savings of stereotactic vacuum-assisted biopsy (SVAB) over open surgical biopsy (OSB) in diagnosis of nonpalpable lesions on mammography and to estimate the cost-saving effect on lesions at different levels of malignant probability. METHODS This retrospective study was approved by our Institutional Review Board. We retrospectively reviewed 276 (33.8 %) SVAB and 541 (66.2 %) OSB medical records at a medical center. Direct costs included patients' self-paid and national health insurance claim charges. Indirect costs were calculated using sick days, average salary, and age-adjusted employment rate. One-way and two-way sensitivity analyses were conducted. Lesion classification was determined by the assessment categories of Breast Imaging Reporting and Data System (BI-RADS), 4th or 5th editions. RESULTS SVAB decreased the direct cost by $90.3 (10.1 %) per diagnosis. The indirect cost was decreased by $560.2 (96.0 %). Overall, SVAB saved 43.9 % of resource utilization for each biopsy. Taking the cost of the subsequent malignant surgery into account, from the healthcare providers' perspective, SVAB was cost-effective if a lesion had less than 19 % likelihood of malignancy. From the societal perspective, SVAB reduced productivity loss for all the lesions. Based on the positive predictive value of the BI-RADS categories, SVAB was more suitable for the lesions of category 4A and category 3, resulting in greater savings in both medical and societal resources. CONCLUSIONS SVAB is a cost-effective diagnostic option for nonpalpable breast lesions. The cost-saving effect is greater for the lesions of category 4A and category 3.
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Affiliation(s)
- Huei-Yi Tsai
- Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan No.100, Ziyou 1st Rd., Sanmin Dist., Kaohsiung City, 807, Taiwan; Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan No.100, Shiquan 1st Rd., Sanmin Dist., Kaohsiung City, 807, Taiwan
| | - Siou-Tang Huang
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan No.100, Shiquan 1st Rd., Sanmin Dist., Kaohsiung City, 807, Taiwan
| | - Min-Fang Chao
- Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan No.100, Ziyou 1st Rd., Sanmin Dist., Kaohsiung City, 807, Taiwan
| | - Jung-Yu Kan
- Division of Breast Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan No.100, Ziyou 1st Rd., Sanmin Dist., Kaohsiung City, 807, Taiwan
| | - Jui-Sheng Hsu
- Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan No.100, Ziyou 1st Rd., Sanmin Dist., Kaohsiung City, 807, Taiwan
| | - Ming-Feng Hou
- Division of Breast Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan No.100, Ziyou 1st Rd., Sanmin Dist., Kaohsiung City, 807, Taiwan
| | - Herng-Chia Chiu
- Institute of Hospital Management, Tsinghua Shenzhen International Graduate School, Tsinghua University No. 2279 Lishui Road, Nanshan District, Shenzhen, 518055, PR China.
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Ultrasound-Guided Vacuum-Assisted Biopsy in Small Breast: A Cost-Saving Solution. Clin Breast Cancer 2019; 19:e352-e357. [DOI: 10.1016/j.clbc.2018.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/01/2018] [Accepted: 12/01/2018] [Indexed: 11/21/2022]
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Pistolese CA, Tosti D, Citraro D, Ricci F, Di Stefano C, Lamacchia F, Ferrari D, Floris R. Probably Benign Breast Nodular Lesions (BI-RADS 3): Correlation between Ultrasound Features and Histologic Findings. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:78-84. [PMID: 30340921 DOI: 10.1016/j.ultrasmedbio.2018.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/30/2018] [Accepted: 09/05/2018] [Indexed: 06/08/2023]
Abstract
The purpose of this retrospective study was to determine the validity of the BI-RADS system in ultrasound findings assigned to BI-RADS 3 category, using cytologic and histologic results as a benchmark. Our study population consisted of 122 ultrasound nodular lesions in 122 women who underwent fine-needle aspiration cytology and biopsy for probably benign lesions (Breast Imaging Reporting and Data System [BI-RADS] category 3). Contrary to what was previously reported in the literature (risk of malignancy of BI-RADS 3 <2%), malignancy was the outcome in seven of 122 cases (5.7%). Our study also found that the presence of a cellular component with a mobile fluid-fluid level in a cystic lesion and small (<3 mm) anechoic components in solid lesions is not always an indication of benignity. Our experience seems to indicate the need to consider the presence of non-homogeneous echoes in the corpuscular cyst and solid nodular lesions with cystic components as suspicious, especially in lesions with large dimensions. Therefore it would be necessary to conduct further studies to establish a dimensional criterion in the assessment of the malignant nature of the mentioned lesions. The management of probably benign nodular lesions should not only be guided by BI-RADS classification; it is also necessary to include clinical and anamnestic data and apply a multidisciplinary approach to select cases that require histologic verification instead of the usual follow-up.
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Affiliation(s)
| | - Daniela Tosti
- Department of Diagnostic Imaging, Tor Vergata University Rome, Rome, Italy
| | - Daniele Citraro
- Department of Diagnostic Imaging, Tor Vergata University Rome, Rome, Italy
| | - Francesca Ricci
- Department of Diagnostic Imaging, Tor Vergata University Rome, Rome, Italy
| | - Carla Di Stefano
- Department of Diagnostic Imaging, Tor Vergata University Rome, Rome, Italy.
| | | | - Donatella Ferrari
- Department of Diagnostic Imaging, Tor Vergata University Rome, Rome, Italy
| | - Roberto Floris
- Department of Diagnostic Imaging, Tor Vergata University Rome, Rome, Italy
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The cost effectiveness of vacuum-assisted versus core-needle versus surgical biopsy of breast lesions. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.rxeng.2016.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Fernández-García P, Marco-Doménech SF, Lizán-Tudela L, Ibáñez-Gual MV, Navarro-Ballester A, Casanovas-Feliu E. The cost effectiveness of vacuum-assisted versus core-needle versus surgical biopsy of breast lesions. RADIOLOGIA 2016; 59:40-46. [PMID: 27865561 DOI: 10.1016/j.rx.2016.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 09/10/2016] [Accepted: 09/11/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To determine the cost effectiveness of breast biopsy by 9G vacuum-assisted guided by vertical stereotaxy or ultrasonography in comparison with breast biopsy by 14G core-needle biopsy and surgical biopsy. MATERIAL AND METHODS We analyzed a total of 997 biopsies (181 vacuum-assisted, 626 core, and 190 surgical biopsies). We calculated the total costs (indirect and direct) of the three types of biopsy. We did not calculate intangible costs. We measured the percentage of correct diagnoses obtained with each technique. To identify the most cost-effective option, we calculated the mean ratios for the three types of biopsies. RESULTS Total costs were €225.09 for core biopsy, €638.90 for vacuum-assisted biopsy, and €1780.01 for surgical biopsy. The overall percentage of correct diagnoses was 91.81% for core biopsy, 94.03% for vacuum-assisted biopsy, and 100% for surgical biopsy; however, these differences did not reach statistical significance (p=0.3485). For microcalcifications, the percentage of correct diagnoses was 50% for core biopsy and 96.77% for vacuum-assisted biopsy (p<0.0001). For nodules, there were no significant differences among techniques. The mean cost-effectiveness ratio considering all lesions was 2.45 for core biopsy, 6.79 for vacuum-assisted biopsy, and 17.80 for surgical biopsy. CONCLUSION Core biopsy was the dominant option for the diagnosis of suspicious breast lesions in general. However, in cases with microcalcifications, the low percentage of correct diagnoses achieved by core biopsy (50%) advises against its use in this context, where vacuum-assisted biopsy would be the technique of choice because it is more cost-effective than surgical biopsy, the other technique indicated for biopsying microcalcifications.
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Affiliation(s)
- P Fernández-García
- Servicio de Radiología Diagnóstica y Terapéutica, Hospital General Universitario de Castellón, Castellón, España.
| | - S F Marco-Doménech
- Servicio de Radiología Diagnóstica y Terapéutica, Hospital General Universitario de Castellón, Castellón, España; Departamento de Medicina, Universidad Jaime I, Castellón, España
| | | | - M V Ibáñez-Gual
- Departamento de Matemáticas, IMAC, Universidad Jaime I, Castellón, España
| | - A Navarro-Ballester
- Servicio de Radiología Diagnóstica y Terapéutica, Hospital General Universitario de Castellón, Castellón, España
| | - E Casanovas-Feliu
- Servicio de Radiología Diagnóstica y Terapéutica, Hospital General Universitario de Castellón, Castellón, España
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Ruggeri M, Manca A, Coretti S, Codella P, Iacopino V, Romano F, Mascia D, Orlando V, Cicchetti A. Investigating the Generalizability of Economic Evaluations Conducted in Italy: A Critical Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2015; 18:709-720. [PMID: 26297100 DOI: 10.1016/j.jval.2015.03.1795] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 02/27/2015] [Accepted: 03/29/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To assess the methodological quality of Italian health economic evaluations and their generalizability or transferability to different settings. METHODS A literature search was performed on the PubMed search engine to identify trial-based, nonexperimental prospective studies or model-based full economic evaluations carried out in Italy from 1995 to 2013. The studies were randomly assigned to four reviewers who applied a detailed checklist to assess the generalizability and quality of reporting. The review process followed a three-step blinded procedure. The reviewers who carried out the data extraction were blind as to the name of the author(s) of each study. Second, after the first review, articles were reassigned through a second blind randomization to a second reviewer. Finally, any disagreement between the first two reviewers was solved by a senior researcher. RESULTS One hundred fifty-one economic evaluations eventually met the inclusion criteria. Over time, we observed an increasing transparency in methods and a greater generalizability of results, along with a wider and more representative sample in trials and a larger adoption of transition-Markov models. However, often context-specific economic evaluations are carried out and not enough effort is made to ensure the transferability of their results to other contexts. In recent studies, cost-effectiveness analyses and the use of incremental cost-effectiveness ratio were preferred. CONCLUSIONS Despite a quite positive temporal trend, generalizability of results still appears as an unsolved question, even if some indication of improvement within Italian studies has been observed.
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Affiliation(s)
- Matteo Ruggeri
- Director of Post-Graduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Manca
- Centre for Health Economics, University of York, York, UK
| | - Silvia Coretti
- Director of Post-Graduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Paola Codella
- Director of Post-Graduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valentina Iacopino
- Director of Post-Graduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Federica Romano
- Director of Post-Graduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Daniele Mascia
- Director of Post-Graduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valentina Orlando
- Inter-departmental Research Centre of PharmacoEconomics and Drug utilization (CIRFF), Center of Pharmacoeconomics, Federico II University of Naples, Naples, Italy
| | - Americo Cicchetti
- Director of Post-Graduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
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