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Mora S, Giannini B, Di Biagio A, Cenderello G, Nicolini LA, Taramasso L, Dentone C, Bassetti M, Giacomini M. Ten Years of Medical Informatics and Standards Support for Clinical Research in an Infectious Diseases Network. Appl Clin Inform 2023; 14:16-27. [PMID: 36631000 PMCID: PMC9833953 DOI: 10.1055/s-0042-1760081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND It is 30 years since evidence-based medicine became a great support for individual clinical expertise in daily practice and scientific research. Electronic systems can be used to achieve the goal of collecting data from heterogeneous datasets and to support multicenter clinical trials. The Ligurian Infectious Diseases Network (LIDN) is a web-based platform for data collection and reuse originating from a regional effort and involving many professionals from different fields. OBJECTIVES The objective of this work is to present an integrated system of ad hoc interfaces and tools that we use to perform pseudonymous clinical data collection, both manually and automatically, to support clinical trials. METHODS The project comprehends different scenarios of data collection systems, according to the degree of information technology of the involved centers. To be compliant with national regulations, the last developed connection is based on the standard Clinical Document Architecture Release 2 by Health Level 7 guidelines, interoperability is supported by the involvement of a terminology service. RESULTS Since 2011, the LIDN platform has involved more than 8,000 patients from eight different hospitals, treated or under treatment for at least one infectious disease among human immunodeficiency virus (HIV), hepatitis C virus, severe acute respiratory syndrome coronavirus 2, and tuberculosis. Since 2013, systems for the automatic transfer of laboratory data have been updating patients' information for three centers, daily. Direct communication was set up between the LIDN architecture and three of the main national cohorts of HIV-infected patients. CONCLUSION The LIDN was originally developed to support clinicians involved in the project in the management of data from HIV-infected patients through a web-based tool that could be easily used in primary-care units. Then, the developed system grew modularly to respond to the specific needs that arose over a time span of more than 10 years.
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Affiliation(s)
- Sara Mora
- Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), University of Genoa, Genoa, Italy,Address for correspondence Sara Mora, Eng Department of Informatics, Bioengineering, Robotics and System Engineering, (DIBRIS), University of GenoaItaly
| | - Barbara Giannini
- Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), University of Genoa, Genoa, Italy
| | - Antonio Di Biagio
- Infectious Diseases Unit, Policlinico San Martino Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy,Department of Infectious Disease, IRCCS AOU San Martino IST, (DISSAL), University of Genoa, Italy
| | | | - Laura Ambra Nicolini
- Infectious Diseases Unit, Policlinico San Martino Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Lucia Taramasso
- Infectious Diseases Unit, Policlinico San Martino Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Chiara Dentone
- Infectious Diseases Unit, Policlinico San Martino Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Matteo Bassetti
- Infectious Diseases Unit, Policlinico San Martino Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy,Department of Infectious Disease, IRCCS AOU San Martino IST, (DISSAL), University of Genoa, Italy
| | - Mauro Giacomini
- Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), University of Genoa, Genoa, Italy
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Clinical and economic benefits of a new paradigm of HCV diagnosis and treatment. GLOBAL & REGIONAL HEALTH TECHNOLOGY ASSESSMENT 2021; 8:58-66. [PMID: 36627870 PMCID: PMC9616196 DOI: 10.33393/grhta.2021.2183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 02/15/2021] [Indexed: 01/13/2023] Open
Abstract
Introduction The current paradigm (CP) of hepatitis C virus (HCV) diagnosis and treatment in Italy's National Health Service system has numerous steps. The European Association for the Study of the Liver recommends initiation of a pan-genotypic direct-acting antiviral regimen after a simple diagnostic process. The present study estimated the efficiency gains resulting from two simplified pathways from diagnosis to treatment of chronic hepatitis C patients in Italy over the next 5 years from a societal perspective. Methods The CP, a New Paradigm 1 (NP1), and a New Paradigm 2 (NP2) were evaluated in a Markov model. The NP1 model simplifies monitoring and laboratory test requirements in the diagnosis and treatment phases. The NP2 model also eliminates the primary care referral requirement. Results Treatment process time for non-cirrhotic patients was 48, 43, and 25 weeks in the CP, NP1, and NP2, respectively, and in cirrhotic patients was 49, 46, and 37 weeks. Under the CP, 19% of patients/year would be lost to follow-up, which decreases by 11% in NP1 and 100% in NP2. Compared with the CP, implementation of NP1 at 5 years would reduce compensated cirrhosis, decompensated cirrhosis, hepatocellular carcinoma, and liver-related deaths by 12.6%, 12.4%, 8.1%, and 8.8%, respectively; these cases would be reduced by 94.0%, 93.8%, 61.0%, and 58.4% in NP2. Total 5-year costs with the CP, NP1, and NP2 are estimated at 135.6€ million, 110.5€ million, and 80.5€ million, respectively. Conclusions Simplification of HCV diagnosis and monitoring requirements would allow Italy to move closer to international guidelines with significant health benefits and economic gains.
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Rolli FR, Ruggeri M, Kheiraoui F, Drago C, Basile M, Favaretti C, Cicchetti A. Economic evaluation of Zepatier for the management of HCV in the Italian scenario. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2018; 19:1365-1374. [PMID: 29696459 DOI: 10.1007/s10198-018-0980-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 04/16/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Hepatitis C virus (HCV) is a major health issue worldwide. New generation of direct-active antiviral medications is an epoch-making turning point in the management of HCV infections. OBJECTIVE Conducing a cost-effectiveness analysis comparing the combination of elbasvir/grazoprevir and sofosbuvir + pegylated interferon/ribavirin for the management of all HCV patients (even those in the initial stages of fibrosis). METHODS A Markov model was built on the natural history of the disease to assess the efficacy of the alternatives. The outcomes are expressed in terms of quality adjusted life-years (QALYs) and result in terms of incremental cost-effectiveness ratio). RESULTS Elbasvir/grazoprevir implies an expenditure of €21,104,253.74 with a gain of 19,287.90 QALYs and sofosbuvir + pegylated interferon/ribavirin implies an expenditure of €31,904,410.11 with a gain of 18,855.96 QALYs. Elbasvir/grazoprevir is thus a dominant strategy. CONCLUSION Consideration should be given to the opportunity cost of not treating patients with a lower degree of fibrosis (F0-F2).
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Affiliation(s)
- F R Rolli
- Catholic University of Sacred Heart, Largo Francesco Vito 1, 00186, Rome, Italy
| | - M Ruggeri
- Catholic University of Sacred Heart, Largo Francesco Vito 1, 00186, Rome, Italy
| | - F Kheiraoui
- Istituto di Sanità Pubblica, Sezione Igiene, Catholic University of Sacred Heart, Rome, Italy
- VIHTALI, Value in Health Technology and Academy for Leadership and Innovation Spin-Off of the Catholic University of Sacred Heart, Rome, Italy
| | - C Drago
- "Nicolò Cusano" University, Rome, Italy
| | - M Basile
- Catholic University of Sacred Heart, Largo Francesco Vito 1, 00186, Rome, Italy.
| | - C Favaretti
- VIHTALI, Value in Health Technology and Academy for Leadership and Innovation Spin-Off of the Catholic University of Sacred Heart, Rome, Italy
| | - A Cicchetti
- Catholic University of Sacred Heart, Largo Francesco Vito 1, 00186, Rome, Italy
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Cenderello G, Taramasso L, Marra D, Orcamo P, Pasa A, Di Biagio A. HCV elimination plan leads to significant benefits in managing liver-related diseases and hospital interventions: a regional simulation. Expert Rev Pharmacoecon Outcomes Res 2018; 19:189-193. [PMID: 30321071 DOI: 10.1080/14737167.2019.1537124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES This article presents a 3-year budget impact simulation on the effects of a chronic Hepatitis C (HCV) eradication plan in real-life costs incurred by the Regional Health Service. METHODS The Liguria Region network performed a prospective 3-year (2017-2019) timeframe horizon trends simulation analysis focusing on management interventions and costs. It involved all the eight prescribing centers in the region, starting from retrospective historical performance data and assuming the impact of sustained viral response rates for patients treated for HCV. Data on hospital admissions, medical visits, number of patients, and deaths were collected through the healthcare database. RESULTS At the beginning of 2017, 2,940 patients were eligible for HCV treatment with direct-acting antivirals. Assuming to treat this entire population with a success rate of 90%, the events related to liver complications in the horizon would decrease to 5,538 cumulatively (-35%), with a 27% reduction of direct costs, showing a global savings of 24,779.024 Euros. CONCLUSION Treating the entire eligible HCV population would lead to significant benefits and savings in managing liver-related diseases and their direct costs, opening opportunities to re-think new settings for the future organization of liver disease management in the regional health system.
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Affiliation(s)
| | - Lucia Taramasso
- b Infectious Diseases Unit, Hospital Policlinico San Martino, Department of Health Science (DISSAL) , University of Genoa , Genoa , Italy.,c Infectious Diseases Unit, Department of Internal Medicine , Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
| | | | - Patrizia Orcamo
- e Department Health and Social Care , Regione Liguria, Health promoting unit , Genoa , Italy
| | - Ambra Pasa
- f IT Unit , EO Ospedali Galliera , Genoa , Italy
| | - Antonio Di Biagio
- g Infectious Diseases Unit , Hospital Policlinico San Martino , Genoa , Italy
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Ruggeri M, Romano F, Basile M, Coretti S, Rolli FR, Drago C, Cicchetti A. Cost-Effectiveness Analysis of Early Treatment of Chronic HCV with Sofosbuvir/Velpatasvir in Italy. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2018; 16:711-722. [PMID: 30039348 DOI: 10.1007/s40258-018-0410-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Chronic Hepatitis C virus (cHCV) is a major health issue worldwide. New effective direct-acting anti-viral (DAA) drugs such as the combination sofosbuvir/velpatasvir, represent an important turning point, given the high sustained virologic response (SVR) rates associated with their use. OBJECTIVES To estimate the cost and effects of two different treatment strategies based on sofosbuvir/velpatasvir. Strategy 1: treating all patients, including those in the early stages of fibrosis; Strategy 2: reserving treatments for patients at more advanced stages of disease (≥ F3). The analysis compares the incremental cost-effectiveness ratio (ICER) of Strategy 1 versus Strategy 2 in a cohort of HCV-infected patients and a cohort of hepatitis C virus (HCV)-human immunodeficiency virus (HIV) patients. METHODS A Markov model simulating the natural history of the disease was built considering a 60-year time horizon and two cohorts of 1000 patients aged ≥ 35 years. Disease morbidity was classified according to the METAVIR classification. The robustness of the model was tested using deterministic and probabilistic sensitivity analyses (PSA). RESULTS In both cohorts, Strategy 1 results in higher resource consumption and a greater number of quality-adjusted life-years (QALYs) compared with Strategy 2. The ICERs for the cohort of HCV patients and the cohort of co-infected HCV/HIV patients ranged between €15,555-74,804/QALY and €10,708-55,138/QALY, respectively, depending on the assumed cost of the treatment. In the PSA, the ICER distribution remained below the threshold of €30,000/QALY in 96 and 97% of the scenarios in the cohorts of HCV and HCV/HIV patients, respectively. CONCLUSIONS Extending the treatment of HCV to patients at an early stage of HCV infection is estimated to be cost effective from the perspective of the Italian Healthcare System.
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Giannini B, Riccardi N, Cenderello G, Di Biagio A, Dentone C, Giacomini M. From Liguria HIV Web to Liguria Infectious Diseases Network: How a Digital Platform Improved Doctors' Work and Patients' Care. AIDS Res Hum Retroviruses 2018; 34:239-240. [PMID: 29466022 DOI: 10.1089/aid.2017.0064] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Barbara Giannini
- Department of Informatics, Bioengineering, Robotics and System Engineering, (DIBRIS), University of Genoa, Genoa, Italy
| | - Niccolò Riccardi
- Department of Infectious Disease, IRCCS AOU San Martino IST, (DISSAL), University of Genoa, Genoa, Italy
| | | | - Antonio Di Biagio
- Department of Infectious Disease, IRCCS AOU San Martino IST, (DISSAL), University of Genoa, Genoa, Italy
| | - Chiara Dentone
- Infectious Diseases Unit, ASL-1 Imperiese, Sanremo, Imperia, Italy
| | - Mauro Giacomini
- Department of Informatics, Bioengineering, Robotics and System Engineering, (DIBRIS), University of Genoa, Genoa, Italy
- Centre of Excellence for Biomedical Research, (CEBR), University of Genoa, Genoa, Italy
- Healthropy, Savona, Italy
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Cenderello G, Fanizza C, Marenco S, Nicolini LA, Artioli S, Baldissarro I, Dentone C, De Leo P, Di Biagio A. Cost per care of the first year of direct antiviral agents in the Liguria Region: a multicenter analysis. CLINICOECONOMICS AND OUTCOMES RESEARCH 2017; 9:281-293. [PMID: 28579812 PMCID: PMC5446971 DOI: 10.2147/ceor.s129859] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Aims Despite the remarkable efficacy shown in clinical practice, concerns have been raised about the costs associated with direct antiviral agent (DAA) therapy. This article presents the real-life costs for DAA treatment sustained by the Italian National Health Service in the Liguria Region (Northern Italy). Methods A retrospective analysis of the cost per care sustained for DAA treatment, relating to the period from January 1 to December 31, 2015 in five centers in Liguria was performed. All patients undergoing DAA-based treatments for hepatitis C virus (HCV) infection were enrolled. On-treatment costs included: HCV treatment, laboratory test, outpatient services, attended visits, drugs used for the management of adverse events (erythropoietin, albumin or red blood cell packs) and inpatient service admissions. Results In total, 327 patients were enrolled. No difference in terms of sustained virologic response (SVR) rate among different treatments was reported. The majority (85.0%) of patients did not report any side effects and only 15 (4.6%) required hospital admission. Forty-two patients (12.8%) required high-cost drugs for the management of adverse events. The overall cost sustained was €14,744,433. DAA±ribavirin (RBV) accounted for the wide majority of this cost (98.9%; €14,585,123). Genotype (GT) 1, the most commonly treated GT, was associated with an average cost of €43,445 per patient. Detailed analysis of the costs for GT 1 showed the treatment based on ritonavir boosted paritaprevir/ombitasvir + dasabuvir±RBV with an average cost of €24,978 (RBV+) and €25,448 (RBV−) per patient was the most cost-effective. The average cost per SVR was €48,184. Once again, the ritonavir boosted paritaprevir/ombitasvir + dasabuvir regimen was associated with the lowest cost/SVR (€25,448/SVR [GT 1b] and similar results for other GTs). Conclusion Antiviral regimen is the major contributor to costs in the treatment of HCV infection. Appropriate regimen selection could result in a major cost saving, which can be reinvested to allow more patients to be treated.
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