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Cammarota S, Conti V, Corbi G, Di Gregorio L, Dolce P, Fogliasecca M, Iannaccone T, Manzo V, Passaro V, Toraldo B, Valente A, Citarella A. Predictors of Opioid Prescribing for Non-Malignant Low Back Pain in an Italian Primary Care Setting. J Clin Med 2021; 10:jcm10163699. [PMID: 34441993 PMCID: PMC8397205 DOI: 10.3390/jcm10163699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/11/2021] [Accepted: 08/16/2021] [Indexed: 11/16/2022] Open
Abstract
This study explores which patient characteristics could affect the likelihood of starting low back pain (LBP) treatment with opioid analgesics vs. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) in an Italian primary care setting. Through the computerized medical records of 65 General Practitioners, non-malignant LBP subjects who received the first pain intensity measurement and an NSAID or opioid prescription, during 2015–2016, were identified. Patients with an opioid prescription 1-year before the first pain intensity measurement were excluded. A multivariable logistic regression model was used to determine predictive factors of opioid prescribing. Results were reported as Odds Ratios (ORs) with a 95% confidence interval (CI), with p < 0.05 indicating statistical significance. A total of 505 individuals with LBP were included: of those, 72.7% received an NSAID prescription and 27.3% an opioid one (64% of subjects started with strong opioid). Compared to patients receiving an NSAID, those with opioid prescriptions were younger, reported the highest pain intensity (moderate pain OR = 2.42; 95% CI 1.48–3.96 and severe pain OR = 2.01; 95% CI 1.04–3.88) and were more likely to have asthma (OR 3.95; 95% CI 1.99–7.84). Despite clinical guidelines, a large proportion of LBP patients started with strong opioid therapy. Asthma, younger age and pain intensity were predictors of opioid prescribing when compared to NSAIDs for LBP treatment.
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Affiliation(s)
- Simona Cammarota
- LinkHealth Health Economics, Outcomes & Epidemiology s.r.l., 80143 Naples, Italy; (M.F.); (A.C.)
- Correspondence: ; Tel.: +39-333-532-0054
| | - Valeria Conti
- Clinical Pharmacology and Pharmacogenetics Unit, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84084 Salerno, Italy; (V.C.); (T.I.); (V.M.)
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy;
| | - Graziamaria Corbi
- Department of Medicine and Health Sciences, “Vincenzo Tiberio”, University of Molise, 86100 Campobasso, Italy;
- Italian Society of Gerontology and Geriatrics (SIGG), 50122 Florence, Italy
| | - Luigi Di Gregorio
- Parmenide Medical Cooperative, 84084 Salerno, Italy; (L.D.G.); (V.P.)
| | - Pasquale Dolce
- Department of Public Health, University of Naples “Federico II”, 80138 Naples, Italy;
| | - Marianna Fogliasecca
- LinkHealth Health Economics, Outcomes & Epidemiology s.r.l., 80143 Naples, Italy; (M.F.); (A.C.)
| | - Teresa Iannaccone
- Clinical Pharmacology and Pharmacogenetics Unit, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84084 Salerno, Italy; (V.C.); (T.I.); (V.M.)
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy;
| | - Valentina Manzo
- Clinical Pharmacology and Pharmacogenetics Unit, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84084 Salerno, Italy; (V.C.); (T.I.); (V.M.)
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy;
| | - Vincenzo Passaro
- Parmenide Medical Cooperative, 84084 Salerno, Italy; (L.D.G.); (V.P.)
| | | | - Alfredo Valente
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy;
| | - Anna Citarella
- LinkHealth Health Economics, Outcomes & Epidemiology s.r.l., 80143 Naples, Italy; (M.F.); (A.C.)
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Sciattella P, Mennini FS, Marcellusi A, Toraldo B, Koch M. [Clinical outcomes and hospital costs of hepatic encephalopathy: an analysis of "real life" data from Marche Region.]. Recenti Prog Med 2019; 109:585-594. [PMID: 30667388 DOI: 10.1701/3082.30743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Hepatic encephalopathy (HE) describes a spectrum of potentially reversible neuropsychiatric changes observed in patients with hepatic dysfunction and/or portosystemic shunt. The aim of this study is to compare data from clinical trials and observational studies with Italian real-world (RW) data as for clinical outcomes; other aim is to evaluate economic burden of hepatic encephalopathy related to hospitalization for overt HE. The work is based on data from the Health Information Systems (SIS) of Marche Region, Italy (about 1.5 million patients) available for the period 2008-2014. 450 subjects were identified (62% men, mean age 68 years) with a first episode of overt HE (OHE) in the three-year period 2010-2012. The mortality in the index hospitalization was equal to 32.2%; the 2-year mortality rate for a specific cause was 24.3% while that for all cases was 33.1%. The proportion of patients discharged alive from the hospitalization index that in the following two years incurs in rehospitalization, correlated with OHE is on average 66.6%. These figures largely exceed those identified in clinical trials or observational studies. Assuming that the incidence of OHE cases observed in the Marche region is representative of the national one we could estimate a charge to the NHS equal to about € 200 million for hospital assistance in the first year from the OHE event.
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Affiliation(s)
- Paolo Sciattella
- Economic Evaluation and HTA (EEHTA-CEIS), DEF Department, Faculty of Economics, Università di Roma Tor Vergata - Dipartimento di Scienze Statistiche, Sapienza Università di Roma
| | - Francesco Saverio Mennini
- Economic Evaluation and HTA (EEHTA-CEIS), DEF Department, Faculty of Economics, Università di Roma Tor Vergata - Institute for Leadership and Management in Health, Kingston University, London, UK
| | - Andrea Marcellusi
- Economic Evaluation and HTA (EEHTA-CEIS), DEF Department, Faculty of Economics, Università di Roma Tor Vergata - Institute for Leadership and Management in Health, Kingston University, London, UK
| | | | - Maurizio Koch
- Unità Complessa di Gastroenterologia ed Epatologia, Ospedale San Filippo Neri, Roma
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Mennini FS, Sciattella P, Marcellusi A, Toraldo B, Koch M. [Burden of diverticular disease: an observational analysis based on Italian real-world data.]. Recenti Prog Med 2018; 109:15-24. [PMID: 29451517 DOI: 10.1701/2848.28749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Diverticular disease (DD) represent a wide variety of conditions associated with the presence of diverticula in the colon. The most serious form is an acute episode of diverticulitis which can lead to hospitalization and surgery with various types of consequences. The main aim of this study was to evaluate, from both cross-sectional and longitudinal perspective, the economic burden of diverticulitis in the real practice. METHOD A deterministic linkage was performed at individual user level between the different administrative sources of the Marche Region through anonymised ID number for a period of analysis between 1 January 2008 and 31 December 2014. We enrolled all patients with at least one hospitalization for "diverticulitis of the colon without mention of haemorrhage" (ICD-9-CM code 562.11) or "diverticulitis of the colon with haemorrhage" (ICD-9-CM code 562.13) as primary or secondary diagnosis. Cost and outcome were analysed considering transversally (for contemporaneous) and longitudinal (for cohort) perspective. Hospital mortality at one year after discharge was evaluated by mortality rates and Kaplan-Meier curve considering the surgery performed (or not performed) during the index hospitalization. RESULTS Considering the cross-sectional perspective, 427 patients per year were estimated (about 35 patients per 100,000 adult residents) with an average number of hospitalization equal to 1.14. The direct healthcare costs incurred by the Marche region for episodes of diverticulitis in 2008-2014 amounted to approximately € 11.4 million (€ 1.6 million a year), of which € 10.9 million (95.5%) for the hospitalizations, € 246,000 (2.1%) for pharmaceutical treatment and € 270,000 (2.4%) for specialist outpatient services. The cohort analysis estimates an intra-hospital mortality rate equal to 5.9 per 100 patients' year (5.5 for non-surgery patients and 8.9 for surgery patients - P<0.05). Kaplan-Meier curve demonstrate that there were no differences between intra-hospital mortality due to surgery during index hospitalization. CONCLUSIONS Our study is the first analysis in Italy to use real-world data to measure the burden of DD with a cross-sectional and longitudinal perspective. This study could be useful for decision maker that could quantify the economic and epidemiological burden of DD in hospital.
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Affiliation(s)
- Francesco Saverio Mennini
- Economic Evaluation and HTA (CEIS- EEHTA) - IGF Department, Faculty of Economics, Università di Roma "Tor Vergata" - Institute for Leadership and Management in Health - Kingston University London, UK
| | - Paolo Sciattella
- Economic Evaluation and HTA (CEIS- EEHTA) - IGF Department, Faculty of Economics, Università di Roma "Tor Vergata" - Dipartimento di Scienze Statistiche, "Sapienza" Università di Roma
| | - Andrea Marcellusi
- Consiglio Nazionale delle Ricerche (CNR), Istituto di Ricerche sulla Popolazione e le Politiche Sociali (IRPPS), Roma
| | | | - Maurizio Koch
- Unità Complessa di Gastroenterologia ed Epatologia, Ospedale San Filippo Neri, Roma
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Cammarota S, Cargiolli M, Andreozzi P, Toraldo B, Citarella A, Flacco ME, Binda GA, Annibale B, Manzoli L, Cuomo R. Increasing trend in admission rates and costs for acute diverticulitis during 2005-2015: real-life data from the Abruzzo Region. Therap Adv Gastroenterol 2018; 11:1756284818791502. [PMID: 30159036 PMCID: PMC6109850 DOI: 10.1177/1756284818791502] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 06/14/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Scarce data are available on the epidemiological trend of diverticulitis and its financial burden in Italy. The aim of this work was to explore a potential variation in the rate and costs of hospital admissions for uncomplicated and complicated diverticulitis over the last decade. METHODS We selected all hospitalizations for diverticulitis of residents in the Abruzzo Region, Italy between 2005 and 2015. Age-standardized hospitalization rates (HRs) per 100,000 inhabitants for overall, uncomplicated and complicated diverticulitis were calculated. A linear model on the log of the age-standardized rates was used to calculate annual percentage changes (APC). Costs were derived from the official DRG tariff. RESULTS From 2005 to 2015, the HR for acute diverticulitis increased from 38.9 to 45.2 per 100,000 inhabitants (APC + 1.9%). The HR for complicated diverticulitis increased from 5.9 to 13.3 (APC + 7.6%), whereas it remained stable for uncomplicated diverticulitis. The mean hospital cost was 1.8-times higher for complicated diverticulitis compared with that for uncomplicated disease and 3.5-times higher for patients with a surgery stay compared with that for patients with a medical stay. CONCLUSION During the last decade, in the Abruzzo Region, the HRs for diverticulitis and their costs increased significantly, mainly due to disease complications. Further studies are needed to explore strategies to prevent complications and to realise cost-saving policies.
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Affiliation(s)
- Simona Cammarota
- LinkHealth Health Economics, Outcomes & Epidemiology s.r.l., Naples, Italy
| | - Martina Cargiolli
- Gastroenterology Unit, Department of Clinical Medicine and Surgery University Federico II, Naples, Italy
| | - Paolo Andreozzi
- Gastroenterology Unit, Department of Clinical Medicine and Surgery University Federico II, Naples, Italy
| | | | - Anna Citarella
- LinkHealth Health Economics, Outcomes & Epidemiology s.r.l., Naples, Italy
| | | | | | - Bruno Annibale
- Medical-Surgical Science and Translational Medicine Department, Sapienza University, Rome, Italy
| | - Lamberto Manzoli
- Department of Medicine Sciences, University of Ferrara, Ferrara, Italy; Regional Healthcare Agency of Abruzzo, Pescara, Italy
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Mennini FS, Sciattella P, Marcellusi A, Toraldo B, Koch M. Economic burden of diverticular disease: An observational analysis based on real world data from an Italian region. Dig Liver Dis 2017; 49:1003-1008. [PMID: 28663067 DOI: 10.1016/j.dld.2017.05.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 05/18/2017] [Accepted: 05/30/2017] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Diverticular disease (DD), a herniation of the colonic mucosa through the muscle layer, covers a wide variety of conditions associated with the presence of diverticula in the colon. The most serious form is an acute episode of diverticulitis, which can lead to hospitalization and surgery with various types of consequences. The main aim of this study is to evaluate the economic burden of hospitalizations arising from acute episodes of diverticulitis using data from the administrative databases used in the Marche region in Italy and, as a secondary objective of this real-world data analysis, to study patient outcome variables following initial hospitalization for diverticulitis. METHOD A deterministic linkage was performed at individual user level between the different administrative sources of the Marche region through anonymous ID number for a period of analysis between 1 January, 2008 and 31 December, 2014. We enrolled all patients with at least one hospitalization for "diverticulitis of the colon without mention of haemorrhage" (ICD-9-CM code 562.11) or "diverticulitis of the colon with haemorrhage" (ICD-9-CM code 562.13) as primary or secondary diagnosis. For each patient we assessed the cost of hospitalization, of medicines and of specialist services considering a time-scale of one year or cohort analysis 365days after first admission. RESULTS The total number of residents in the Marche region who had at least one hospitalization for diverticulitis in the period 2008-2014 was 2987 (427 patients a year, corresponding to about 35 patients per 100,000 adult residents); the total number of admissions was 3453 (just over 490 a year). The direct healthcare costs incurred by the Marche region for episodes of diverticulitis in 2008-2014 amounted to approximately €11.4 million (€1.6 million a year), of which €10.9 million (95.5%) for the hospitalizations, € 246,000 (2.1%) for pharmaceutical treatment and €270,000 (2.4%) for specialist outpatient services. The average annual cost per patient was €3826, of which €3653 was for hospitalization, while pharmaceutical expenditure and specialist services accounted for €83 and €90, respectively. The cohort of patients undergoing a first admission for diverticulitis between 2010 and 2013 was made up of 1729 people (54.4% women, mean age 68.9 years), of whom 1500 (86.8%) did not undergo surgery while in hospital. Hospital mortality, recorded only for the over-65 age class, averaged 1.2%; for patients not receiving surgery during the initial hospitalization it was 0.5%, reaching 5.2% in patients undergoing surgery. The percentage of patients with one or more readmissions for diverticulitis within a year of the first was on average 7.8% and in 48% of cases this resulted in surgery. CONCLUSIONS Our study is the first analysis in Italy to use real-world data to measure the financial impact of diverticular disease. Assuming that the diagnostic and therapeutic behaviour identified in the Marche region could be representative of the situation nationwide, the estimated annual number of hospitalizations in Italy for acute episodes of diverticulitis is 19,000. The total amount of economic resources needed to treat patients suffering from acute episodes of diverticulitis is estimated at €63.5 million a year.
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Affiliation(s)
- F S Mennini
- Economic Evaluation and HTA (CEIS-EEHTA)-IGF Department, Faculty of Economics, University of Rome "Tor Vergata", Italy; Institute for Leadership and Management in Health-Kingston University London, London, UK
| | - P Sciattella
- Economic Evaluation and HTA (CEIS-EEHTA)-IGF Department, Faculty of Economics, University of Rome "Tor Vergata", Italy; Department of Statistical Sciences, "Sapienza" University of Rome, Rome, Italy
| | - A Marcellusi
- National Research Council (CNR), Institute for Research on Population and Social Policies (IRPPS), Rome, Italy
| | | | - M Koch
- Complex Unit of Gastroenterology and Hepatology, San Filippo Neri Hospital, Italy.
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