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Mariotti G, Siciliani L, Rebba V, Coretti S, Gentilini M. Consensus among clinicians on referrals' priority and use of digital decision-making support systems. Health Policy 2022; 126:906-914. [PMID: 35858954 DOI: 10.1016/j.healthpol.2022.07.003] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/19/2022] [Accepted: 07/12/2022] [Indexed: 11/24/2022]
Abstract
The growing demand for referrals is a main policy concern in health systems. One approach involves the development of demand management tools in the form of clinical prioritization to regulate patient referrals from primary care to specialist care. For clinical prioritization to be effective, it is critical that general practitioners (GPs) assess patient priority in the same way as specialists. The progressive development of IT tools in clinical practice, in the form of electronic referrals support systems (e-RSS), can facilitate clinical prioritization. In this study, we tested if higher use of e-RSS or higher use of high-priority categories was associated with the degree of agreement and therefore consensus on clinical priority between GPs and specialists. We found that higher use by GPs of the e-RSS tool was positively associated with greater degree of priority agreement with specialists, while higher use of the high-priority categories was associated with lower degree of priority agreement with specialists. Furthermore, female GPs, GPs in association with others, and GPs using a specific electronic medical record showed higher agreement with specialists. Our study therefore supports the use of electronic referrals systems to improve clinical prioritization and manage the demand of specialist visits and diagnostic tests. It also shows that there is scope for reducing excessive use by GPs of high-priority categories.
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Affiliation(s)
- Giuliano Mariotti
- Department of Governance, LHU APSS, Viale Alcide Degasperi, 79, Trento 38123, Italy.
| | - Luigi Siciliani
- Department of Economics and Related Studies, University of York, York, United Kingdom
| | - Vincenzo Rebba
- Department of Economics and Management "Marco Fanno" - University of Padua, and CRIEP (Inter-University Center for Research on Public Economics), Padua, Italy
| | - Silvia Coretti
- Department of Economics and Management "Marco Fanno", University of Padua, Italy; Epidemiology Service, LHU APSS, Viale Verona, Trentom, Italy
| | - Maria Gentilini
- Epidemiology Service, LHU APSS, Viale Verona, Trentom, Italy
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Buja A, Zabeo F, Cristofori V, Paganini M, Baldovin T, Fusinato R, Boccuzzo G, Cocchio S, Coretti S, Rebba V, Parpinel M. Opening Schools and Trends in SARS-CoV-2 Transmission in European Countries. Int J Public Health 2021; 66:1604076. [PMID: 34483809 PMCID: PMC8408313 DOI: 10.3389/ijph.2021.1604076] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 08/03/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: Benefits of school attendance have been debated against SARS-CoV-2 contagion risks. This study examined the trends of contagion before and after schools reopened across 26 countries in the European Union. Methods: We compared the average values of estimated R t before and after school reopening, identifying any significant increase with a one-sample t-test. A meta-analysis and meta-regression analysis were performed to calculate the overall increase in R t for countries in the EU and to search for relationships between R t before schools reopened and the average increase in R t afterward. Results: The mean reproduction number increased in 16 out of 26 countries. The maximum increase in R t was reached after a mean 28 days. We found a negative relationship between the R t before school reopening and its increasing after that event. By 45 days after the first day of school reopening, the overall average increase in R t for the European Union was 23%. Conclusion: We observed a significant increase in the mean reproduction number in most European countries, a public health issue that needs strategies to contain the spread of COVID-19.
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Affiliation(s)
- Alessandra Buja
- Department of Cardiologic, Vascular and Thoracic Sciences, and Public Health, University of Padova, Padova, Italy
| | - Federico Zabeo
- Department of Cardiologic, Vascular and Thoracic Sciences, and Public Health, University of Padova, Padova, Italy
| | - Vittorio Cristofori
- Department of Cardiologic, Vascular and Thoracic Sciences, and Public Health, University of Padova, Padova, Italy
| | - Matteo Paganini
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Tatjana Baldovin
- Department of Cardiologic, Vascular and Thoracic Sciences, and Public Health, University of Padova, Padova, Italy
| | - Riccardo Fusinato
- Department of Statistical Sciences, University of Padova, Padova, Italy
| | - Giovanna Boccuzzo
- Department of Statistical Sciences, University of Padova, Padova, Italy
| | - Silvia Cocchio
- Department of Cardiologic, Vascular and Thoracic Sciences, and Public Health, University of Padova, Padova, Italy
| | - Silvia Coretti
- Department of Economics and Management “Marco Fanno”, University of Padova, Padova, Italy
| | - Vincenzo Rebba
- Department of Economics and Management “Marco Fanno”, University of Padova, Padova, Italy
| | - Maria Parpinel
- Department of Medicine, DAME, University of Udine, Udine, Italy
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Bordignon M, Coretti S, Piacenza M, Turati G. Hardening subnational budget constraints via administrative subordination: The Italian experience of recovery plans in regional health services. Health Econ 2020; 29:1378-1399. [PMID: 32789958 DOI: 10.1002/hec.4138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 05/11/2020] [Accepted: 06/22/2020] [Indexed: 06/11/2023]
Abstract
Since 2007, Italian regions running large deficits underwent recovery plans (Piani di Rientro) imposed by the central government. The goal was twofold: regions were asked (i) to restore a balanced budget and (ii) to continue supply the set of services defined by the constitution. We investigate whether recovery plans have reached their objectives. Our evidence suggests that recovery plans have proved to be an effective mechanism to eliminate subnational governments deficits. We also do not find any significant effects on health care utilization and on citizens' health. Overall, spending efficiency has likely improved.
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Affiliation(s)
- Massimo Bordignon
- Department of Economics and Finance, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Silvia Coretti
- Department of Economics and Management "Marco Fanno", University of Padova, Padova, Italy
| | - Massimiliano Piacenza
- Department of Economics and Business (DISEI), University of Piemonte Orientale, Novara, Italy
| | - Gilberto Turati
- Department of Economics and Finance, Università Cattolica del Sacro Cuore, Milan, Italy
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Coretti S, Ruggeri M, Dibidino R, Gitto L, Marcellusi A, Mennini FS, Cicchetti A. Economic evaluation of colorectal cancer screening programs: Affordability for the health service. J Med Screen 2020; 27:186-193. [PMID: 31948342 DOI: 10.1177/0969141319898732] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To estimate the cost-effectiveness of the public colorectal cancer screening program in the Abruzzo region, Italy. METHODS Cost-effectiveness was analysed using a two-armed Markov model comparing: (1) Abruzzo screening program based on biennial faecal immunochemical occult blood testing, with colonoscopy as second level test for individuals with positive results, with (2) Treatment of symptomatic patients according to the stage of the neoplasm. Transition probabilities were adjusted for accuracy of tests and incidence of colorectal cancer. Diagnosis-related groups' charges and field collected data were used to estimate costs. Costs and benefits were discounted by 3.5%. Monte Carlo simulation confirmed the robustness of the model results. RESULTS Assuming a compliance rate of 64.7%, the incremental cost-effectiveness ratio for the current colorectal screening program was €433.06/quality adjusted life year gained, considerably lower than conventional thresholds (around €30,000). CONCLUSION Early detection and intervention programs help to avoid a large number of highly debilitating and expensive cancer treatments. These results show that the screening program currently implemented in Abruzzo should be considered as a good investment in health.
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Affiliation(s)
- Silvia Coretti
- Department of Economics and Management "Marco Fanno", University of Padova, Italy
| | - Matteo Ruggeri
- Graduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome , Italy
| | - Rossella Dibidino
- Graduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome , Italy
| | - Lara Gitto
- Dipartimento di Economia, Università degli Studi di Messina, Messina, Italy
| | - Andrea Marcellusi
- CEIS EEHTA (Economic Evaluation & HTA), University "Tor Vergata", Rome, Italy
| | | | - Americo Cicchetti
- Graduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome , Italy
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Abstract
Major depression (MD) is a major cause of disability and a significant public health problem due to strong physical and mental impairment, possible complications for patients (including suicides), serious social and working problems to the patient and his/her family. We provide an overview of the social cost of Major depression worldwide. We conducted a systematic literature review. Two search engines were queried. Screening of records and summary of evidence was performed by two researchers blindly. The review was conducted in accordance with the standards of the PRISMA guidelines.
Twenty studies met the inclusion criteria. Despite the heterogeneity in terms of population, setting and estimation techniques, the studies showed that the largest share of the burden of disease is represented by indirect costs. Among direct healthcare costs, inpatient care represents the most significant item, followed by outpatient care. The average total direct cost of depression ranges between €508 and €24 069, depending on the jurisdiction where the analysis was run and the range of cost items included. Indirect costs range between €1963 and €27 364.
Evidence on the cost of MD in some countries is currently lacking. A deeper understanding of the drivers of the economic burden of disease is a crucial starting point for studies concerned with the cost-effectiveness of new treatment strategies.
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Coretti S, Rumi F, Sacchini D, Cicchetti A. SIR-Spheres ® Y-90 resin microspheres in chemotherapy refractory or intolerant patients with metastatic colorectal cancer. Global & Regional Health Technology Assessment 2019. [DOI: 10.1177/2284240319847446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Selective internal radiation therapy is a form of intra-arterial brachytherapy used to treat primary liver cancer and liver metastases. This article aims to provide an overview of the clinical, economic, organizational legal, social and ethical impact of selective internal radiation therapy using SIR-Spheres Y-90 resin microspheres in the treatment of patients with unresectable, liver-dominant metastatic colorectal cancer who are refractory to or intolerant of chemotherapy. A systematic literature review was performed by querying PubMed, Scopus, EBSCO, CRD and GIN. Two reviewers blindly screened the records retrieved against predefined inclusion/exclusion criteria. The selected studies where summarized following a simplified version of the EuNetHTA Core Model® 2.1. The studies included evaluated selective internal radiation therapy in first-line or further-line treatment and showed a good safety and tolerability profile and significant improvement in efficacy expressed as time to liver progression, progression-free survival and overall survival. Selective internal radiation therapy should be provided in specialized centres and administered by a multidisciplinary team. A hub-and-spoke network could be a viable option to guarantee access to this technology across jurisdictions. The lack of a specific diagnosis-related group tariff accounting for the cost of the device could be seen as the major obstacle to a fair diffusion of this technology. The economic evaluations currently available show the cost-effectiveness of this technology in the population under study. Selective internal radiation therapy using SIR-Spheres Y-90 resin microspheres appears to be a clinically effective and cost-effective option in the treatment of metastatic colorectal cancer patients who are chemotherapy refractory or chemotherapy intolerant.
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Affiliation(s)
- Silvia Coretti
- Graduate School of Health Economics and Management, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Filippo Rumi
- Graduate School of Health Economics and Management, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Dario Sacchini
- Institute of Bioethics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Americo Cicchetti
- Graduate School of Health Economics and Management, Università Cattolica del Sacro Cuore, Rome, 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. Appl Health Econ 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Ruggeri M, Basile M, Zini A, Mangiafico S, Agostoni EC, Lobotesis K, Saver J, Coretti S, Drago C, Cicchetti A. Cost-effectiveness analysis of mechanical thrombectomy with stent retriever in the treatment of acute ischemic stroke in Italy. J Med Econ 2018; 21:902-911. [PMID: 29882711 DOI: 10.1080/13696998.2018.1484748] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND Stroke has a significant disease burden in terms of acute and long-term disability in Italy and throughout the world. Endovascular treatments for the management of a stroke event have been coupled in the past years with the possibility to mechanically remove the occlusion by means of specially designed thrombectomy devices, and their exclusive use showed levels of effectiveness in line with those of the existing pharmacological treatments. OBJECTIVE To assess the cost-effectiveness of mechanical thrombectomy (MT) with the Solitaire Revascularization Device (stent retriever) for the treatment of acute ischemic stroke (AIS) in patients with large vessel occlusions (LVOs), comparing MT plus intravenous tissue plasminogen activation (MT plus IV t-PA) vs IV t-PA alone, in Italy. METHODS A Markov model was used to simulate costs and benefits of MT plus IV t-PA and IV t-PA alone over a 5-year time horizon and considering the perspective of the Italian National Health Service (NHS). Results are reported in terms of Incremental Cost Effectiveness Ratio (ICER). Deterministic and probabilistic sensitivity analyses are carried out in order to test the robustness of the results. RESULTS Total costs of MT plus IV t-PA and IV t-PA alone are equal to €31,798 and €34,855, respectively. The MT allows incremental QALYs for 0.77, determining a dominant ICER. The utilities associated to the mRS health states are the parameters with the highest impact on the results. Multiway sensitivity analyses determined a 90% probability of dominance. CONCLUSIONS MT plus IV t-PA for AIS patients with LVO is cost-effective from year 1 through year 3, and cost-saving from year 4 onward in the Italian context, achieving better results, both in terms of efficacy and in terms of resource consumption.
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Affiliation(s)
- Matteo Ruggeri
- a ALTEMS Postgraduate School of Health Economics , Rome , Italy
| | - Michele Basile
- a ALTEMS Postgraduate School of Health Economics , Rome , Italy
| | - Andrea Zini
- b Stroke Unit, Neurology Clinic, Department of Neuroscience , Nuovo Ospedale Civile "S.Agostino-Estense", Modena University Hospital , Modena , Italy
| | - Salvatore Mangiafico
- c Neurovascular Interventional Unit , Careggi University Hospital , Florence , Italy
| | | | | | - Jeffrey Saver
- f Department of Neurology and Comprehensive Stroke Center , David Geffen School of Medicine, University of California, Los Angeles (UCLA) , Los Angeles , CA , USA
| | - Silvia Coretti
- a ALTEMS Postgraduate School of Health Economics , Rome , Italy
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Ruggeri M, Drago C, Moramarco V, Coretti S, Köppen J, Islam MK, Gibson J, Busse R, van Exel J, Sutton M, Askildsen JE, Bond CM, Elliott RF. New professional roles and patient satisfaction: Evidence from a European survey along three clinical pathways. Health Policy 2018; 122:1078-1084. [PMID: 30227975 DOI: 10.1016/j.healthpol.2018.07.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/24/2018] [Accepted: 07/25/2018] [Indexed: 10/28/2022]
Abstract
This paper reports the results of an empirical analysis exploring the impact of new professions (eg a physician associate) and new professional roles on patient experiences of and satisfaction with care. A sub set of data from a patient survey conducted as part of the MUNROS programme of work was used. The overall survey aim was to describe and quantify the use of new professionals and new roles for established health care professionals other than medical doctors, in primary and secondary care sectors in three care pathways in nine European countries Ordered logit models were used to investigate the association between: (1) patient satisfaction with the last visit; (2) with their care provider; (3) with the information provided and a set of covariates explaining the involvement of new professional roles in three clinical pathways: type 2 diabetes, heart disease and breast cancer. For patients with breast cancer, high levels of satisfaction are associated with the involvement of new professions/professional roles in the provision of conditions specific education and monitoring. For patients with heart disease, the involvement of new professions/professional roles is likely to have a negative impact on satisfaction. For patients with Type 2 diabetes results are ambivalent. Patients belonging to countries experiencing innovative models of healthcare delivery and with high levels of involvement of new professions/professional roles are generally more satisfied. In conclusion, the introduction of new professions does not affect patient satisfaction negatively, therefore introducing new health professional roles is a pursuable strategy from a patient satisfaction perspective, at least for breast cancer and type 2 diabetes.
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10
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Ruggeri M, Coretti S, Romano F, Kondili LA, Vella S, Cicchetti A. Economic Evaluation of the Hepatitis C Virus Treatment Extension to Early-Stage Fibrosis Patients: Evidence from the PITER Real-World Cohort. Value Health 2018; 21:783-791. [PMID: 30005750 DOI: 10.1016/j.jval.2017.10.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 10/12/2017] [Accepted: 10/29/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To conduct a cost-effectiveness analysis of two planning strategies of the second-generation direct-acting antiviral interferon-free regimens for the treatment of chronic hepatitis C virus infection. METHODS A lifetime multicohort model comprised 8125 real-life patients enrolled in the PITER (Italian platform for the study of viral hepatitis) registry, implemented by the ISS (Istituto Superiore di Sanità). Two treatment planning strategies were compared: 1) policy 1-treat all patients regardless of the stage of fibrosis (F0-F4) with second-generation direct-acting antivirals and 2) policy 2-treat patients at F3/F4 stage and those who are prioritized by the scientific guidelines first, and the remaining patients when they reach the F3 stage. Clinical outcomes and costs were evaluated by using a lifetime horizon Markov model and adopting the third-party payer perspective. Health outcomes were expressed in terms of quality-adjusted life-years (QALYs). A sensitivity analysis was run to explore first- and second-order uncertainty and heterogeneity. An expected value of perfect information analysis was also conducted. RESULTS Policy 1 exhibits an incremental cost-effectiveness ratio of €8,775/QALY gained and remains less than €30,000/QALY in 94% of realizations produced by the Monte-Carlo simulation. Such a proportion increases to 97% when adopting a threshold of €40,000/QALY gained. CONCLUSIONS Moving from the urgency criterion to evidence-based escalating strategies when prioritizing the access to new anti-hepatitis C virus treatments is a good investment in health, whose affordability should be explored through context-specific budget impact analyses.
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Affiliation(s)
- Matteo Ruggeri
- Institute of Economic Policy, Università Cattolica del Sacro Cuore, Milan, Italy; Graduate School of Health Economics and Management, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Silvia Coretti
- Graduate School of Health Economics and Management, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Federica Romano
- Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | - Americo Cicchetti
- Graduate School of Health Economics and Management, Università Cattolica del Sacro Cuore, Rome, Italy
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Cicchetti A, Coretti S, Mascia D, Mazzanti N, Refolo P, Rolli FR, Rumi F. Assessing social and economic impact of subcutaneous mAbs in oncology. Global & Regional Health Technology Assessment 2018. [DOI: 10.1177/2284240318757871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Americo Cicchetti
- ALTEMS (Alta Scuola di Economia e Management dei Sistemi Sanitari), Università Cattolica del Sacro Cuore, Roma, Italia
| | - Silvia Coretti
- ALTEMS (Alta Scuola di Economia e Management dei Sistemi Sanitari), Università Cattolica del Sacro Cuore, Roma, Italia
| | - Daniele Mascia
- Dipartimento di Scienze Aziendali, Università di Bologna, Italia
| | | | - Pietro Refolo
- Istituto di Bioetica e Medical Humanities, Facoltà di Medicina e chirurgia “A. Gemelli”, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Francesca R. Rolli
- ALTEMS (Alta Scuola di Economia e Management dei Sistemi Sanitari), Università Cattolica del Sacro Cuore, Roma, Italia
| | - Filippo Rumi
- ALTEMS (Alta Scuola di Economia e Management dei Sistemi Sanitari), Università Cattolica del Sacro Cuore, Roma, Italia
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Ruggeri M, Basile M, Coretti S, Drago C, Cicchetti A. Economic Analysis and Budget Impact of Tenofovir and Entecavir in the First-Line Treatment of Hepatitis B Virus in Italy. Appl Health Econ Health Policy 2017; 15:479-490. [PMID: 28197805 DOI: 10.1007/s40258-017-0311-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND Chronic hepatitis B is a common, progressive disease, particularly when viral replication is detected. Oral antivirals can suppress viral replication and prevent or delay the development of cirrhosis and liver-related complications. The treatments of chronic hepatitis B cannot totally cure the disease but can prevent its progression to hepatocellular carcinoma, decreasing the levels of both morbidity and mortality. To date, there are several therapies indicated by the international guidelines as first-line treatments for the management of hepatitis B; two of the most effective are those based on either tenofovir or entecavir. OBJECTIVE The aim of this study is to evaluate the cost-effectiveness of tenofovir and entecavir in the treatment of naïve patients with chronic hepatitis B. The two treatments are compared with the "no treatment" and to one another. METHODS The cost-effectiveness analysis was conducted using a Markov model; patients entered one of the following health states: chronic hepatitis, cirrhosis (compensated or decompensated), hepatocellular carcinoma, liver transplantation or death. The analysis was carried out from the perspective of the Italian National Health Service by considering a life-time horizon with cycles lasting 1 year and with costs and QALYs (quality-adjusted life years) discounted at a rate of 3.5%. The results of the model were analysed in terms of incremental cost-effectiveness ratio (ICER). RESULTS ICERs for tenofovir and entecavir emerging from the comparison versus "no treatment" were equal to €10,274.73 and €16,300.44 per QALY gained, respectively, on the life-time horizon. Tenofovir was dominant in the direct comparison with entecavir, indicating more QALYs and a lower consumption of resources. The Monte Carlo simulation demonstrated that in 97% (tenofovir) and in 85% (entecavir) of the scenarios performed, the cost per QALY fell below the threshold of €30,000/QALY. The budget impact analysis showed savings for tenofovir amounting to 33% compared to entecavir in the first year on treatment and to 31% in following years. CONCLUSIONS Entecavir and tenofovir are recommended for the treatment of patients with chronic Hepatitis B in the Italian Health System. In particular, tenofovir appeared to be the more cost-effective drug for the management of chronic hepatitis B virus (HBV) infections. These results could help decision makers and clinicians to address their decision when choosing a first-line treatment for the management of people affected by chronic HBV.
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Affiliation(s)
- M Ruggeri
- Catholic University of Sacred Heart, Rome, Italy
| | - M Basile
- Catholic University of Sacred Heart, Rome, Italy.
| | - S Coretti
- Catholic University of Sacred Heart, Rome, Italy
| | - C Drago
- "Nicolò Cusano" University, Rome, Italy
| | - A Cicchetti
- Catholic University of Sacred Heart, Rome, Italy
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Sirven N, Rapp T, Coretti S, Ruggeri M, Cicchetti A. Preventing mobility disability in Europe: a health economics perspective from the SPRINTT study. Aging Clin Exp Res 2017; 29:75-79. [PMID: 28160252 DOI: 10.1007/s40520-016-0713-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 09/21/2016] [Indexed: 10/20/2022]
Abstract
In a global context of population aging, gaining better knowledge of the mechanisms leading to loss of autonomy has become a major objective, notably with the aim of implementing effective preventive health policies. The concept of frailty, originally introduced in gerontology and geriatrics as a precursor state to functional dependency, appears as a useful tool in this specific context. The "Sarcopenia and Physical fRailty IN older people: multi-componenT Treatment strategies" (SPRINTT) project will provide a unique opportunity to explore health economics issues associated with frailty. In terms of health economics, the loss of autonomy approach retained here focuses on the economic and social causes and consequences of the onset of frailty in older adults, and examines the challenges not only in terms of health system efficiency but also in terms of social protection.
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de Bont A, van Exel J, Coretti S, Ökem ZG, Janssen M, Hope KL, Ludwicki T, Zander B, Zvonickova M, Bond C, Wallenburg I. Reconfiguring health workforce: a case-based comparative study explaining the increasingly diverse professional roles in Europe. BMC Health Serv Res 2016; 16:637. [PMID: 27825345 PMCID: PMC5101691 DOI: 10.1186/s12913-016-1898-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 11/02/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Over 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? METHODS We 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. RESULTS The 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. CONCLUSION There 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.
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Affiliation(s)
- Antoinette de Bont
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Job van Exel
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Silvia Coretti
- Postgraduate School of Health Economics and management (ALTEMS), Universita Cattolica del Sacro Cuore School of Economics, Milan, Italy
| | - Zeynep Güldem Ökem
- Faculty of Economics and Administrative Sciences, TOBB University of Economics and Technology, Ankara, Turkey
| | - Maarten Janssen
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | | | - Tomasz Ludwicki
- Faculty of Management, the University of Warsaw, Warsaw, Poland
| | - Britta Zander
- Faculty of Economics and Management, Technische Universität Berlin, Berlin, Germany
| | - Marie Zvonickova
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Christine Bond
- Division of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland
| | - Iris Wallenburg
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - On behalf of the MUNROS Team
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
- Postgraduate School of Health Economics and management (ALTEMS), Universita Cattolica del Sacro Cuore School of Economics, Milan, Italy
- Faculty of Economics and Administrative Sciences, TOBB University of Economics and Technology, Ankara, Turkey
- Uni Research Rokkan Centre, Bergen, Norway
- Faculty of Management, the University of Warsaw, Warsaw, Poland
- Faculty of Economics and Management, Technische Universität Berlin, Berlin, Germany
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
- Division of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland
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Romano F, Ruggeri M, Coretti S, Giannini EG, Sacchini D, Annichiarico BE, Marchetti M, Rodeghiero F, Lidonnici D. Economic assessment of eltrombopag in the treatment of thrombocytopenia. Expert Rev Pharmacoecon Outcomes Res 2016; 15:713-20. [PMID: 26176754 DOI: 10.1586/14737167.2015.1028373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study assesses the cost-effectiveness of eltrombopag in the treatment of hepatitis C virus (HCV)-related thrombocytopenia. METHODS A Markov model was constructed on the basis of the clinical trials ENABLE 1 and ENABLE 2. Three alternatives were considered: scenario 1; treatment with eltrombopag in both the enabling phase and during antiviral therapy, as in the ENABLE trial design; scenario 2; no eltrombopag treatment and no antiviral therapy; scenario 3; no eltrombopag treatment and subsequent administration of a reduced dose of peg-IFN. RESULTS Base case results demonstrate that scenario 1 is associated with a cost per QALY of €30,020.94 in comparison with scenario 2. The incremental cost-effectiveness ratio reaches a value of €32,752.44 per QALY when scenario 1 is compared with scenario 3. CONCLUSION The use of eltrombopag in HCV patients with thrombocytopenia is cost-effective as it leads to a reduction in disease progression and thus a drop in the number of patients with advanced liver disease.
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Affiliation(s)
- Federica Romano
- ALTEMS - Postgraduate School of Health Economics and Management, Università Cattolica del Sacro Cuore, Rome, Italy
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Rossitto C, Gueli Alletti S, Romano F, Fiore A, Coretti S, Oradei M, Ruggeri M, Cicchetti A, Marchetti M, Fanfani F, Scambia G. Use of robot-specific resources and operating room times: the case of Telelap Alf-X robotic hysterectomy. Int J Med Robot 2016; 12:613-619. [DOI: 10.1002/rcs.1724] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 11/21/2015] [Accepted: 11/26/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Cristiano Rossitto
- Division of Gynaecological Oncology; Catholic University of the Sacred Heart; Rome Italy
| | | | - Federica Romano
- ALTEMS, Postgraduate School in Health Economics and Management; Catholic University of the Sacred Heart; Rome Italy
| | - Alessandra Fiore
- ALTEMS, Postgraduate School in Health Economics and Management; Catholic University of the Sacred Heart; Rome Italy
| | - Silvia Coretti
- ALTEMS, Postgraduate School in Health Economics and Management; Catholic University of the Sacred Heart; Rome Italy
| | - Marco Oradei
- Health Technology Assessment Unit; 'A.Gemelli' Hospital; Rome Italy
| | - Matteo Ruggeri
- ALTEMS, Postgraduate School in Health Economics and Management; Catholic University of the Sacred Heart; Rome Italy
- Institute of Economic Policy; Catholic University of the Sacred Heart; Milan Italy
| | - Americo Cicchetti
- ALTEMS, Postgraduate School in Health Economics and Management; Catholic University of the Sacred Heart; Rome Italy
- Health Technology Assessment Unit; 'A.Gemelli' Hospital; Rome Italy
| | - Marco Marchetti
- Health Technology Assessment Unit; 'A.Gemelli' Hospital; Rome Italy
| | - Francesco Fanfani
- Division of Gynaecological Oncology; Catholic University of the Sacred Heart; Rome Italy
| | - Giovanni Scambia
- Division of Gynaecological Oncology; Catholic University of the Sacred Heart; Rome Italy
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Menditto E, Orlando V, Coretti S, Putignano D, Fiorentino D, Ruggeri M. Doctors commitment and long-term effectiveness for cost containment policies: lesson learned from biosimilar drugs. Clinicoecon Outcomes Res 2015; 7:575-81. [PMID: 26635482 PMCID: PMC4646475 DOI: 10.2147/ceor.s88531] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Agency is a pervasive feature of the health care market, with doctors acting as agents for both patients and the health care system. In a context of scarce resources, doctors are required to take opportunity cost into account when prescribing treatments, while cost containment policies cannot overlook their active role in determining health care resource allocation. This paper addresses this issue, investigating the effects of cost containment measures in the market of biosimilar drugs that represent a viable and cost-saving strategy for the reduction of health care expenditure. The analysis focuses on a particular region in Italy, where several timely policies to incentivize biosimilar prescribing were launched. METHODS Drugs were identified by the anatomical therapeutic chemical classification system. Information about biosimilar drugs and their originator biological products was extracted from the IMS Health regional database. Drug consumption was expressed in terms of counting units, while expenditure was evaluated in Euro (€). The market penetration of biosimilars was analyzed by year and quarterly. RESULTS In the Campania region of Italy, the effects of cost containment policies, launched between 2009 and 2013, showed the prescription of biosimilars strongly increasing in 2010 until prescribing levels reached and exceeded the market share of the reference biological products in 2012. After a slight reduction, a plateau was observed at the beginning of 2013. At the same time, the use of the originator products had been decreasing until the first quarter of 2011. However, after a 1-year plateau, this trend was reversed, with a new increase in the consumption of the originators observed. CONCLUSION Results show that the cost containment policies, applied to cut health expenditure "to cure and not to care", did not produce the cultural change necessary to make these policies effective in the long run. Therefore, top-down policies for cost containment are not successful; rather, a bottom-up approach based on consensus among professionals should become the preferred option.
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Affiliation(s)
- Enrica Menditto
- CIRFF, Center of Pharmacoeconomics, Federico II University of Naples, Naples, Italy
| | - Valentina Orlando
- CIRFF, Center of Pharmacoeconomics, Federico II University of Naples, Naples, Italy
| | - Silvia Coretti
- Postgraduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, School of Economics, Rome, Italy
| | - Daria Putignano
- CIRFF, Center of Pharmacoeconomics, Federico II University of Naples, Naples, Italy
| | - Denise Fiorentino
- CIRFF, Center of Pharmacoeconomics, Federico II University of Naples, Naples, Italy
| | - Matteo Ruggeri
- Postgraduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, School of Economics, Rome, Italy
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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 Health 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Ruggeri M, Coretti S. Do Probability and Certainty Equivalent Techniques Lead to Inconsistent Results? Evidence from Gambles Involving Life-Years and Quality of Life. Value Health 2015; 18:413-424. [PMID: 26091595 DOI: 10.1016/j.jval.2014.12.019] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 11/19/2014] [Accepted: 12/22/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Within the standard gamble approach to the elicitation of health preferences, no previous studies compared probability equivalent (PE) and certainty equivalent (CE) techniques OBJECTIVE This study aimed to explore the differences between CE and PE techniques when payoffs are expressed in terms of life-years or quality of life. METHODS Individuals were interviewed through both CE and PE techniques within an experimental setting. Inferential statistics and regression analysis where applied to process data. Order and sequence effect were also investigated. RESULTS On average, the elicitation technique did not affect individuals' risk attitude significantly. Individuals proved to be risk averse in gambles concerning life-years and risk seekers in those concerning quality of life. No order or sequence effect was observed. Risk premium, measuring the strength of risk attitude as the percentage variation between the individual's estimated PE or CE and the risk neutral PE or CE, was affected by the kind of gamble that the interviewee is presented with. It increased in gambles concerning health profiles, denoting a stronger risk propensity, and decreased in gambles concerning life years, denoting a stronger risk aversion. CONCLUSION The choice of the elicitation technique did not affect the individuals' risk attitude significantly, which instead was sensitive to the kind of gamble.
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Affiliation(s)
- Matteo Ruggeri
- Institute of Policy and Economics, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Silvia Coretti
- Graduate School of Health Economics and Management, Università Cattolica del Sacro Cuore, Rome, Italy
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Coretti S, Romano F, Orlando V, Codella P, Prete S, Di Brino E, Ruggeri M. Economic evaluation of screening programs for hepatitis C virus infection: evidence from literature. Risk Manag Healthc Policy 2015; 8:45-54. [PMID: 25960681 PMCID: PMC4410893 DOI: 10.2147/rmhp.s56911] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [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] [Indexed: 12/19/2022] Open
Abstract
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 $4,200 and $50,000/quality adjusted life year gained, while in those focusing on specific risk factors the incremental cost-effectiveness ratio ranged between $848 and $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.
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Affiliation(s)
- Silvia Coretti
- Post-Graduate School of Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Federica Romano
- Post-Graduate School of Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valentina Orlando
- Center of Pharmacoeconomics (CIRFF), Department of Pharmacy, Federico II University, Naples, Italy
| | - Paola Codella
- Post-Graduate School of Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Sabrina Prete
- Post-Graduate School of Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Eugenio Di Brino
- Post-Graduate School of Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Matteo Ruggeri
- Post-Graduate School of Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
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Abstract
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.
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Affiliation(s)
- Silvia Coretti
- Dr. Catholic University of Sacred Hearth - Faculty of Economics, L.go F. Vito 1, Rome 00168, Italy
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Coretti S, Ruggeri M, Codella P. Cost Effectiveness Analysis of A Vaccine To Prevent Herpes Zoster and Postherpetic Neuralgia in Italy. Value Health 2014; 17:A511. [PMID: 27201575 DOI: 10.1016/j.jval.2014.08.1572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- S Coretti
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - M Ruggeri
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - P Codella
- Università Cattolica del Sacro Cuore, Rome, Italy
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Ruggeri M, Coretti S, Gasbarrini A, Cicchetti A. Economic assessment of an anti-HCV screening program in Italy. Value Health 2013; 16:965-72. [PMID: 24041346 DOI: 10.1016/j.jval.2013.07.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 06/08/2013] [Accepted: 07/23/2013] [Indexed: 05/23/2023]
Abstract
BACKGROUND The progression of hepatitis C virus (HCV) disease usually occurs over a 10-year period. HCV-related complications as well as the highly debilitating effects on patients represent a significant item of expenditure for the National Health Service. Early detection of HCV infection is an excellent opportunity to improve patients' quality of life and to rationalize resource allocation. OBJECTIVE The aim of this study was to provide a cost-effectiveness evaluation of an anti-HCV screening program in the Italian National Health Service perspective. METHODS We 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 as first-level test and the research of HCV RNA as second-level detection; patients with positive test results are treated with peg-interferon alfa in combination with ribavirine. Parameters were derived from the literature and validated through experts' opinion. Costs and benefits were discounted by 3.5%. Results were expressed as cost/quality-adjusted life-year (QALY) gained through the screening program compared with the treatment of symptomatic patients. Deterministic and probabilistic sensitivity analysis was performed. RESULTS The incremental cost-effectiveness ratio of the ''Test Strategy'' is €5171/QALY, definitively below the cost/QALY of other approved treatments in Italy. Model results turned out as sensitive to the age of the target population, the prevalence of HCV infection, and the time horizon adopted. CONCLUSIONS The anti-HCV screening program is a valid health-related investment improving patients' quality of life and survival with an acceptable expenditure increase for the National Health Service.
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Affiliation(s)
- Matteo Ruggeri
- Faculty of Economics, Catholic University of Sacred Heart, Rome, Italy.
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Cicchetti A, Ruggeri M, Coretti S, Piscaglia A, Ponziani FR, Lanati E, Gasbarrini A. Valutazione economica di un programma di screening anti-HCV in Italia. ACTA ACUST UNITED AC 2013. [DOI: 10.1007/bf03320686] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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