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Dovizio M, Hartz S, Buzzoni C, Redondo I, Nedeljkovic Protic M, Birra D, Perrone V, Veronesi C, Degli Esposti L, Armuzzi A. Real-World Treatment Patterns and Healthcare Resource Use for Ulcerative Colitis and Crohn's Disease in Italy. Adv Ther 2024:10.1007/s12325-024-02840-x. [PMID: 38619721 DOI: 10.1007/s12325-024-02840-x] [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: 12/19/2023] [Accepted: 03/11/2024] [Indexed: 04/16/2024]
Abstract
INTRODUCTION Real-world data are used to inform decision-makers and optimise therapeutic management for patients with ulcerative colitis (UC) and Crohn's disease (CD). We analysed data on the epidemiology (by using proxies of prevalence and incidence), patient characteristics, treatment patterns and associated healthcare direct costs for the management of patients with UC and patients with CD in Italy. METHODS This retrospective observational study used administrative databases from eight Local Health Units geographically distributed across Italy. Adult patients with a hospitalisation and/or an exemption for UC or CD were included. Study outcomes were summarised descriptively, and limited statistical tests were performed. RESULTS At baseline, 9255 adults with UC and 4747 adults with CD were included. Mean (standard deviation) age at inclusion was 54.0 (18.4)/48.6 (18.1) years, for UC/CD. The estimated average incidence of UC and CD for the period 2013-2020 was 36.5 and 18.7 per 100,000, respectively. The most frequently prescribed drug category for patients with UC/CD was conventional treatment [mesalazine and topical corticosteroids (67.4%/61.1%), immunomodulators and systemic corticosteroids (43.2%/47.7%)], followed by biologic treatments (2.1%/5.1%). The mean annual total direct cost per patient was 7678 euro (€), for UC and €6925 for CD. CONCLUSION This analysis, carried-out in an Italian clinical setting, may help to optimise therapy for patients with UC and CD and provide relevant clinical practice data to inform decision-makers.
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Affiliation(s)
- Melania Dovizio
- CliCon S.R.L. Società Benefit Health, Economics and Outcomes Research, Via Murri, 9-40137, Bologna, Italy
| | | | | | | | | | | | - Valentina Perrone
- CliCon S.R.L. Società Benefit Health, Economics and Outcomes Research, Via Murri, 9-40137, Bologna, Italy
| | - Chiara Veronesi
- CliCon S.R.L. Società Benefit Health, Economics and Outcomes Research, Via Murri, 9-40137, Bologna, Italy
| | - Luca Degli Esposti
- CliCon S.R.L. Società Benefit Health, Economics and Outcomes Research, Via Murri, 9-40137, Bologna, Italy
| | - Alessandro Armuzzi
- IBD Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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Perrone V, Sabatino S, Avitabile A, Dovizio M, Leogrande M, Degli Esposti L. Real world evidence: patients with alopecia areata in Italy. Ital J Dermatol Venerol 2024; 159:182-189. [PMID: 38650498 DOI: 10.23736/s2784-8671.24.07785-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND This real-world analysis aimed at characterizing patients hospitalized for alopecia areata (AA) in Italy, focusing on comorbidities, treatment patterns and the economic burden for disease management. METHODS Administrative databases of healthcare entities covering 8.9 million residents were retrospectively browsed to include patients of all ages with hospitalization discharge diagnosis for AA from 2010 to 2020. The population was characterized during the year before the first AA-related hospitalization (index-date) and followed-up for all the available successive period. AA drug prescriptions and treatment discontinuation were analyzed during follow-up. Healthcare costs were also examined. RESULTS Among 252 patients with AA (mean age 32.1 years, 40.9% males), the most common comorbidities were thyroid disease (22.2%) and hypertension (21.8%), consistent with literature; only 44.4% (112/252) received therapy for AA, more frequently with prednisone, triamcinolone and clobetasol. Treatment discontinuation (no prescriptions during the last trimester) was observed in 86% and 88% of patients, respectively at 12 and 24-month after therapy initiation. Overall healthcare costs were 1715€ per patient (rising to 2143€ in the presence of comorbidities), mostly driven by hospitalization and drugs expenses. CONCLUSIONS This first real-world description of hospitalized AA patients in Italy confirmed the youth and female predominance of this population, in line with international data. The large use of corticosteroids over other systemic therapies followed the Italian guidelines, but the high discontinuation rates suggest an unmet need for further treatment options. Lastly, the analysis of healthcare expenses indicated that hospitalizations and drugs were the most impactive cost items.
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Affiliation(s)
- Valentina Perrone
- CliCon S.r.l. Società Benefit, Health Economics and Outcomes Research, Bologna, Italy -
| | | | | | - Melania Dovizio
- CliCon S.r.l. Società Benefit, Health Economics and Outcomes Research, Bologna, Italy
| | - Melania Leogrande
- CliCon S.r.l. Società Benefit, Health Economics and Outcomes Research, Bologna, Italy
| | - Luca Degli Esposti
- CliCon S.r.l. Società Benefit, Health Economics and Outcomes Research, Bologna, Italy
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Dovizio M, Veronesi C, Bartolini F, Cavaliere A, Grego S, Pagliaro R, Procacci C, Ubertazzo L, Bertizzolo L, Muzii B, Parisi S, Perrone V, Baraldi E, Bozzola E, Mosca F, Esposti LD. Clinical and economic burden of respiratory syncytial virus in children aged 0-5 years in Italy. Ital J Pediatr 2024; 50:57. [PMID: 38528616 DOI: 10.1186/s13052-024-01628-7] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 03/13/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is among the leading causes of hospitalization due to lower respiratory tract infections (LRTIs) in children younger than 5 years worldwide and the second cause of infant death after malaria. RSV infection occurs in almost all the infants before the second year of life with variable clinical severity, often requiring medical assistance. This analysis investigated patients aged 0-5 years with RSV infection focusing on epidemiology, clinical features, and economic burden of RSV-associated hospitalizations in a setting of Italian real clinical practice. METHODS An observational retrospective analysis was conducted on administrative databases of healthcare entities covering around 2.6 million residents of whom 120,000 health-assisted infants aged < 5 years. From 2010 to 2018, pediatric patients were included in the presence of hospitalization discharge diagnosis for RSV infections, and RSV-related acute bronchiolitis or pneumonia. Epidemiology, demographics, clinical picture and costs were evaluated in RSV-infected patients, overall and stratified by age ranges (0-1, 1-2, 2-5 years) and compared with an age-matched general population. RESULTS Overall 1378 RSV-infected children aged 0-5 years were included. Among them, the annual incidence rate of RSV-related hospitalizations was 175-195/100,000 people, with a peak in neonates aged < 1 year (689-806/100,000). While nearly 85% of infected infants were healthy, the remaining 15% presented previous hospitalization for known RSV risk factors, like preterm birth, or congenital heart, lung, and immune diseases. The economic analysis revealed that direct healthcare costs per patient/year were markedly higher in RSV patients than in the general population (3605€ vs 344€). CONCLUSIONS These findings derived from the real clinical practice in Italy confirmed that RSV has an important epidemiological, clinical, and economic burden among children aged 0-5 years. While the complex management of at-risk infants was confirmed, our data also highlighted the significant impact of RSV infection in infants born at term or otherwise healthy, demonstrating that all infants need protection against RSV disease, reducing then the risk of medium and long-term complications, such as wheezing and asthma.
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Affiliation(s)
- Melania Dovizio
- CliCon Società Benefit S.r.l., Health, Economics & Outcomes Research, Via Murri 9, Bologna, 40137, Italy
| | - Chiara Veronesi
- CliCon Società Benefit S.r.l., Health, Economics & Outcomes Research, Via Murri 9, Bologna, 40137, Italy
| | | | | | - Stefano Grego
- Dipartimento Tecnico-Amministrativo, ASL 3 Genovese, Genova, Italy
| | - Romina Pagliaro
- UOC Farmaceutica Territoriale, Azienda Sanitaria Locale Roma 5, Rome, Italy
| | - Cataldo Procacci
- Dipartimento Farmaceutico, ASL BAT (Barletta-Trani-Andria), Trani, Italy
| | | | | | | | | | - Valentina Perrone
- CliCon Società Benefit S.r.l., Health, Economics & Outcomes Research, Via Murri 9, Bologna, 40137, Italy
| | - Eugenio Baraldi
- Neonatal Intensive Care Unit, Department of Woman's and Child's Health, Padova University Hospital, Padova, Italy
| | - Elena Bozzola
- Pediatric Disease Unit, Bambino Gesù Children Hospital IRCCS, Rome, Italy
| | - Fabio Mosca
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Luca Degli Esposti
- CliCon Società Benefit S.r.l., Health, Economics & Outcomes Research, Via Murri 9, Bologna, 40137, Italy.
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Bo M, Fumagalli S, Degli Esposti L, Perrone V, Dovizio M, Poli D, Marcucci R, Verdecchia P, Reboldi G, Lip GYH, Ungar A, Boccanelli A, Fumagalli C, Marchionni N. Anticoagulation in atrial fibrillation. A large real-world update. Eur J Intern Med 2024; 121:88-94. [PMID: 37879969 DOI: 10.1016/j.ejim.2023.10.010] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/03/2023] [Accepted: 10/10/2023] [Indexed: 10/27/2023]
Abstract
INTRODUCTION In a large nationwide administrative database including ∼35 % of Italian population, we analyzed the impact of oral anticoagulant treatment (OAT) in patients with a hospital diagnosis of non-valvular atrial fibrillation (NVAF). METHODS AND RESULTS Of 170404 OAT-naïve patients (mean age 78.7 years; 49.4 % women), only 61.1 % were prescribed direct oral anticoagulants, DOACs, or vitamin-K antagonists, VKAs; 14.2 % were given aspirin (ASA), and 24.8 % no anti-thrombotic drugs (No Tx). We compared ischemic stroke (IS), IS and systemic embolism (IS/SE), intracranial hemorrhage (ICH), major bleeding (MB), major gastro-intestinal bleeding, all-cause deaths and the composite outcome, across four propensity-score matched treatment cohorts with >15400 patients each. Over 2.9±1.5 years, the incidence of IS and IS/SE was slightly less with VKAs than with DOACs (1.62 and 1.84 vs 1.81 and 1.99 events.100 person-years; HR=0.85, 95%CI=0.76-0.95 and HR=0.87, 95%CI=0.78-0.97). This difference disappeared in a sensitivity analysis which excluded those patients treated with low-dose of apixaban, edoxaban, or rivaroxaban (41.7% of DOACs cohort). Compared with DOACs, VKAs were associated with greater incidence of ICH (1.09 vs 0.81; HR=1.38, 95%CI=1.17-1.62), MB (3.78 vs 3.31; HR=1.14, 95%CI=1.02-1.28), all-cause mortality (9.66 vs 10.10; HR=1.07, 95%CI=1.02-1.11), and composite outcome (13.72 vs 13.32; HR=1.04, 95%CI=1.01-1.08). IS, IS/SE, and mortality were more frequent with ASA or No Tx than with VKAs or DOACs (p<0.001 for all comparisons). CONCLUSIONS Beyond confirming the association with a better net clinical benefit of DOACs over VKAs, our findings substantiate the large proportion of NVAF patients still inappropriately anticoagulated, thereby reinforcing the need for educational programs.
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Affiliation(s)
- Mario Bo
- Section of Geriatrics, Department of Medical Sciences, University of Turin, AOU Città della Salute e della Scienza, Molinette, Turin, Italy
| | - Stefano Fumagalli
- Department of Experimental and Clinical Medicine, University of Florence, Largo G. Brambilla 3, Florence 50134, Italy.
| | - Luca Degli Esposti
- CliCon Società Benefit Srl, Health, Economics & Outcome Research, Bologna, Italy
| | - Valentina Perrone
- CliCon Società Benefit Srl, Health, Economics & Outcome Research, Bologna, Italy
| | - Melania Dovizio
- CliCon Società Benefit Srl, Health, Economics & Outcome Research, Bologna, Italy
| | - Daniela Poli
- Department of Experimental and Clinical Medicine, University of Florence, Largo G. Brambilla 3, Florence 50134, Italy
| | - Rossella Marcucci
- Department of Experimental and Clinical Medicine, University of Florence, Largo G. Brambilla 3, Florence 50134, Italy
| | - Paolo Verdecchia
- Fondazione Umbra Cuore e Ipertensione-ONLUS and Struttura Complessa di Cardiologia, Ospedale S. Maria della Misericordia, Perugia, Italy
| | - Gianpaolo Reboldi
- Department of Medicine and Centro di Ricerca Clinica e Traslazionale (CERICLET), University of Perugia, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Danish Centre for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Andrea Ungar
- Department of Experimental and Clinical Medicine, University of Florence, Largo G. Brambilla 3, Florence 50134, Italy
| | | | - Carlo Fumagalli
- Department of Experimental and Clinical Medicine, University of Florence, Largo G. Brambilla 3, Florence 50134, Italy; Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Niccolò Marchionni
- Department of Experimental and Clinical Medicine, University of Florence, Largo G. Brambilla 3, Florence 50134, Italy
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Degli Esposti L, Perrone V, Sangiorgi D, Saragoni S, Dovizio M, Caprioli F, Rizzello F, Daperno M, Armuzzi A. Estimation of patients affected by inflammatory bowel disease potentially eligible for biological treatment in a real-world setting. Dig Liver Dis 2024; 56:29-34. [PMID: 37147200 DOI: 10.1016/j.dld.2023.04.022] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/22/2023] [Accepted: 04/23/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND/AIMS This analysis estimated the number of inflammatory bowel disease (IBD) patients presenting criteria of eligibility for biological therapies in an Italian real-world setting. METHODS An observational analysis was performed on administrative databases of a sample of Local Health Units, covering 11.3% of the national population. Adult IBD patients (CD or UC) from 2010 to the end of data availability were included. Eligibility criteria for biologics were the following: Criterion A, steroid-refractory active disease; Criterion B, steroid-dependent patients; Criterion C, intolerance or contraindication to conventional therapies; Criterion D, severe relapsing disease; Criterion E (CD only), highly active CD disease and poor prognosis. RESULTS Of 26,781 IBD patient identified, 18,264 (68.2%) were treated: 3,125 (11.7%) with biologics and 15,139 (56.5%) non-biotreated. Among non-biotreated, 7,651 (28.6%) met at least one eligibility criterion for biologics, with criterion B (steroid-dependence) and criterion D (relapse) as the most represented (58-27% and 56-76%, respectively). Data reportioned to the Italian population estimated 67,635 patients as potentially eligible for biologics. CONCLUSIONS This real-world analysis showed a trend towards undertreatment with biologics in IBD patients with 28.6% being potentially eligible, suggesting that an unmet medical need still exists among the Italian general clinical practice for IBD management.
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Affiliation(s)
- Luca Degli Esposti
- CliCon S.r.l. Società Benefit Health, Economics & Outcomes Research, Bologna, Italy.
| | - Valentina Perrone
- CliCon S.r.l. Società Benefit Health, Economics & Outcomes Research, Bologna, Italy
| | - Diego Sangiorgi
- CliCon S.r.l. Società Benefit Health, Economics & Outcomes Research, Bologna, Italy
| | - Stefania Saragoni
- CliCon S.r.l. Società Benefit Health, Economics & Outcomes Research, Bologna, Italy
| | - Melania Dovizio
- CliCon S.r.l. Società Benefit Health, Economics & Outcomes Research, Bologna, Italy
| | - Flavio Caprioli
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Fernando Rizzello
- IBD Unit, DIMEC, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Marco Daperno
- Gastroeterology Unit, Mauriziano Hospital, Turin, Italy
| | - Alessandro Armuzzi
- IBD Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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Snyman JR, Bortolotto LA, Degli Esposti L, Jayagopal PB, Konradi AO, Perrone V, Borghi C. A real-world analysis of outcomes and healthcare costs of patients on perindopril/indapamide/amlodipine single-pill vs. multiple-pill combination in Italy. J Hypertens 2024; 42:136-142. [PMID: 37728093 PMCID: PMC10712996 DOI: 10.1097/hjh.0000000000003570] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/21/2023] [Accepted: 08/22/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVES This analysis compared adherence, cardiovascular (CV) events and all-cause mortality incidence, and healthcare costs among hypertensive patients treated with perindopril (PER)/indapamide (IND)/amlodipine (AML) in single-pill combination (SPC) vs. multiple-pill combination, in a real-world setting in Italy. METHODS In this observational retrospective analysis of Italian administrative databases, adult patients treated with PER/IND/AML between 2010 and 2020 were divided into two cohorts: single-pill vs. multiple-pill. Patient data were available for at least one year before and after index date. Propensity score matching (PSM) was applied to reduce selection bias. Adherence was defined as proportion of days covered: non-adherence, <40%; partial adherence, 40-79%, and adherence ≥80%. Mortality incidence and CV events as single, or composite, endpoints were evaluated after first year of follow-up. Healthcare cost analyses were performed from the perspective of the Italian National Health Service. RESULTS Following PSM, the single-pill cohort included 12 150 patients, and the multiple-pill cohort, 6105. The SPC cohort had a significantly higher percentage of adherent patients vs. the multiple-pill cohort (59.9% vs. 26.9%, P < 0.001). Following the first year of follow-up, incidence of all-cause mortality, and combined endpoint of all-cause mortality and CV events were lower in the SPC cohort compared with multiple-pill cohort. Average annual direct healthcare costs were lower in the single-pill cohort (€2970) vs. multiple-pill cohort (€3642); cost of all drugs and all-cause hospitalizations were major contributors. CONCLUSION The SPC of PER/IND/AML, compared with multiple-pill combination, is associated with higher adherence to medication, lower incidence of CV events and mortality, and reduced healthcare costs.
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Affiliation(s)
- Jacques R. Snyman
- Forte Research (Pty ltd) and Private Practice South Africa, Pretoria, South Africa
| | | | - Luca Degli Esposti
- CliCon S.r.l., Società Benefit-Health, Economics & Outcomes Research, Bologna, Italy
| | | | | | - Valentina Perrone
- CliCon S.r.l., Società Benefit-Health, Economics & Outcomes Research, Bologna, Italy
| | - Claudio Borghi
- University of Bologna, IRCCS Ospedale S. Orsola, Bologna, Italy
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Degli Esposti L, Perrone V, Dovizio M, Sangiorgi D, DI Cesare A, Rosi E, Peris K, Prignano F. Estimation of patients with psoriasis potentially eligible and currently untreated with biological drugs in Italy. Ital J Dermatol Venerol 2023; 158:445-451. [PMID: 37768706 DOI: 10.23736/s2784-8671.23.07568-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
BACKGROUND Psoriasis (PSO) patients can benefit from the growing availability of novel biological agents, that are often underused or discontinued. This real-world analysis estimated PSO patients potentially eligible and currently untreated with biologics in Italy. METHODS An observational analysis was performed on administrative databases of a pool of healthcare entities, covering 11.3% of Italian population. During the inclusion period (2010- 2020), patients were identified by: 1) at least one prescription of topical drugs for PSO; or 2) active exemption for PSO; or 3) at least one PSO hospital discharge diagnosis. The index-date was the first PSO identification across inclusion period. Eligibility for biologics was evaluated prior to index-date (characterization period) through two not-mutually exclusive criteria: Criterion A, failure of at least one systemic treatment, and/or Criterion B, onset of psoriatic arthritis (PsA). Data were re-proportioned to the Italian population. RESULTS The study sample showed a PSO prevalence of 2%. Projection to 2020 national population (N=59,236.213) estimated 1.43 million Italian patients affected by PSO: 95% treated with conventional therapies, 4% with biologics, and 1% untreated. Among those non-treated with biologics, 3.8% of overall PSO patients met one or both eligibility criteria for biologics, specifically 25% met criterion A (failure to conventional treatments), 68% criterion B (PsA co-diagnosis), and 7% met both. About half of them had 1 or 2 comorbidities and 30% above 3. CONCLUSIONS These findings from real clinical practice estimated about 4% PSO patients potentially eligible for biologics, but still untreated, with nearly one-third exhibiting a complex comorbidity profile.
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Affiliation(s)
- Luca Degli Esposti
- CliCon S.r.l., Società Benefit, Health, Economics & Outcomes Research, Bologna, Italy -
| | - Valentina Perrone
- CliCon S.r.l., Società Benefit, Health, Economics & Outcomes Research, Bologna, Italy
| | - Melania Dovizio
- CliCon S.r.l., Società Benefit, Health, Economics & Outcomes Research, Bologna, Italy
| | - Diego Sangiorgi
- CliCon S.r.l., Società Benefit, Health, Economics & Outcomes Research, Bologna, Italy
| | - Antonella DI Cesare
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Elia Rosi
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Ketty Peris
- Unit of Dermatology, Department of Translational Medicine and Surgery, Sacred Heart Catholic University, Rome, Italy
| | - Francesca Prignano
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
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Degli Esposti L, Dovizio M, Perrone V, Veronesi C, Andretta M, Bacca M, Barbieri A, Bartolini F, Cavaliere A, Chinellato A, Ciaccia A, Cillo M, Citraro R, Costantini A, Dell'Orco S, Ferrante F, Gentile S, Grego S, Mancini D, Moscogiuri R, Mosele E, Pagliaro R, Procacci C, Re D, Santoleri F, Ubertazzo L, Vercellone A, Ramirez de Arellano A, Gigliotti G, Quartuccio L. Profile, Healthcare Resource Consumption and Related Costs in ANCA-Associated Vasculitis Patients: A Real-World Analysis in Italy. Adv Ther 2023; 40:5338-5353. [PMID: 37787877 PMCID: PMC10611841 DOI: 10.1007/s12325-023-02681-0] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/07/2023] [Indexed: 10/04/2023]
Abstract
INTRODUCTION Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV) are rare autoimmune diseases triggering inflammation of small vessels. This real-world analysis was focused on the most common AAV forms, granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA), to describe patients' demographic and clinical characteristics, therapeutic management, disease progression, and the related economic burden. METHODS A retrospective analysis was conducted on administrative databases of a representative sample of Italian healthcare entities, covering approximately 12 million residents. Between January 2010 and December 2020, adult GPA patients were identified by payment waiver code or hospitalization discharge diagnosis, and MPA patients by payment waiver code with or without hospitalization discharge diagnosis. Clinical outcomes were evaluated through AAV-related hospitalizations, renal failure onset, and mortality. Economic analysis included healthcare resource utilization deriving from drugs, hospitalizations, and outpatient specialist services. The related mean direct costs year/patient were also calculated in patients stratified by presence/absence of glucocorticoid therapy and type of inclusion criterion (hospitalization/payment waiver code). RESULTS Overall, 859 AAV patients were divided into GPA (n = 713; 83%) and MPA (n = 146; 17%) cohorts. Outcome indicators highlighted a clinically worse phenotype associated with GPA compared to MPA. Cost analysis during follow-up showed tendentially increased expenditures in glucocorticoid-treated patients versus untreated (overall AAV: €8728 vs. €7911; GPA: €9292 vs. €9143; MPA: €5967 vs. €2390), mainly driven by drugs (AAV: €2404 vs. €874; GPA: €2510 vs. €878; MPA: €1881 vs. €854) and hospitalizations. CONCLUSION Among AAV forms, GPA resulted in a worse clinical picture, higher mortality, and increased costs. This is the first real-world pharmaco-economic analysis on AAV patients stratified by glucocorticoid use on disease management expenditures. In both GPA and MPA patients, glucocorticoid treatment resulted in higher healthcare costs, mostly attributable to medications, and then hospitalizations, confirming the clinical complexity and economic burden for management of patients with autoimmune diseases under chronic immunosuppression.
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Affiliation(s)
- Luca Degli Esposti
- CliCon S.r.l. Società Benefit, Health, Economics & Outcomes Research, Via Murri, 9, 40137, Bologna, Italy.
| | - Melania Dovizio
- CliCon S.r.l. Società Benefit, Health, Economics & Outcomes Research, Via Murri, 9, 40137, Bologna, Italy
| | - Valentina Perrone
- CliCon S.r.l. Società Benefit, Health, Economics & Outcomes Research, Via Murri, 9, 40137, Bologna, Italy
| | - Chiara Veronesi
- CliCon S.r.l. Società Benefit, Health, Economics & Outcomes Research, Via Murri, 9, 40137, Bologna, Italy
| | | | | | | | | | | | | | | | | | - Rita Citraro
- Dipartimento di Scienze della Salute, Università Magna Grecia di Catanzaro, Unità Operativa Di Farmacologia Clinica e Farmacovigilanza, Azienda Ospedaliero-Universitaria "Mater Domini", Catanzaro, Italy
| | | | | | | | - Simona Gentile
- Direzione Generale per la Salute Regione Molise, Campobasso, Italy
| | | | | | | | - Elena Mosele
- Azienda ULSS 7 Pedemontana, Bassano del Grappa, VI, Italy
| | | | | | | | - Fiorenzo Santoleri
- Dipartimento di Scienze della Salute, Università Magna Grecia di Catanzaro, Unità Operativa Di Farmacologia Clinica e Farmacovigilanza, Azienda Ospedaliero-Universitaria "Mater Domini", Catanzaro, Italy
| | | | | | | | | | - Luca Quartuccio
- Dipartimento di Medicina (DAME), Clinica di Reumatologia, Università degli Studi di Udine, Azienda Sanitaria Universitaria del Friuli Centrale, Udine, Italy
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Giacomini E, Leogrande M, Perrone V, Andretta M, Bacca M, Chinellato A, Ciaccia A, Cillo M, Lombardi R, Mancini D, Pagliaro R, Pastorello M, Procacci C, Degli Esposti L. Characteristics and Drug Utilization of Patients with Hereditary Angioedema in Italy, a Real-World Analysis. Healthcare (Basel) 2023; 11:2509. [PMID: 37761706 PMCID: PMC10530529 DOI: 10.3390/healthcare11182509] [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: 06/12/2023] [Revised: 07/24/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
This real-world analysis investigated the characteristics and treatment patterns of patients with hereditary angioedema (HAE) in Italy using the administrative data of health units across Italy. Patients were identified via exemption code or HAE-specific treatments (thus, all known forms, type I, II and, III, were included). The index date was that of first prescription of HAE treatments within the inclusion period (01/2010-06/2021) or of the date of exemption. The number of HAE patients included was 148 (43.2% male, mean age 43.3 years). Gastrointestinal disorders affected 36.5% patients, hypertension affected 28.4%, hypercholesterolemia affected 11.5%, and depression affected 9.5%. The frequent gastrointestinal involvement was further confirmed by the use of antiemetics and systemic antihistamines that doubled after the index date. Among patients enrolled by treatment (n = 125), n = 105 (84%) were receiving a treatment for acute attacks. This analysis provided insights into the characterization of patients with HAE and their management in Italian clinical practice, suggesting that an unmet therapeutic need could be present for such patients in terms of the clinical burden.
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Affiliation(s)
- Elisa Giacomini
- CliCon S.r.l. Società Benefit, Health Economics and Outcomes Research, 40137 Bologna, Italy; (M.L.); (V.P.); (L.D.E.)
| | - Melania Leogrande
- CliCon S.r.l. Società Benefit, Health Economics and Outcomes Research, 40137 Bologna, Italy; (M.L.); (V.P.); (L.D.E.)
| | - Valentina Perrone
- CliCon S.r.l. Società Benefit, Health Economics and Outcomes Research, 40137 Bologna, Italy; (M.L.); (V.P.); (L.D.E.)
| | - Margherita Andretta
- Unità Operativa Complessa Assistenza Farmaceutica Territoriale, Azienda ULSS 8 Berica, 36100 Vicenza, Italy;
| | - Marcello Bacca
- Programmazione e Controllo di Gestione, ASL Brindisi, 72100 Brindisi, Italy;
| | - Alessandro Chinellato
- Unità Operativa Complessa Farmacia Ospedaliera, Azienda ULSS 3 Serenissima, 30174 Mestre, Italy;
| | - Andrea Ciaccia
- Servizio Farmaceutico Territoriale, ASL Foggia, 71121 Foggia, Italy; (A.C.); (R.L.)
| | - Mariarosaria Cillo
- Dipartimento Farmaceutico, Azienda Sanitaria Locale di Salerno, 84124 Salerno, Italy;
| | - Renato Lombardi
- Servizio Farmaceutico Territoriale, ASL Foggia, 71121 Foggia, Italy; (A.C.); (R.L.)
| | - Daniela Mancini
- Dipartimento Farmaceutico, ASL Brindisi, 72100 Brindisi, Italy;
| | - Romina Pagliaro
- Unità Operativa Complessa Farmaceutica Territoriale, Azienda Sanitaria Locale Roma 5, 00034 Roma, Italy;
| | - Maurizio Pastorello
- Dipartimento Farmaceutico, Azienda Sanitaria Provinciale di Palermo, 90141 Palermo, Italy;
| | | | - Luca Degli Esposti
- CliCon S.r.l. Società Benefit, Health Economics and Outcomes Research, 40137 Bologna, Italy; (M.L.); (V.P.); (L.D.E.)
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10
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Degli Esposti L, Daperno M, Dovizio M, Franchi A, Sangiorgi D, Savarino EV, Scaldaferri F, Secchi O, Serra A, Perrone V, Armuzzi A. A retrospective analysis of treatment patterns, drug discontinuation and healthcare costs in Crohn's disease patients treated with biologics. Dig Liver Dis 2023; 55:1214-1220. [PMID: 37100708 DOI: 10.1016/j.dld.2023.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Received: 02/20/2023] [Revised: 04/07/2023] [Accepted: 04/07/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND/AIMS This real-world analysis evaluated the persistence and direct healthcare costs of Crohn's Disease (CD) patients treated with biologics in Italy. METHODS A retrospective analysis on administrative databases of Italian healthcare entities, covering 10.4 million residents, was performed. Adult CD patients under biologics between 2015 and 2020 were included and attributed to first/second treatment line based on absence/presence of biologic prescriptions 5-years before index-date (first biologic prescription). RESULTS Of 16,374 CD patients identified, 1,398 (8.5%) were biologic-treated: 1,256 (89.8%) in first line and 135 (9.7%) in second line. Kaplan-Meier curves estimated a higher persistence for ustekinumab-treated patients followed by vedolizumab, infliximab and adalimumab, in both lines. Considering baseline variables and adalimumab as reference, infliximab in first line (HR: 0.537) and ustekinumab in first (HR: 0.057) and second line (HR: 0.213) were associated with significantly reduced risk of drug-discontinuation. First line total/average healthcare direct-costs were €13,637, €11,201, €17,104 and €18,340 in patients persistent on adalimumab, infliximab, ustekinumab and vedolizumab, respectively. CONCLUSIONS This real-world analysis showed differences in persistence over 12-months between biologic treatments, being higher in ustekinumab-treated group, followed by vedolizumab, infliximab and adalimumab. Patients' management was associated with comparable direct healthcare costs among treatment lines, mainly driven by drug-related expenses.
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Affiliation(s)
- Luca Degli Esposti
- CliCon S.r.l., Società Benefit, Health, Economics & Outcomes Research, 40137 Bologna, Italy.
| | - Marco Daperno
- SC Gastroenterologia AO Ordine Mauriziano di Torino, 10128 Torino, Italy
| | - Melania Dovizio
- CliCon S.r.l., Società Benefit, Health, Economics & Outcomes Research, 40137 Bologna, Italy
| | | | - Diego Sangiorgi
- CliCon S.r.l., Società Benefit, Health, Economics & Outcomes Research, 40137 Bologna, Italy
| | | | - Franco Scaldaferri
- CEMAD (Centro Malattie Apparato Digerente) - UOS Malattie Infiammatorie Croniche Intestinali, IBD UNIT, Fondazione Policlinico A. Gemelli IRCSS - Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | | | - Andrea Serra
- Janssen Cilag Spa, 20093 Cologno Monzese, Milano, Italy
| | - Valentina Perrone
- CliCon S.r.l., Società Benefit, Health, Economics & Outcomes Research, 40137 Bologna, Italy
| | - Alessandro Armuzzi
- IBD Center, IRCCS Humanitas Research Hospital, 20089 Rozzano, Milano, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
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Marcon IG, Valsecchi D, Durso L, Premoli E, Sangiorgi D, Perrone V, Catena L, Degli Esposti L. Real-World Evaluation of the Management, Treatment Pathways and Outcome of Melanoma Patients with Target Therapies in Italy. Adv Ther 2023; 40:3875-3895. [PMID: 37368101 PMCID: PMC10427535 DOI: 10.1007/s12325-023-02578-y] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/05/2023] [Indexed: 06/28/2023]
Abstract
INTRODUCTION In recent years, an increasing trend in the incidence of melanoma has been observed in Europe. Although early diagnosis and prompt intervention with local resection often results in positive outcomes, conversely, metastatic disease is still clinically challenging with a poor prognosis and a 5-year survival of around 30%. The growing awareness of melanoma biology and of antitumor immune responses has allowed the development of novel therapies targeted at specific molecular alterations occurring at advanced stages. This real-world analysis examined patients with melanoma in Italy, focusing on treatment patterns, outcome, time to discontinuation (TTD), and resource consumption. METHODS Two retrospective observational analyses were conducted for BRAF+ patients with metastatic melanoma and those with a positive sentinel lymph node biopsy in an adjuvant setting, retrieving data from the administrative databases covering 13.3 million residents. The cohort melanoma BRAF+ in metastatic setting comprised 729 patients with targeted therapy (TT) (n = 671 with TT as first line and 79 as second line). RESULTS Median TTD was 10.6 months in first line and 8.1 months in second line. Median overall survival from the start of first TT line was 27 months and was 11.8 months for patients with brain metastasis. In the dabrafenib plus trametinib patients, main healthcare resource consumption tended to increase in the presence of brain metastasis. The cohort with a positive sentinel lymph node biopsy under adjuvant therapy (n = 289) included 8% patients treated with dabrafenib plus trametinib or tested BRAF+, 5% BRAF wild-type, and 10% under immunotherapy. CONCLUSION Our findings provided an overview on TT utilization on metastatic melanoma patients in real clinical practice and highlighted an increased burden in brain metastatic patients.
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Affiliation(s)
| | | | | | | | - Diego Sangiorgi
- CliCon S.r.l. Società Benefit, Health, Economics and Outcomes Research, Via Murri, 9, 40137, Bologna, Italy
| | - Valentina Perrone
- CliCon S.r.l. Società Benefit, Health, Economics and Outcomes Research, Via Murri, 9, 40137, Bologna, Italy
| | | | - Luca Degli Esposti
- CliCon S.r.l. Società Benefit, Health, Economics and Outcomes Research, Via Murri, 9, 40137, Bologna, Italy.
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12
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Nava FA, Mangia A, Riglietta M, Somaini L, Foschi FG, Claar E, Maida I, Ucciferri C, Frigerio F, Hernandez C, Dovizio M, Perrone V, Degli Esposti L, Puoti M. Analysis of Patients' Characteristics and Treatment Profile of People Who Use Drugs (PWUDs) with and without a Co-Diagnosis of Viral Hepatitis C: A Real-World Retrospective Italian Analysis. Ther Clin Risk Manag 2023; 19:645-656. [PMID: 37560130 PMCID: PMC10408688 DOI: 10.2147/tcrm.s409134] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 07/23/2023] [Indexed: 08/11/2023] Open
Abstract
PURPOSE Hepatitis C virus (HCV) spreads from contact with blood of an infected person. HCV infections are common among people who use drugs (PWUDs), when sharing needles, syringes, or other equipment for injected drugs. The advent of pangenotypic direct-antiviral agents (DAA) in 2017 transformed the treatment landscape for HCV, but PWUDs remain a complex and hard-to-treat population with high risk of HCV reinfection. The aim of this real-world analysis was to characterize the demographic and clinical features of PWUDs in Italy, also focusing on comorbidity profile, treatment with DAAs, resource consumptions for the National Health System (NHS). PATIENTS AND METHODS During 01/2011-06/2020, administrative databases of Italian healthcare entities, covering 3,900,000 individuals, were browsed to identify PWUDs with or without HCV infection. Among HCV+ patients, a further stratification was made into treated and untreated with DAAs. The date of PWUD or HCV first diagnosis or DAA first prescription was considered as index-date. Patients were then followed-up for one year. Alcohol-dependency was also investigated. RESULTS Total 3690 PWUDs were included, of whom 1141 (30.9%) PWUD-HCV+ and 2549 (69.1%) PWUD-HCV-. HCV-positive were significantly older (43.6 vs 38.5 years, p < 0.001), had a worse comorbidity profile (Charlson-index: 0.8 vs 0.4, p < 0.001), and high rates of psychiatric, respiratory, dermatological, musculoskeletal diseases and genitourinary (sexually transmitted) infections. Moreover, they received more drug prescriptions (other than DAAs, like anti-acids, antiepileptics, psycholeptics) and had undergone more frequent hospitalization, predominantly for hepatobiliary, respiratory system and mental disorders. DDA-untreated had significantly higher Charlson-index than DAA-treated (0.9 vs 0.6, p = 0.003). Alcoholism was found in 436 (11.8%) cases. CONCLUSION This Italian real-world analysis suggests that PWUDs with HCV infection, especially those untreated with DAAs, show an elevated drug consumption due to their complex clinical profile. These findings could help to ameliorate the healthcare interventions on PWUDs with HCV infection.
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Affiliation(s)
- Felice Alfonso Nava
- U.O. Sanità Penitenziaria e Area Dipendenze, Azienda ULSS 6 Euganea, Padova, Italy
| | - Alessandra Mangia
- UOS Epatologia, Istituto di Ricovero e Cura “Casa Sollievo della Sofferenza”, S. Giovanni Rotondo, Italy
| | | | | | | | - Ernesto Claar
- UOC Medicina Interna, Ospedale Evangelico “Villa Betania”, Napoli, Italy
| | - Ivana Maida
- UOC Malattie Infettive e Parassitarie, Azienda Ospedaliero Universitaria di Sassari, Sassari, Italy
| | - Claudio Ucciferri
- Clinica di Malattie Infettive Ospedale “SS Annunziata”, Chieti, Italy
| | | | - Candido Hernandez
- Gilead Sciences, Global Medical Affairs, Stockley Park, London, UB11 1BD, UK
| | - Melania Dovizio
- CliCon S.R.L. Società Benefit, Health Economics and Outcomes Research, Bologna, Italy
| | - Valentina Perrone
- CliCon S.R.L. Società Benefit, Health Economics and Outcomes Research, Bologna, Italy
| | - Luca Degli Esposti
- CliCon S.R.L. Società Benefit, Health Economics and Outcomes Research, Bologna, Italy
| | - Massimo Puoti
- SC Malattie Infettive, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
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13
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Palladino S, Perrone V, Giacomini E, Sangiorgi D, Premoli E, Valsecchi D, Degli Esposti L, Suter MB. Real-world analysis of the economic and therapeutic burden in advanced breast cancer patients in Italy. Expert Rev Pharmacoecon Outcomes Res 2023; 23:1041-1048. [PMID: 37459247 DOI: 10.1080/14737167.2023.2234637] [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: 12/07/2022] [Accepted: 06/29/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND This real-world analysis evaluated drug utilization focusing on wastage and healthcare costs for treatment of patients with advanced breast cancer (aBC) hormone receptor-positive (HR+)/human epidermal growth factor receptor-2 negative (HER2-) in Italy. METHODS A retrospective analysis was conducted on administrative data covering about 13.3 million health-assisted individuals. Across January/2017-June/2021, all patients with HR+/HER2-aBC were identified by ≥ 1 prescription for cyclin-dependent kinase 4/6 inhibitors (CDK 4/6i). Cost analysis was performed and updated referring to the prices of November 2021. RESULTS Overall, 3,647 HR+/HER2-aBC patients were included (2,627 palbociclib treated, 729 ribociclib treated, and 291 abemaciclib treated). After 12 months of follow-up, 35% of palbociclib patients had a dose reduction (on average 8.9 wasted pills/patient), 44.7% of abemaciclib patients had a dose reduction (on average 6.7 wasted pills/patient), 22.1% of ribociclib patients had a dose reduction (no wasted pills). Therapy wastage added up to 528,716€ for palbociclib-treated patients (524€/patient) and 5,738€ in abemaciclib-treated patients (151€/patient). No wastage was attributed to ribociclib. CONCLUSIONS Dose reduction was associated with drug wastage in palbociclib and abemaciclib-treated patients, but not in ribociclib-treated ones. These findings might be helpful to policy decision-makers who, for healthcare strategies implementation, among several variables should consider the possible restraining of drug wastage.
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Affiliation(s)
| | - Valentina Perrone
- CliCon S.r.l. Società Benefit Health, Economics & Outcomes Research, Bologna, Italy
| | - Elisa Giacomini
- CliCon S.r.l. Società Benefit Health, Economics & Outcomes Research, Bologna, Italy
| | - Diego Sangiorgi
- CliCon S.r.l. Società Benefit Health, Economics & Outcomes Research, Bologna, Italy
| | | | | | - Luca Degli Esposti
- CliCon S.r.l. Società Benefit Health, Economics & Outcomes Research, Bologna, Italy
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14
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Perrone V, Giacomini E, Sangiorgi D, Tamma A, Giovannitti M, Buzzoni C, Degli Esposti L. Description of characteristics, management of care and healthcare direct costs of patients with HR+/HER2- early breast cancer in Italy: a real-world study involving administrative and pathological anatomy databases. Expert Rev Pharmacoecon Outcomes Res 2023; 23:1077-1085. [PMID: 37638590 DOI: 10.1080/14737167.2023.2246652] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 08/07/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Healthcare administrative and pathological anatomy data were used to identify Italian patients with early breast cancer (EBC) with HR+/HER2- status at high risk of recurrence, evaluating drug utilization and other healthcare resource use in clinical practice. METHODS This retrospective analysis, based on 9.4 million of Italian National Health Service beneficiaries, included adult patients with hospitalization discharge diagnosis for EBC in 01/2015-12/2020. Those with HR+/HER2- status were selected; among them, patients that underwent removal of lymph nodes (LN) were analyzed. RESULTS Of 24,137 patients with EBC and HR+/HER2- status, 3619 patients (15%) had documented LN removal. Overall, 4.7% of HR+/HER2- patients and 9.9% of patients with LN removal experienced distant relapse over a median follow-up of 33.2 months (Q1-Q3: 17.0-50.6). Local relapse occurred in approximately 9.1-9.3% of patients in each group. Among the 1,175 patients with LN removal that had available pathological anatomy data, 399 (34.0%) had pathological high-risk characteristics and 13.3% experienced distant relapse. CONCLUSIONS One in ten patients with EBC who underwent LN removal experienced a relapse, highlighting the strong need to prevent early recurrence.
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Affiliation(s)
- Valentina Perrone
- CliCon S.r.l. Società Benefit, Health Economics and Outcomes Research, Bologna, Italy
| | - Elisa Giacomini
- CliCon S.r.l. Società Benefit, Health Economics and Outcomes Research, Bologna, Italy
| | - Diego Sangiorgi
- CliCon S.r.l. Società Benefit, Health Economics and Outcomes Research, Bologna, Italy
| | | | | | | | - Luca Degli Esposti
- CliCon S.r.l. Società Benefit, Health Economics and Outcomes Research, Bologna, Italy
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15
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Antonini G, Habetswallner F, Inghilleri M, Mantegazza R, Rodolico C, Saccà F, Sgarzi M, deRuyck F, Paci S, Phillips G, Crippa L, Veronesi C, Perrone V, Degli Esposti L. Real world study on prevalence, treatment and economic burden of myasthenia gravis in Italy. Heliyon 2023; 9:e16367. [PMID: 37274644 PMCID: PMC10238888 DOI: 10.1016/j.heliyon.2023.e16367] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 11/23/2022] [Revised: 05/12/2023] [Accepted: 05/14/2023] [Indexed: 06/06/2023] Open
Abstract
The purpose of this study was to investigate the epidemiology, management, and economic burden of myasthenia gravis in settings of real clinical practice. The analysis used administrative databases covering around 12 million subjects across Italy and included all adult patients with hospitalization discharge diagnosis or active exemption code for myasthenia gravis or with ≥1 pyridostigmine prescription from 2011 to 2018. The estimated prevalence of myasthenia gravis during 2018 was in the range 13.5-29.3/100,000 people (depending on the criteria applied), corresponding to 8190-17,728 alive patients, when reproportioning data to the entire Italian population. Overall 4397 patients with myasthenia gravis (mean age 61.7 years, 46.6% males) were included. A large pyridostigmine use was observed (84.0%-46.8% from 1st to 3rd year of follow-up), followed by corticosteroids (54.5%-44.6% from 1st to 3rd year of follow-up) and non-steroidal immunosuppressants (16% over follow-up). Total direct healthcare costs for myasthenia gravis were 4-times higher than those of the general population (€3771 and €869, respectively), and up to 9-fold increased when considering patients with exacerbation (€7827). These findings showed the epidemiologic burden of myasthenia gravis and the complexity of the therapeutic management for the affected patients, with large use of treatments and elevated healthcare expenditures.
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Affiliation(s)
- Giovanni Antonini
- Department of Neurology Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, University of Rome La Sapienza, Rome, Italy
| | | | - Maurizio Inghilleri
- Neuromuscular Disorders Unit, Department of Human Neurosciences, Sapienza University, Rome, Italy
| | - Renato Mantegazza
- Neurology IV-Neuroimmunology and Neuromuscular Diseases Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Carmelo Rodolico
- Neurology and Neuromuscular Disorders Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Francesco Saccà
- NSRO Department, University of Naples Federico II, Napoli, Italy
| | - Manlio Sgarzi
- Department of Neurology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | | | | | | | - Chiara Veronesi
- CliCon S.r.l. Società Benefit Health, Economics & Outcomes Research, Bologna, Italy
| | - Valentina Perrone
- CliCon S.r.l. Società Benefit Health, Economics & Outcomes Research, Bologna, Italy
| | - Luca Degli Esposti
- CliCon S.r.l. Società Benefit Health, Economics & Outcomes Research, Bologna, Italy
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Pontremoli R, Desideri G, Arca M, Temporelli PL, Perrone V, Dovizio M, Borghi C, Esposti LD. Hypertriglyceridemia is associated with decline of estimated glomerular filtration rate and risk of end-stage kidney disease in a real-word Italian cohort: Evidence from the TG-RENAL Study. Eur J Intern Med 2023; 111:90-96. [PMID: 36906475 DOI: 10.1016/j.ejim.2023.02.019] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 03/12/2023]
Abstract
BACKGROUND This analysis investigated the role of hypertriglyceridemia on renal function decline and development of end-stage kidney disease (ESKD) in a real-world clinical setting. METHODS A retrospective analysis using administrative databases of 3 Italian Local Health Units was performed searching patients with at least one plasma triglyceride (TG) measurement between 2013 and June 2020, followed-up until June 2021. Outcome measures included reduction in estimated glomerular filtration rate (eGFR) ≥30% from baseline and ESKD onset. Subjects with normal (normal-TG), high (HTG) and very high TG levels (vHTG) (respectively <150 mg/dL, 150-500 mg/dL and >500 mg/dL) were comparatively evaluated. RESULTS Overall 45,000 subjects (39,935 normal-TGs, 5,029 HTG and 36 vHTG) with baseline eGFR of 96.0 ± 66.4 mL/min were considered. The incidence of eGFR reduction was 27.1 and 31.1 and 35.1 per 1000 person-years, in normal-TG, HTG and vHTG subjects, respectively (P<0.01). The incidence of ESKD was 0.7 and 0.9 per 1000 person-years, in normal-TG and HTG/vHTG subjects, respectively (P<0.01). Univariate and multivariate analyses revealed that HTG subjects had a risk of eGFR reduction or ESKD occurrence (composite endpoint) increased by 48% compared to normal-TG subjects (adjusted OR:1.485, 95%CI 1.300-1.696; P<0.001). Moreover, each 50 mg/dL increase in TG levels resulted in significantly greater risk of eGFR reduction (OR:1.062, 95%CI 1.039-1.086 P<0.001) and ESKD (OR:1.174, 95%CI 1.070-1.289, P = 0.001). CONCLUSIONS This real-word analysis in a large cohort of individuals with low-to-moderate cardiovascular risk suggests that moderate-to-severe elevation of plasma TG levels is associated with a significantly increased risk of long-term kidney function deterioration.
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Affiliation(s)
- Roberto Pontremoli
- Department of Internal Medicine and Medical Specialties, University of Genoa and IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| | - Giovambattista Desideri
- Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Marcello Arca
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Pier Luigi Temporelli
- Division of Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Gattico-Veruno, Novara, , Italy
| | - Valentina Perrone
- CliCon s.r.l. Società Benefit, Health, Economics & Outcomes Research, Bologna, Italy
| | - Melania Dovizio
- CliCon s.r.l. Società Benefit, Health, Economics & Outcomes Research, Bologna, Italy
| | - Claudio Borghi
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Luca Degli Esposti
- CliCon s.r.l. Società Benefit, Health, Economics & Outcomes Research, Bologna, Italy
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Borghi C, Jayagopal PB, Konradi A, Bortolotto LA, Degli Esposti L, Perrone V, Snyman JR. Adherence to Triple Single-Pill Combination of Perindopril/Indapamide/Amlodipine: Findings from Real-World Analysis in Italy. Adv Ther 2023; 40:1765-1772. [PMID: 36829102 PMCID: PMC10070199 DOI: 10.1007/s12325-023-02451-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/01/2023] [Indexed: 02/26/2023]
Abstract
INTRODUCTION Single-pill combination therapy for hypertension is recognized to improve adherence to treatment. However, less is known about the benefits of triple single-pill combinations. This retrospective observational analysis aimed to assess changes in adherence when treatment was switched from perindopril (PER)/indapamide (IND) + amlodipine (AML) to PER/IND/AML single-pill combination, in Italian clinical practice. METHODS This analysis used data extracted from administrative databases of Italian healthcare entities. Adult patients receiving PER/IND/AML were selected, and the prescription date was considered as the index date. Among them, those who had a prescription for PER/IND + AML during the 12 months before the index date and a prescription of PER/IND/AML during 6 months of follow-up were included. Adherence was calculated as the proportion of days covered (PDC: PDC < 40%, non-adherent; PDC = 40-79%, partially adherent; PDC ≥ 80%, adherent). RESULTS Among the identified patients, 158 were exposed users and were included in the analysis. When patients were compared before and after switch to triple single-pill combination, the proportion of adherent patients was significantly higher with PER/IND/AML single-pill combination (75.3%) than with PER/IND + AML combination (44.3%) (P < 0.05). Conversely, the proportion of non-adherent patients was lower with the PER/IND/AML single-pill combination (14.6%) vs PER/IND + AML (17.7%) (P < 0.001). CONCLUSION This real-world analysis showed that switching to a triple single-pill combination could offer an opportunity to improve adherence to antihypertensive treatment in real-life clinical practice.
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Affiliation(s)
- Claudio Borghi
- University of Bologna, IRCCS Ospedale S. Orsola, Bologna, Italy.
| | | | - Alexandra Konradi
- Almazov National Medical Research Center, St. Petersburg, Russian Federation
| | | | - Luca Degli Esposti
- CliCon S.r.l, Società Benefit-Health, Economics and Outcomes Research, Bologna, Italy
| | - Valentina Perrone
- CliCon S.r.l, Società Benefit-Health, Economics and Outcomes Research, Bologna, Italy
| | - Jacques R Snyman
- Forte Research (Pty Ltd) and Private Practice, Pretoria, South Africa
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De Luca L, Dovizio M, Sangiorgi D, Perrone V, Degli Esposti L. Incidence and Predictors of Switching and Dose Change of Direct Oral Anticoagulants among Elderly Patients with Nonvalvular Atrial Fibrillation: A 5-Year Analysis of a Large Administrative Database. J Clin Med 2023; 12:jcm12062379. [PMID: 36983380 PMCID: PMC10056372 DOI: 10.3390/jcm12062379] [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: 02/23/2023] [Revised: 03/09/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
In the last decade, novel oral anticoagulants (NOACs) have emerged as prominent therapeutic options in non-valvular atrial fibrillation (NVAF). We analysed the clinical burden and the switching rate between all available NOACs, and their dosage change over a period of 5 years in a representative population of patients with NVAF aged between 70 and 75 years. Methods and Results: This is a retrospective observational study on administrative databases, covering approximately 6.2 million health-assisted individuals by the Italian National Health System (around 11% of the entire Italian residents). Out of 4640 NVAF patients treated with NOACs and aged 70-75 years in 2017, 3772 (81.3%) patients were still in treatment with NOAC up to 2021 and among them, 3389 (73.0%) patients remained in treatment with the same NOAC during 2017-2021. In fact, 10.2% of patients switched NOAC type and 10.3% changed the dose of the same NOAC. Overall, after switching, the dabigatran and rivaroxaban groups lost, respectively, 13.5% and 2.8% of patients, while apixaban and edoxaban resulted in a relative percentage increase of 6.8% and 44.6% of patients, respectively. By a logistic regression analysis, the treatment with rivaroxaban, apixaban, and edoxaban (respect to dabigatran) was associated with a significant risk reduction of switch of 57%, 68%, and 44%, respectively. On the other hand, several features of high risk were associated with dose reduction. Conclusions. In our 5-year analysis of a large administrative database, a switching among NOACs or a change in NOAC dosages occurred in around 20% of elderly patients with NVAF. The type of NOAC was associated with a high switching rate, while several characteristics of high risk resulted as predictors of dose reduction of NOACs. Moreover, a worsening trend of clinical conditions occurred in patients maintaining the same NOAC treatment across 2017-2021.
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Affiliation(s)
- Leonardo De Luca
- Department of Cardio-Thoracic-Vascular Sciences, A.O. San Camillo-Forlanini, 00151 Rome, Italy
- Department of Cardio-Thoracic and Vascular Medicine and Surgery, U.O.C. Cardiologia, Azienda Ospedaliera San Camillo-Forlanini Circonvallazione Gianicolense, 87, 00152 Roma, Italy
- UniCamillus-Saint Camillus International, University of Health Sciences, 00131 Rome, Italy
| | - Melania Dovizio
- CliCon S.r.l. Società Benefit, Health, Economics & Outcomes Research, 40137 Bologna, Italy
| | - Diego Sangiorgi
- CliCon S.r.l. Società Benefit, Health, Economics & Outcomes Research, 40137 Bologna, Italy
| | - Valentina Perrone
- CliCon S.r.l. Società Benefit, Health, Economics & Outcomes Research, 40137 Bologna, Italy
| | - Luca Degli Esposti
- CliCon S.r.l. Società Benefit, Health, Economics & Outcomes Research, 40137 Bologna, Italy
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Minutolo R, Grandaliano G, Di Rienzo P, Snijder R, Degli Esposti L, Perrone V, Todorova L. Prevalence, incidence, and treatment of anaemia in patients with non-dialysis-dependent chronic kidney disease: findings from a retrospective real-world study in Italy. J Nephrol 2023; 36:347-357. [PMID: 36370331 PMCID: PMC9998309 DOI: 10.1007/s40620-022-01475-x] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 10/01/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Limited data are available on the epidemiology and clinical management of anaemia in patients with non-dialysis-dependent chronic kidney disease (NDD-CKD). METHODS This retrospective observational study was based on records from databases of five Local Health Units across Italy. Adults with reported NDD-CKD stage 3a-5 between 1 January 2014 and 31 December 2016 were identified. Annual prevalence and incidence of anaemia (age- and sex-standardised) and clinical management (erythropoiesis-stimulating agents [ESAs], intravenous [IV] iron, and blood transfusions) were evaluated. Eligibility for ESAs was defined by ≥ 2 records of Hb < 10 g/dL, or < 11 g/dL over 6 months. RESULTS Overall, 101,143 individuals with NDD-CKD (3a-5) recorded between 2014 and 2016 were identified, of whom 40,020 (39.6%) were anaemic. Prevalence of anaemia was 33.8% in 2016 and incidence of anaemia was stable (11.4-12.4%) from 2014 to 2016. Prevalence and incidence of anaemia increased with CKD stage. Among eligible patients, 12.8% with Hb < 11 g/dL and 15.5% with Hb < 10 g/dL received ESAs, and the proportion treated increased with CKD stage. Among ESA-treated patients with at least 2 years of follow up, 18.4% and 19.3% received IV iron in the Hb < 11 and < 10 g/dL groups, respectively, and 16.5% and 19.4% received blood transfusions. Corresponding proportions for the overall anaemic cohort were 9.0% and 11.3%, respectively. CONCLUSIONS Anaemia is a significant issue in patients with NDD-CKD. Low rates of ESA treatment indicate a potential treatment gap and suggest that anaemia may not be adequately controlled in many patients.
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Affiliation(s)
- Roberto Minutolo
- Nephrology Division, Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy.
| | - Giuseppe Grandaliano
- Nephrology Unit, Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Perrone V, Dovizio M, Sangiorgi D, Andretta M, Bartolini F, Cavaliere A, Ciaccia A, Chinellato A, Costantini A, Dell’Orco S, Ferrante F, Gentile S, Lavalle A, Moscogiuri R, Mosele E, Procacci C, Re D, Santoleri F, Roccia A, Maggiolo F, Degli Esposti L. Healthcare Resource Consumption and Related Costs in Patients on Antiretroviral Therapies: Findings from Real-World Data in Italy. Int J Environ Res Public Health 2023; 20:3789. [PMID: 36900813 PMCID: PMC10000772 DOI: 10.3390/ijerph20053789] [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] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 06/18/2023]
Abstract
This real-world analysis conducted on administrative databases of a sample of Italian healthcare entities was aimed at describing the role of therapeutic pathways and drug utilization in terms of adherence, persistence, and therapy discontinuation in HIV-infected patients under antiretroviral therapies (ART) and Tenofovir Alafenamide (TAF)-based regimens on healthcare resource consumption and related direct healthcare costs. Between 2015 and 2019, adults (≥18 years) prescribed with TAF-based therapies were identified and characterized in the year prior to the first prescription (index-date) for TAF-based therapies and followed-up until the end of data availability. Overall, 2658 ART-treated patients were included, 1198 of which were under a TAF-based regimen. TAF-based therapies were associated with elevated percentages of adherence (83.3% patients with proportion of days covered, PDC > 95% and 90.6% with PDC > 85%) and persistence (78.5%). The discontinuation rate was low in TAF-treated patients, ranging from 3.3% in TAF-switchers to 5% in naïve. Persistent patients had lower overall mean annual healthcare expenditures (EUR 11,106 in persistent vs. EUR 12,380 in non-persistent, p = 0.005), and this trend was statistically significant also for costs related to HIV hospitalizations. These findings suggest that a better therapeutic management of HIV infection might result in positive clinical and economic outcomes.
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Affiliation(s)
- Valentina Perrone
- CliCon S.r.l. Società Benefit—Health, Economics & Outcomes Research, 40137 Bologna, Italy
| | - Melania Dovizio
- CliCon S.r.l. Società Benefit—Health, Economics & Outcomes Research, 40137 Bologna, Italy
| | - Diego Sangiorgi
- CliCon S.r.l. Società Benefit—Health, Economics & Outcomes Research, 40137 Bologna, Italy
| | | | | | | | - Andrea Ciaccia
- Servizio Farmaceutico Territoriale ASL Foggia, 71121 Foggia, Italy
| | | | | | | | | | - Simona Gentile
- Direzione Generale per la Salute Regione Molise, 86100 Campobasso, Italy
| | - Antonella Lavalle
- Direzione Generale per la Salute Regione Molise, 86100 Campobasso, Italy
| | | | - Elena Mosele
- UOC Assistenza Farmaceutica Territoriale, Azienda ULSS 7 Pedemontana, 36061 Bassano del Grappa, Italy
| | | | | | | | | | | | - Luca Degli Esposti
- CliCon S.r.l. Società Benefit—Health, Economics & Outcomes Research, 40137 Bologna, Italy
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Fagiuoli S, Toniutto P, Coppola N, Ancona DD, Andretta M, Bartolini F, Ferrante F, Lupi A, Palcic S, Rizzi FV, Re D, Alvarez Nieto G, Hernandez C, Frigerio F, Perrone V, Degli Esposti L, Mangia A. Italian Real-World Analysis of the Impact of Polypharmacy and Aging on the Risk of Multiple Drug-Drug Interactions (DDIs) in HCV Patients Treated with Pangenotypic Direct-Acting Antivirals (pDAA). Ther Clin Risk Manag 2023; 19:57-65. [PMID: 36699017 PMCID: PMC9868280 DOI: 10.2147/tcrm.s394467] [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: 11/01/2022] [Accepted: 12/29/2022] [Indexed: 01/19/2023] Open
Abstract
Purpose The study aims at investigating the impact of polymedication and aging in the prevalence of multiple drug-drug interactions (DDIs) on HCV patients treated with sofosbuvir/velpatasvir (SOF/VEL) or glecaprevir/pibrentasvir (GLE/PIB). Patients and Methods This is a retrospective analysis based on administrative data covering around 6.9 million individuals. Patients treated with SOF/VEL or GLE/PIB over November 2017-March 2020 were included. Index date corresponded to SOF/VEL or GLE/PIB first prescription during such period; patients were followed up for treatment duration. Analyses were then focused on patients with ≥2 comedications at risk of multiple DDIs. The severity and the effect of multiple DDI were identified using the Liverpool University tool. Results A total of 2057 patients with SOF/VEL and 2128 with GLE/PIB were selected. Mean age of SOF/VEL patients was 58.5 years, higher than GLE/PIB ones (52.5 years) (p < 0.001), and patients >50 years were more present in SOF/VEL vs GLE/PIB cohorts: 72% vs 58%, (p < 0.001). Most prescribed co-medications were cardiovascular, alimentary and nervous system drugs. Proportion of patients with ≥2 comedications was higher in SOF/VEL compared to GLE/PIB cohort (56.5% vs 32.3%, p < 0.001). Those at high-risk of multiple DDIs accounted for 11.6% (N = 135) of SOF/VEL and 19.6% (N = 135) of GLE/PIB (p < 0.001) patients with ≥2 comedications. Among them, the potential effect of DDI was a decrease of DAA serum levels (11% of SOF/VEL and GLE/PIB patients) and an increased concentration of comedication serum levels (14% of SOF/VEL and 42% of GLE/PIB patients). Conclusion This real-world analysis provided a thorough characterization on the burden of polymedication regimens in HCV patients treated with SOF/VEL or GLE/PIB that expose such patients to an increased risk of DDIs. In our sample population, SOF/VEL regimen was more frequently detected on elderly patients and on those with ≥2 comedications at risk of multi-DDI, ie, among patients characterized by higher rates of comorbidities and polypharmacy.
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Affiliation(s)
- Stefano Fagiuoli
- Department of Medicine and Surgery, University of Milan Bicocca & Gastroenterology Hepatology and Transplantation Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Pierluigi Toniutto
- Hepatology and Liver Transplantation Unit, Azienda Ospedaliero Universitaria, Udine, Italy
| | - Nicola Coppola
- Infectious Diseases Unit, University of Campania L. Vanvitelli, Naples, Italy
| | | | - Margherita Andretta
- UOC Assistenza Farmaceutica Territoriale, Azienda Ulss 8 Berica, Vicenza, Italy
| | | | - Fulvio Ferrante
- Dipartimento Diagnostica Ed Assistenza Farmaceutica – ASL Frosinone, Frosinone, Italy
| | | | - Stefano Palcic
- Farmaceutica Territoriale- Azienda Sanitaria Universitaria Integrata Giuliano-Isontina (ASUGI), Trieste, Italy
| | | | - Davide Re
- Servizio Farmaceutico Territoriale ASL Teramo, Teramo, Italy
| | | | | | | | - Valentina Perrone
- Clicon S.r.l., Health Economics and Outcomes Research, Bologna, Italy
| | - Luca Degli Esposti
- Clicon S.r.l., Health Economics and Outcomes Research, Bologna, Italy,Correspondence: Luca Degli Esposti, CliCon S.r.l. Società Benefit, Health, Economics & Outcomes Research, Via Murri, 9, Bologna, 40137, Italy, Tel +390544 38393, Email
| | - Alessandra Mangia
- Gastroenterology and Transplant Hepatology, Papa Giovanni XXIII Hospital, Bergamo, 24127, Italy
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Barbuto S, Perrone V, Veronesi C, Dovizio M, Zappulo F, Vetrano D, Giannini S, Fusaro M, Ancona DD, Barbieri A, Ferrante F, Lena F, Palcic S, Re D, Rizzi FV, Cogliati P, Soro M, Esposti LD, Cianciolo G. Real-World Analysis of Outcomes and Economic Burden in Patients with Chronic Kidney Disease with and without Secondary Hyperparathyroidism among a Sample of the Italian Population. Nutrients 2023; 15:nu15020336. [PMID: 36678208 PMCID: PMC9867108 DOI: 10.3390/nu15020336] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/06/2023] [Accepted: 01/06/2023] [Indexed: 01/12/2023] Open
Abstract
This real-world analysis evaluated the clinical and economic burden of non-dialysis-dependent CKD patients with and without secondary hyperparathyroidism (sHPT) in Italy. An observational retrospective study was conducted using administrative databases containing a pool of healthcare entities covering 2.45 million health-assisted individuals. Adult patients with hospitalization discharge diagnoses for CKD stages 3, 4, and 5 were included from 1 January 2012 to 31 March 2015 and stratified using the presence/absence of sHPT. Of the 5710 patients, 3119 were CKD-only (62%) and 1915 were CKD + sHPT (38%). The groups were balanced using Propensity Score Matching (PSM). Kaplan-Meier curves revealed that progression to dialysis and cumulative mortality had a higher incidence in the CKD + sHPT versus CKD-only group in CKD stage 3 patients and the overall population. The total direct healthcare costs/patient at one-year follow-up were significantly higher in CKD + sHPT versus CKD-only patients (EUR 8593 vs. EUR 5671, p < 0.001), mostly burdened by expenses for drugs (EUR 2250 vs. EUR 1537, p < 0.001), hospitalizations (EUR 4628 vs. EUR 3479, p < 0.001), and outpatient services (EUR 1715 vs. EUR 654, p < 0.001). These findings suggest that sHPT, even at an early CKD stage, results in faster progression to dialysis, increased mortality, and higher healthcare expenditures, thus indicating that timely intervention can ameliorate the management of CKD patients affected by sHPT.
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Affiliation(s)
- Simona Barbuto
- Nephrology, Dialysis and Kidney Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Valentina Perrone
- CliCon S.r.l., Società Benefit, Health, Economics & Outcomes Research, 40137 Bologna, Italy
| | - Chiara Veronesi
- CliCon S.r.l., Società Benefit, Health, Economics & Outcomes Research, 40137 Bologna, Italy
| | - Melania Dovizio
- CliCon S.r.l., Società Benefit, Health, Economics & Outcomes Research, 40137 Bologna, Italy
| | - Fulvia Zappulo
- Nephrology, Dialysis and Kidney Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Daniele Vetrano
- Nephrology, Dialysis and Kidney Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Sandro Giannini
- Clinica Medica 1, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Maria Fusaro
- National Research Council (CNR), Institute of Clinical Physiology (IFC), 56124 Pisa, Italy
- Department of Medicine, University of Padova, 35128 Padova, Italy
| | | | | | - Fulvio Ferrante
- UOC Farmacia, Ufficio di Farmacovigilanza, ASL Frosinone, 03100 Frosinone, Italy
| | - Fabio Lena
- U.O.C. Politiche del Farmaco, USL Toscana Sud Est, 58100 Grosseto, Italy
| | - Stefano Palcic
- SC Farmacia Ospedaliera e Territoriale—Area Giuliana, Azienda Sanitaria Universitaria Integrata Giuliano-Isontina (ASUGI), 34128 Trieste, Italy
| | - Davide Re
- Servizio Farmaceutico Territoriale, ASL Teramo, 64100 Teramo, Italy
| | | | | | | | - Luca Degli Esposti
- CliCon S.r.l., Società Benefit, Health, Economics & Outcomes Research, 40137 Bologna, Italy
- Correspondence:
| | - Giuseppe Cianciolo
- Nephrology, Dialysis and Kidney Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
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Perrone V, Losi S, Sabatino S, Mezzetti M, Dovizio M, Sangiorgi D, Degli Esposti L. Analysis of Drug Utilization in Patients with Psoriasis: A Real-World Retrospective Study Among the Italian Population. Psoriasis (Auckl) 2023; 13:1-9. [PMID: 36891082 PMCID: PMC9987452 DOI: 10.2147/ptt.s396003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 02/15/2023] [Indexed: 03/06/2023]
Abstract
Purpose An Italian real-world retrospective study was conducted in patients with psoriasis (PSO) to evaluate their characteristics, treatment patterns, and biological/targeted synthetic disease-modifying antirheumatic drug (b/tsDMARD) drug utilization. Patients and Methods The retrospective analysis was carried out on real-world data collected from administrative databases of selected Italian health-departments; the dataset covered approximately 22% of the Italian population. PSO patients (identified by PSO hospitalization, and/or active exemption code and/or a topical anti-psoriatic medication prescription) were included. In prevalent patients identified during 2017-2018-2019-2020, baseline characteristics and treatment patterns were investigated. Moreover, b/tsDMARD drug utilization (focusing on persistence, monthly dosage, and mean duration between prescriptions) was evaluated in bionaïve patients included during 2015 and 2018. Results PSO was diagnosed in 241,552 (in 2017), 269,856 (in 2018), 293,905 (in 2019) and 301,639 (in 2020) patients. At the index date, almost 50% of patients had not received systemic medications, and 2% had received biological treatment. Among the b/tsDMARD-treated patients, a decrease in the use of tumour necrosis factor (TNF) inhibitors (60.0-36.4%, from 2017 to 2020) and an increase in the use of interleukin (IL) inhibitors (36.3-50.6%, from 2017 to 2020) were observed. In 2018, the persistence rates of TNF inhibitors and IL inhibitors in bionaïve patients ranged from 60.8-79.7% and 83.3-87.9%, respectively. Conclusion This real-world study of PSO drug utilization in Italy showed that a significant number of patients were not treated with systemic medications and only 2% of patients were treated with biologics. An increase in the use of IL inhibitors and a decrease in the prescription of TNF inhibitors over years were found. Patients treated with biologics were highly persistent with treatment. These data provide insight into routine clinical practice for PSO patients in Italy, suggesting that the optimization of treatment for PSO still represents an unmet medical need.
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Affiliation(s)
- Valentina Perrone
- CliCon S.r.l., Società Benefit-Health Economics and Outcomes Research, Bologna, 40137, Italy
| | - Serena Losi
- Eli Lilly Italy S.p.A, Sesto Fiorentino, Italy
| | | | | | - Melania Dovizio
- CliCon S.r.l., Società Benefit-Health Economics and Outcomes Research, Bologna, 40137, Italy
| | - Diego Sangiorgi
- CliCon S.r.l., Società Benefit-Health Economics and Outcomes Research, Bologna, 40137, Italy
| | - Luca Degli Esposti
- CliCon S.r.l., Società Benefit-Health Economics and Outcomes Research, Bologna, 40137, Italy
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Perrone V, Veronesi C, Giacomini E, Citraro R, Dell’Orco S, Lena F, Paciello A, Resta AM, Nica M, Ritrovato D, Degli Esposti L. The Epidemiology, Treatment Patterns and Economic Burden of Different Phenotypes of Multiple Sclerosis in Italy: Relapsing-Remitting Multiple Sclerosis and Secondary Progressive Multiple Sclerosis. Clin Epidemiol 2022; 14:1327-1337. [PMID: 36387930 PMCID: PMC9648183 DOI: 10.2147/clep.s376005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 05/24/2022] [Accepted: 10/17/2022] [Indexed: 01/24/2024] Open
Abstract
PURPOSE A retrospective analysis of real-world data was performed to assess the epidemiology and economic burden of multiple sclerosis (MS), relapsing-remitting MS (RRMS), and secondary-progressive MS (SPMS) in Italy. PATIENTS AND METHODS An observational study on administrative databases from a sample of Italian entities was carried-out. Between 01/2010-12/2017, patients with ≥1 MS diagnosis code (ICD-9-CM:340 and/or exemption code:046) and/or ≥1 disease-modifying therapies (DMTs) prescription, were included. Among MS-cohort, SPMS patients were identified by ≥2 hospitalizations or by ≥2 drug prescriptions related to MS progression. MS patients not fulfilling SPMS criteria were included as RRMS. Mean annual healthcare costs were reported during follow-up and stratified by DMT treatment/untreatment. RESULTS Overall, 9543 MS patients were included; 8397 with RRMS and 1146 with SPMS. Estimated prevalence of MS was 141.6/100,000 inhabitants (RRMS 124.4/100,000 and SPMS 17.2/100,000). Mean annual cost for untreated and treated patient was respectively: €3638 and €11796 (MS-cohort), €3183 and €11486 (RRMS-cohort), €6317 and €15511 (SPMS-cohort). The first-line DMT treatment duration averaged 27.4 ± 22.8 months; the mean cost was 19004€ for the whole period. The second-line DMT treatment lasted on average 31.1 ± 24.5 months; the mean cost was 47293€ for the whole period. CONCLUSION This study provided insights into the MS epidemiology in Italy and its economic burden. Healthcare costs associated with MS management were mainly driven by DMTs expenditure. A trend of higher healthcare-resource consumption was observed among SPMS-cohort.
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Affiliation(s)
- Valentina Perrone
- Clicon S.r.l. Società Benefit, Health Economics & Outcomes Research, Bologna, Italy
| | - Chiara Veronesi
- Clicon S.r.l. Società Benefit, Health Economics & Outcomes Research, Bologna, Italy
| | - Elisa Giacomini
- Clicon S.r.l. Società Benefit, Health Economics & Outcomes Research, Bologna, Italy
| | - Rita Citraro
- Dipartimento di Scienze della Salute, Università Magna Grecia di Catanzaro, Unita’ Operativa di Farmaco-logia Clinica e Farmacovigilanza, Azienda Ospedaliero-Universitaria “Mater Domini”, Catanzaro, Italy
| | | | | | | | - Anna Maria Resta
- Struttura Complessa di Farmacia Territoriale Area Vasta 1, Fano, Italy
| | | | | | - Luca Degli Esposti
- Clicon S.r.l. Società Benefit, Health Economics & Outcomes Research, Bologna, Italy
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Perrone V, Veronesi C, Dovizio M, Ancona DD, Bartolini F, Ferrante F, Lupi A, Palcic S, Re D, Terlizzi AP, Ramirez de Arellano Serna A, Cogliati P, Degli Esposti L. The Influence of Iron-Deficiency Anaemia (IDA) Therapy on Clinical Outcomes and Healthcare Resource Consumptions in Chronic Kidney Disease Patients Affected by IDA: A Real-Word Evidence Study among the Italian Population. J Clin Med 2022; 11:jcm11195820. [PMID: 36233688 PMCID: PMC9573467 DOI: 10.3390/jcm11195820] [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: 09/01/2022] [Revised: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 11/16/2022] Open
Abstract
Anaemia is a uraemia-related complication frequently found in non-dialysis-dependent chronic kidney disease (ND-CKD) patients, with iron-deficiency anaemia (IDA) as the main underlying mechanism. Given the suboptimal anaemia management in ND-CKD patients with a co-diagnosis of IDA, this study evaluated the role of IDA therapy on clinical outcomes and healthcare resource consumptions in an Italian clinical setting. A retrospective observational real-world analysis was performed on administrative databases of healthcare entities, covering around 6.9 million health-assisted individuals. From January 2010 to March 2019, ND-CKD patients were included and diagnosed with IDA in the presence of two low-haemoglobin (Hb) measurements. Patients were divided into IDA-treated and untreated, based on the prescription of iron [Anatomical-Therapeutic Chemical (ATC) code B03A] or anti-anaemia preparations (ATC code B03X), and evaluated during a 6-month follow-up from the index date [first low haemoglobin (Hb) detection]. IDA treatment resulted in significantly decreased incidence of all cause-related, cardiovascular-related, and IDA-related hospitalizations (treated vs. untreated: 44.5% vs. 81.8%, 12.3% vs. 25.3%, and 16.2% vs. 26.2%, respectively, p < 0.001). A healthcare direct cost estimation showed that overall mean expenditure per patient reduced by 47% with IDA treatment (5245€ vs. 9918€, p < 0.001), mainly attributable to hospitalizations (3767€ vs. 8486€, p < 0.001). This real-life analysis on Italian ND-CKD-IDA patients indicates that IDA therapy administration provides significant benefits in terms of patients’ clinical outcomes and healthcare cost savings.
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Affiliation(s)
- Valentina Perrone
- CliCon Società Benefit S.r.l. Health, Economics & Outcomes Research, 40137 Bologna, Italy
| | - Chiara Veronesi
- CliCon Società Benefit S.r.l. Health, Economics & Outcomes Research, 40137 Bologna, Italy
| | - Melania Dovizio
- CliCon Società Benefit S.r.l. Health, Economics & Outcomes Research, 40137 Bologna, Italy
| | - Domenica Daniela Ancona
- Dipartimento Farmaceutico, Azienda Sanitaria Locale delle province di Barletta- Andria- Trani (BAT), 76125 Andria, Italy
| | - Fausto Bartolini
- Dipartimento Farmaceutico, Unità Sanitaria Locale Umbria 2, 05100 Terni, Italy
| | - Fulvio Ferrante
- Dipartimento della Diagnostica ed Assistenza Farmaceutica, ASL Frosinone, 03100 Frosinone, Italy
| | - Alessandro Lupi
- Azienda Sanitaria Locale del Verbano Cusio Ossola (VCO), 28887 Omegna, Italy
| | - Stefano Palcic
- Azienda Sanitaria Universitaria Integrata Giuliano-Isontina (ASUGI), 34148 Trieste, Italy
| | - Davide Re
- Dipartimento Assistenza Territoriale, Azienda Sanitaria Locale di Teramo, 64100 Teramo, Italy
| | - Annamaria Pia Terlizzi
- Dipartimento Farmaceutico, Azienda Sanitaria Locale delle province di Barletta- Andria- Trani (BAT), 76125 Andria, Italy
| | | | | | - Luca Degli Esposti
- CliCon Società Benefit S.r.l. Health, Economics & Outcomes Research, 40137 Bologna, Italy
- Correspondence:
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Perrone V, Veronesi C, Dovizio M, Ancona DD, Andretta M, Bartolini F, Cavaliere A, Chinellato A, Ciaccia A, Cillo M, De Francesco A, Enieri N, Ferrante F, Gentile S, Procacci C, Ubertazzo L, Vercellone A, Lucatelli D, Procaccini M, Degli Esposti L. Analysis of Patients with Focal Epilepsy and Drug-Resistant Epilepsy in Italy: Evaluation of Their Characteristics, Therapeutic Pathway and the Consumption of Healthcare Resources. Clinicoecon Outcomes Res 2022; 14:513-521. [PMID: 35923519 PMCID: PMC9343177 DOI: 10.2147/ceor.s361692] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 07/07/2022] [Indexed: 11/23/2022]
Abstract
Purpose A retrospective analysis was conducted to estimate the number of patients with focal epilepsy and drug-resistant epilepsy (DRE) and their characteristics, the therapeutic patterns, the consumption of health resources in a real-world Italian setting. Patients and Methods A retrospective study was carried out on the administrative databases of a sample of Italian Health Departments, covering approximately 8.7 million health-assisted individuals. All adult patients with at least one hospitalization for focal epilepsy and an electroencephalogram (between 01/2010 and 12/2019), and at least one prescription of antiseizure medication (ASM) (between 01/2011 and 12/2018) were included in the study. Patients with at least two treatment failures and treated with a subsequent ASM were considered DRE. Results Overall, 1897 patients with focal epilepsy (mean age 56 years, 47% male) were identified, of which 485 (25.6%) with DRE (mean age 53 years, 43% male). Among patients with focal epilepsy and DRE, respectively, 48% and 54% had essential hypertension, 23.4% and 26.6% had cardiovascular disease, and 46.3% and 62.1% had peptic ulcer/prescription of gastric secretion inhibitors. During follow-up, patients with focal epilepsy maintained first-line treatment for 53.9 months; among these, 52% passed to the second-line, and 485 (25.6% of the total) began third-line treatment. In patients with focal epilepsy, the mean cost was € 4448 (of which € 1410 were epilepsy-related), and in DRE patients total expenditures averages € 5825 (of which € 2165 were epilepsy-related). In both patients with focal epilepsy and DRE, hospitalizations represented the most impacting item of expenditure. Conclusion The present analysis conducted in a setting of Italian clinical practice has shown that 25% of patients with focal epilepsy were resistant to antiepileptic treatments. Furthermore, these results showed that health-care costs for the management of epileptic patients were mainly accountable for the costs related to the disease-management and to hospitalizations.
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Affiliation(s)
- Valentina Perrone
- CliCon S.r.l., Società Benefit-Health, Economics & Outcomes Research, Bologna, Italy
- Correspondence: Valentina Perrone, CliCon S.r.l., Società Benefit-Health, Economics & Outcomes Research, Via Murri 9, Bologna, 40137, Italy, Tel +39 3450316494, Email
| | - Chiara Veronesi
- CliCon S.r.l., Società Benefit-Health, Economics & Outcomes Research, Bologna, Italy
| | - Melania Dovizio
- CliCon S.r.l., Società Benefit-Health, Economics & Outcomes Research, Bologna, Italy
| | | | - Margherita Andretta
- UOC Assistenza Farmaceutica Territoriale, Azienda ULSS 8 Berica, Vicenza, Italy
| | | | | | | | | | | | | | - Nicola Enieri
- Unità Operativa Farmacia Ospedaliera, ULSS 3 Serenissima, Mestre, Italy
| | | | | | | | | | | | | | | | - Luca Degli Esposti
- CliCon S.r.l., Società Benefit-Health, Economics & Outcomes Research, Bologna, Italy
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Perrone V, Giacomini E, Sangiorgi D, Andretta M, Bartolini F, Lupi A, Ferrante F, Palcic S, Re D, Degli Esposti L. Evaluation of the Therapeutic Pattern and Pharmaco-Utilization in Hypercholesterolemic Patients Treated with Statins: A Retrospective Study on Italian Real-World Data. Risk Manag Healthc Policy 2022; 15:1483-1489. [PMID: 35923556 PMCID: PMC9342867 DOI: 10.2147/rmhp.s358015] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 07/08/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose The study aimed to analyze, in hypercholesterolemic patients under statin medication, patient characteristics and their lipid profile at baseline, the therapeutic pathway, and the pharmaco-utilization, using real-world data in Italy. Patients and Methods A retrospective study was conducted using administrative databases of a sample of entities covering 6.5 million health-assisted individuals. Between January 2010 and June 2019, patients with non-familial hypercholesterolemia (nFH) were identified by 1) ≥1 low-density lipoprotein cholesterol (LDL-C) measurement (LDL-C assessment date was the index-date) and 2) statin prescription during 6 months before the index-date (pharmaco-utilization period). FH patients were defined by LDL-C evaluation, statin treatment during the pharmaco-utilization period, and a score ≥6 according to the Dutch Lipid Clinic Network criteria. nFH patients were divided into four exclusive cohorts based on CV-risk class: 1) with previous CV disease (CVD); 2) with diabetes mellitus; 3) with mixed-dyslipidemia diagnosis; 4) in primary-prevention. Based on LDL-C index values, patient was defined with LDL-C “controlled” if its levels were ≤70mg/dl (CVD), ≤100mg/dl (diabetes, FH), ≤130mg/dl (mixed-dyslipidemia, primary-prevention). Results Overall 164,161 nFH patients were included (mean age 72 years, 51% male); of these, 46,782 (28.5%) were CVD (mean age 74 years, 66% male), 34,803 (21.2%) were diabetic (mean age 72 years, 51% male), 1617 (1%) were with mixed-dyslipidemia (mean age 71 years, 48% male) and 80,959 (49.3%) were in primary-prevention (mean age 71 years, 42% male). The proportion of nFH patients with controlled LDL-C was 41.2% for CVD, 73.6% for diabetic, 80.7% for mixed-dyslipidemia, and 79.5% for primary-prevention patients; 49% of nFH patients were adherent to therapy. Overall, 1287 FH patients (mean age 64 years, 42% male) were included; in 39.2% of the patients, LDL-C was controlled, and 44% of the patients were adherent to therapy. Conclusion The results of this study highlighted non-optimal therapeutic management of hypercholesterolemic patients in Italian clinical practice, with a notable quote of patients non-adherent to therapy.
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Affiliation(s)
- Valentina Perrone
- CliCon S.r.l. Società Benefit – Health, Economics & Outcome Research, Bologna, Italy
- Correspondence: Valentina Perrone, CliCon S.r.l. Società Benefit – Health, Economics & Outcome Research, Via Murri 9, Bologna, 40137, Italy, Tel +39 3450316494, Email
| | - Elisa Giacomini
- CliCon S.r.l. Società Benefit – Health, Economics & Outcome Research, Bologna, Italy
| | - Diego Sangiorgi
- CliCon S.r.l. Società Benefit – Health, Economics & Outcome Research, Bologna, Italy
| | - Margherita Andretta
- UOC Assistenza Farmaceutica Territoriale, Azienda ULSS 8 Berica, Vicenza, Italy
| | | | | | | | - Stefano Palcic
- Azienda Sanitaria Universitaria Integrata Giuliano-Isontina (ASUGI), Trieste, Italy
| | - Davide Re
- U.O.C. Servizio Assistenza Farmaceutica Territoriale, ASL Teramo, Teramo, Italy
| | - Luca Degli Esposti
- CliCon S.r.l. Società Benefit – Health, Economics & Outcome Research, Bologna, Italy
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Perrone V, Losi S, Maiorino A, Antonelli S, Giovannitti M, Giacomini E, Sangiorgi D, Degli Esposti L. Treatment Patterns and Pharmacoutilization in Patients Affected by Psoriasis: An Observational Study in an Italian Real-World Setting. Drugs Real World Outcomes 2022; 9:243-251. [PMID: 35041194 PMCID: PMC9114260 DOI: 10.1007/s40801-021-00290-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Real-world data can inform the use of biologics for psoriasis (PSO). OBJECTIVE The aim was to evaluate treatment patterns and analyze pharmacoutilization in PSO patients in a real-world Italian setting, with a focus on the biologics most recently introduced. METHODS An observational study based on administrative databases was conducted. Patients were included based on PSO diagnosis identified by either discharge diagnosis or exemption code or prescription of anti-psoriatic topical drugs (proxy of diagnosis). To describe patient characteristics and treatment patterns using the most up-to-date data, two different approaches were used: a cross-sectional study performed during 2016-2018, and a longitudinal study conducted with patients who received their first biological/targeted synthetic drugs (naïve patients) in 2014 and 2017 (the inclusion periods). RESULTS During 2016-2018, the number of prevalent patients diagnosed with PSO was 194,054 (2016), 210,830 (2017), and 225,171 (2018). The percentage of patients receiving biologics or targeted synthetic agents ranged from 1.5 to 2.1%. Among them, naïve patients receiving interleukin (IL) inhibitors increased from 37.5% (2016) to 69.4% (2018), while those receiving anti-tumor necrosis factor (anti-TNF) decreased from 62.5% (2016) to 30.6% (2018). The longitudinal analysis included 894 and 1218 naïve patients in 2014 and 2017, respectively, of whom 7.2% (2014) and 6.9% (2017) switched therapy after a mean of 7.1 (2014) and 6.9 (2017) months. Overall, 259 patients were prescribed ixekizumab starting in 2017, of whom 73% were naïve. Ixekizumab was prescribed as monotherapy to 52.5%. CONCLUSIONS The proportion of patients receiving biologics appeared constant over the years, with an increasing number of naïve patients being prescribed IL-17 inhibitors. Ixekizumab patients were mostly naïve.
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Affiliation(s)
- Valentina Perrone
- CliCon S.r.l., Società Benefit Health Economics and Outcomes Research, Via Murri, 9 40137, Bologna, Italy.
| | - Serena Losi
- Eli Lilly Italy S.p.A., Sesto Fiorentino, Italy
| | | | | | | | - Elisa Giacomini
- CliCon S.r.l., Società Benefit Health Economics and Outcomes Research, Via Murri, 9 40137, Bologna, Italy
| | - Diego Sangiorgi
- CliCon S.r.l., Società Benefit Health Economics and Outcomes Research, Via Murri, 9 40137, Bologna, Italy
| | - Luca Degli Esposti
- CliCon S.r.l., Società Benefit Health Economics and Outcomes Research, Via Murri, 9 40137, Bologna, Italy
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Degli Esposti L, Borghi C, Galvani M, Giacomini E, Manotti P, Marra A, Passaro A, Perrone V, Pieraccini F, Sangiorgi D, Navazio A. P342 REAL–WORLD ANALYSIS ON THE ECONOMIC VALUE OF REACHING LIPID TARGET IN ITALY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.329] [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: 11/14/2022]
Abstract
Abstract
The study aimed to evaluate the healthcare direct costs for Italian National Health System of patients treated with lipid–lowering drugs that do not achieve the low–density lipoprotein (LDL)–cholesterol target compared to those reaching their targets, and to analyze costs according to the distance from LDL target by using real–world data.
An observational analysis was performed on administrative and laboratory data from selected Italian Healthcare Departments. Patients were included if they presented at least one laboratory LDL test between 2012 and 2019 and if they were prescribed lipid–lowering drugs during 6 months prior the last LDL detection (index date). Mean annual direct costs were evaluated in the 12 months before index date in terms of all drugs prescribed, all–cause hospitalizations and all outpatient services. Distance to LDL target was calculated as difference between the index LDL level and LDL target. Total mean annual healthcare direct cost for patients that did not reach LDL target was higher compared to total cost of patients achieving LDL target (€3,678 vs €2,906). Costs were mainly driven by hospitalization (€1,330) followed by drugs expenditure (€1,012) and outpatient services (€563). Mean total annual healthcare costs increased with the distance from LDL target, specifically from €3,004 for patients with 10% distance from LDL target up to €4,823 for those 50% or more distance from LDL target. This trend was particularly evident for the cost item related to hospitalization, that went from €1,486 to €2,819 moving from 10% to ≥ 50 distance from LDL target. Results from this real–world study highlighted the higher economic burden for patients that do not reach the therapeutic LDL target, that tend to rise along with increasing distance from the LDL target. Overall, our findings could suggest that reducing the distance from LDL target could have a positive impact also on the economic outcomes for these patients.
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Affiliation(s)
- L Degli Esposti
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - C Borghi
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - M Galvani
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - E Giacomini
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - P Manotti
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - A Marra
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - A Passaro
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - V Perrone
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - F Pieraccini
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - D Sangiorgi
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - A Navazio
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
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Degli Esposti L, Borghi C, Galvani M, Giacomini E, Manotti P, Marra A, Passaro A, Perrone V, Pieraccini F, Sangiorgi D, Navazio A. P358 THE ROLE OF ADHERENCE TO LIPID–LOWERING THERAPIES IN ACHIEVING LIPID TARGET: FINDINGS FROM REAL–WORLD ANALYSIS IN ITALY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.345] [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: 11/14/2022]
Abstract
Abstract
The objective of the present real–world analysis was to evaluate the impact of adherence to lipid–lowering drugs in reaching the lipid target in settings of clinical practice in Italy.
The analysis was based on administrative and laboratory database of selected Healthcare Units in Italy covering approximately 10% of Italian population. Adult patients prescribed with statin and with at least a low–density lipoprotein (LDL) determination were included between 2012 and 2019. The index date was defined as the first prescription for statin within the inclusion period. Patients fell into 4 clusters collectively exhaustive and mutually exclusive based on their characteristics assessed during the year prior index date. Patients were considered as adherent if they had a proportion of days covered (PDC)≥80%. Among overall patients prescribed statin and with a LDL determination, 1% was with familial hypercholesterolemia, 28% with previous cardiovascular events, 21% with diabetes and 50% in primary prevention. Regardless their risk profile, the increasing of adherence was related to a higher achievement of LDL–target, with an increment of + 53.2% among familial hypercholesterolemia, +43.1% in diabetes and +30% in previous cardiovascular events and primary prevention clusters while progressing from low (PDC<40%) to high (PDC≥80%) levels of adherence. However, while in diabetes and primary prevention clusters 80% and 86% of adherent patients, respectively, had their cholesterol level under control, in the familial hypercholesterolemia and previous cardiovascular events clusters only 46% of adherent patients achieve the lipid target.
The analysis showed adherence to be a key factor for cholesterol control. However, our findings underline a therapeutic need for patients that, although adherent, fail to achieve the lipid target, especially among patients with previous cardiovascular events (that have low level of LDL to achieve) and with familial hypercholesterolemia (that have high LDL basal level), suggesting therapeutic intensification should be applied.
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Affiliation(s)
- L Degli Esposti
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - C Borghi
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - M Galvani
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - E Giacomini
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - P Manotti
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - A Marra
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - A Passaro
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - V Perrone
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - F Pieraccini
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - D Sangiorgi
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
| | - A Navazio
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI FORLÌ, AUSL ROMAGNA, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDAL
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Degli Esposti L, Borghi C, Galvani M, Giacomini E, Manotti P, Marra A, Passaro A, Perrone V, Pieraccini F, Sangiorgi D, Navazio A. P357 THE MANAGEMENT OF CHOLESTEROL LEVEL CONTROL WITH LIPID–LOWERING DRUGS IN ITALIAN CLINICAL PRACTICE: FINDINGS FROM THE STREAM (SUPPORTING WITH THE REAL–WORLD EVIDENCE THE ASSESSMENT OF MEDICINES AND HEALTH TECHNOLOGIES) STUDY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.344] [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: 11/13/2022]
Abstract
Abstract
The study aimed to evaluate the proportion of patients not reaching their low–density lipoprotein (LDL)–cholesterol target according to their risk profile in real–world settings of Italian clinical practice.
This observational analysis was based on administrative and laboratory databases from a pool of Italian Entities covering around 10% of Italian population. All patients included had at least one laboratory LDL test between 2012 and 2019. Presence of lipid–lowering drugs was analyzed in the 6 months before index date (last LDL test detected), during which time adherence to these therapies was measured as proportion of days covered (PDC). Risk profile was assessed based on ESC guidelines.1 Among patients with LDL tests that received lipid–lowering drugs, 49.7% were deemed as very high–risk (VHR), 38.3% at high risk (HR), 12% with other risks (OR). Overall, 80% of patients did not reach their LDL–cholesterol target: 87.2% in the HR–cohort, 82.9% in the VHR–cohort (LDL level target 70 mg/dl and 55 mg/dl, respectively) and 49.6% in OR–cohort (LDL level target 116 mg/dl). Statin and ezetimibe combination was observed only in 6.5% of HR and OR and 10.3% of VHR patients, while patients were mainly in monotherapy with statins (87.5 VHR, 91.2% HR, 90.6% OR). Furthermore, patients adherent to treatment (PDC≥80%) accounted for the 52% of VHR–cohort, 47.2% of HR–cohort and 39.1% of OR–cohort. Our findings highlight the need to optimize the management of cholesterol control, especially among patients at risk. Despite the high proportion of patients not reaching LDL target, sub–optimal levels of adherence and a low use of combination regimens were observed, thus suggesting LDL–control could be supported by increasing adherence and/or the use of combination therapies and, if the target is not yet achieved, by the utilization of more recent therapies.
European Heart Journal (2020) 41, 111–188
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Affiliation(s)
- L Degli Esposti
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDALIERA–UNIVERSITARIA S
| | - C Borghi
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDALIERA–UNIVERSITARIA S
| | - M Galvani
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDALIERA–UNIVERSITARIA S
| | - E Giacomini
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDALIERA–UNIVERSITARIA S
| | - P Manotti
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDALIERA–UNIVERSITARIA S
| | - A Marra
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDALIERA–UNIVERSITARIA S
| | - A Passaro
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDALIERA–UNIVERSITARIA S
| | - V Perrone
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDALIERA–UNIVERSITARIA S
| | - F Pieraccini
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDALIERA–UNIVERSITARIA S
| | - D Sangiorgi
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDALIERA–UNIVERSITARIA S
| | - A Navazio
- CLICON S.R.L., BOLOGNA; MEDICINE DEPARTMENT OF MEDICAL AND SURGICAL SCIENCES UNIVERSITY OF BOLOGNA, BOLOGNA; UOC CARDIOLOGIA OSPEDALE MORGAGNI–PIERANTONI, FORLÌ; DIPARTIMENTO CURE PRIMARIE, AUSL DI REGGIO EMILIA, REGGIO EMILIA; U.O. FARMACIA OSPEDALIERA DIPARTIMENTO BIOTECNOLOGIE, TRASFUSIONALE E DI LABORATORIO AZIENDA OSPEDALIERO UNIVERSITARIA S.ANNA, FERRARA; AZIENDA OSPEDALIERA–UNIVERSITARIA S
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Esposti LD, Perrone V, Sella S, Arcidiacono G, Bertoldo F, Giustina A, Minisola S, Napoli N, Passeri G, Rossini M, Giannini S. The Potential Impact of Inducing a Restriction in Reimbursement Criteria on Vitamin D Supplementation in Osteoporotic Patients with or without Fractures. Nutrients 2022; 14:nu14091877. [PMID: 35565842 PMCID: PMC9105449 DOI: 10.3390/nu14091877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 11/16/2022] Open
Abstract
In October 2019, the Italian Drug Agency (AIFA) restricted reimbursement criteria for vitamin D (VD) use outside the osteoporosis setting (Note 96). However, whether this restriction could also have involved patients at risk for or with osteoporotic fractures has not yet been investigated. We retrospectively analyzed databases from five Italian Local Health Units. Patients aged ≥50 years with either at least one prescription for osteoporosis treatment or with fragility fractures and evidence of osteoporosis from 2011 to 2020 were included. The proportion of subjects with an interruption in VD treatment before and after the introduction of the new reimbursement criteria and predictors of this interruption were analyzed. A total of 94,505 patients (aged 69.4 years) were included. Following the introduction of Note 96, a 2-fold (OR 1.98, 95% CI: 1.92–2.04) increased risk of VD discontinuation was observed. These findings were independent of seasonal variation, osteoporosis treatment patterns, as well as other confounding variables. However, a higher rate of interruption was observed in patients without vertebral/femur fracture (37.8%) vs. those with fracture (32.9%). Rheumatoid arthritis, dyslipidemia and previous fracture were associated with a lower risk of VD interruption, while stroke increased the risk of VD interruption. Our results highlight that a possible misinterpretation of newly introduced criteria for reimbursement restrictions in VD outside of osteoporosis have resulted in an inadequate level of VD supplementation in patients with osteoporosis. This undertreatment could reduce the effect of osteoporosis therapies leading to increased risk of negative outcome.
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Affiliation(s)
- Luca Degli Esposti
- CliCon Srl Società Benefit Health Economics and Outcome Research, 40137 Bologna, Italy; (L.D.E.); (V.P.)
| | - Valentina Perrone
- CliCon Srl Società Benefit Health Economics and Outcome Research, 40137 Bologna, Italy; (L.D.E.); (V.P.)
| | - Stefania Sella
- Clinica Medica 1, Department of Medicine, University of Padova, 35128 Padova, Italy; (S.S.); (G.A.)
| | - Gaetano Arcidiacono
- Clinica Medica 1, Department of Medicine, University of Padova, 35128 Padova, Italy; (S.S.); (G.A.)
| | - Francesco Bertoldo
- Internal Medicine, Department of Medicine, University Hospital AOUI, 37134 Verona, Italy;
| | - Andrea Giustina
- Institute of Endocrine and Metabolic Sciences, Instituto di Ricovero e Cura a Carattere Scientifico (IRCSS) San Raffaele Hospital, San Raffaele Vita-Salute University, 20132 Milan, Italy;
| | - Salvatore Minisola
- Department of Clinical, Internal, Anaesthesiology, and Cardiovascular Sciences Sapienza University of Rome, 00185 Rome, Italy;
| | - Nicola Napoli
- Division of Endocrinology and Diabetes, Università Campus Bio-Medico di Roma, 00128 Rome, Italy;
| | - Giovanni Passeri
- Unit of Clinica e Terapia Medica, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy;
| | - Maurizio Rossini
- Rheumatology Unit, Department of Medicine, University of Verona, 37134 Verona, Italy;
| | - Sandro Giannini
- Clinica Medica 1, Department of Medicine, University of Padova, 35128 Padova, Italy; (S.S.); (G.A.)
- Correspondence: ; Tel.: +39-0498212169
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Perrone V, Losi S, Filippi E, Mezzetti M, Dovizio M, Sangiorgi D, Degli Esposti L. Analysis of the Pharmacoutilization of Biological Drugs in Psoriatic Arthritis Patients: A Real-World Retrospective Study Among an Italian Population. Rheumatol Ther 2022; 9:875-890. [PMID: 35316515 PMCID: PMC9127009 DOI: 10.1007/s40744-022-00440-1] [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: 01/17/2022] [Accepted: 03/04/2022] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Real-world pharmacoutilization analysis of biological drugs in psoriatic arthritis (PsA) patients with the aim to evaluate biologic treatment patterns and pharmacoutilization among patients with PsA in Italy. METHODS A retrospective study was conducted using administrative databases of Italian Entities. PsA patients were included and diagnosed by hospitalization and/or an active exemption code. Two analyses were performed: a cross-sectional for treatment patterns in patients enrolled among 2017-2020, and a longitudinal study during 2015 to investigate the pharmacoutilization, in terms of persistence and monthly maintenance dosage of biological/targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs). Patients with or without b/tsDMARDs prescriptions before inclusion were defined as bioexperienced or naïve, respectively. An analysis on ixekizumab-treated patients (IXE patients) from the 2017-to study ending was performed. RESULTS PsA was diagnosed in 24,786 (2017), 27,221 (2018), 28,889 (2019), and 29,292 (2020) patients. Across 2017-2020, 31.1-40.5% of PsA patients were untreated with systemic medications, and 16.4-18.8% were under biological therapies. Among b/tsDMARD-treated patients, decreasing use of TNF-inhibitors (77.6-57.1%) and increasing IL-inhibitors (19.6-33.2%) was found across 2017-2020, respectively. Persistence to TNF-inhibitors and IL inhibitors as first-line ranged, respectively, 74.9-83.0% and 73.0-84.6%; specifically, 73.1-76.9% and 73.0-83.8% among bio-naïve, 83.3-90.0%, and 87.0% among bio-experienced. Among IXE-patients (N = 178), 55.6% were bio-naïve, while 21.9% previously used secukinumab, 12.9% adalimumab, 10.1% etanercept. During a 1-year follow-up, 6.8% of IXE patients switched therapy. CONCLUSIONS This real-world study of PsA pharmacoutilization in Italy showed that more than one-third of patients were systemically untreated, and almost 20% were receiving biological medications. Among biological users, increasing use of IL-inhibitors and a decrease in TNF-inhibitors prescriptions over the years were found. A rather-high extent of persistency in treatment was observed. A focused analysis on IXE patients revealed over half of them to be bio-naïve, while around one-fourth were bio-experienced to IL inhibitors.
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Affiliation(s)
- Valentina Perrone
- CliCon S.R.L. Società Benefit, Health Economics and Outcomes Research, 40141, Bologna, Italy.
| | - Serena Losi
- Eli Lilly Italy S.P.A., 50019, Sesto Fiorentino, Italy
| | - Erica Filippi
- Eli Lilly Italy S.P.A., 50019, Sesto Fiorentino, Italy
| | | | - Melania Dovizio
- CliCon S.R.L. Società Benefit, Health Economics and Outcomes Research, 40141, Bologna, Italy
| | - Diego Sangiorgi
- CliCon S.R.L. Società Benefit, Health Economics and Outcomes Research, 40141, Bologna, Italy
| | - Luca Degli Esposti
- CliCon S.R.L. Società Benefit, Health Economics and Outcomes Research, 40141, Bologna, Italy
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Degli Esposti L, Veronesi C, Ancona DD, Andretta M, Bartolini F, Drei A, Lupi A, Palcic S, Re D, Rizzi FV, Giacomini E, Perrone V. Direct Healthcare Costs by Level of Adherence of a Real-World Population of Statin Users in Italy. Clinicoecon Outcomes Res 2022; 14:139-147. [PMID: 35299992 PMCID: PMC8922236 DOI: 10.2147/ceor.s345852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 02/04/2022] [Indexed: 11/23/2022]
Abstract
Purpose This real-world study investigates the direct healthcare costs from the perspective of the Italian Healthcare National Service of experienced statin users according to their level of adherence to therapy and to their cardiovascular (CV) profile in Italian settings of outpatients clinical practice. Patients and Methods A retrospective observational analysis was performed based on administrative databases covering approximately 6 million health-assisted individuals. Adult patients with statins prescription between January 2014 and December 2016 were screened, and first prescription within this period was the index date. Follow-up lasted 1 year after index date. Only patients receiving statins prior index date (experienced statin users) were included and distributed in clusters based on their CV profile. Adherence was calculated during follow-up as proportion of days covered (PDC) and classified in low adherence (PDC<40%), partial adherence (PDC=40–79%) and adherence (PDC≥80%). Mean direct healthcare costs of drugs, hospitalizations, and outpatient services were evaluated during follow-up. Results A total of 436,623 experienced statin users were included and distributed as follows: 5.5% in the previous CV events, 22.6% in diabetes, 55.7% in CV treatments and 16.2% in the no comorbidity cluster. Total mean annual cost/patient decreased from low adherent to adherent patients from €4826 to €3497 in previous CV events, from €2815 to €2360 in diabetes cluster, from €2077 to €1863 for patients with CV treatments. Same trend was reported for the cost item related to hospitalizations, which was the major determinant of the total costs. In previous CV event cluster, adherence was associated to a saving of €879 on total costs. Conclusion The study highlighted a decrease in overall mean costs as adherence levels increase, particularly for patients with previous CV events, showing how improving adherence could be associated to cost savings and suggesting suited strategy based on CV profile should be undertaken for adherence optimization.
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Affiliation(s)
| | - Chiara Veronesi
- CliCon S.r.l. Health, Economics & Outcomes Research, Bologna, Italy
| | | | - Margherita Andretta
- UOC Assistenza Farmaceutica Territoriale, Azienda ULSS 8 Berica, Vicenza, Italy
| | | | | | | | - Stefano Palcic
- Farmaceutica Territoriale, Azienda Sanitaria Universitaria Integrata Giuliano-Isontina, Trieste, Italy
| | - Davide Re
- UOC Assistenza Farmaceutica Territoriale, ASL Teramo, Teramo, Italy
| | | | - Elisa Giacomini
- CliCon S.r.l. Health, Economics & Outcomes Research, Bologna, Italy
| | - Valentina Perrone
- CliCon S.r.l. Health, Economics & Outcomes Research, Bologna, Italy
- Correspondence: Valentina Perrone, Clicon Srl, Health, Economics and Outcomes Research, Via Murri 9, Bologna, 40137, Italy, Tel +39 544 38393, Fax +39 544 212699, Email
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Perrone V, Dovizio M, Veronesi C, Citraro R, De Francesco A, Dell’Orco S, Di Manno G, Paciello A, Resta AM, Quarta F, Ferrante N, Ritrovato D, Degli Esposti L. Retrospective Analysis of the Pharmaco-Utilization of VEGF Inhibitors and Health Care Costs among Patients with Wet Age-Related Macular Degeneration and Other Ocular Diseases in Italy. Int J Environ Res Public Health 2022; 19:ijerph19052548. [PMID: 35270241 PMCID: PMC8909764 DOI: 10.3390/ijerph19052548] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/28/2022] [Accepted: 02/18/2022] [Indexed: 02/04/2023]
Abstract
This Italian retrospective study aimed to analyze the pharmaco-utilization of anti-VEGF drugs and health care costs among patients with wet age-related macular degeneration (wAMD) or other ocular diseases. A retrospective analysis was performed on administrative databases of Italian entities covering approximately six million individuals. Across January 2010–December 2017, patients aged ≥50 years with a prescription of intravitreal anti-VEGFs were included as “wAMD” patients [by wAMD hospitalization or intravitreal injections] or as “other ocular diseases” patients [by hospitalization for other ocular disorders or intravitreal injections, with concomitant diabetes diagnosis or dexamethasone treatment]. The date of first matching of inclusion criteria was index-date. wAMD-cohort. Overall, 3879 patients were included; at index-date, 82.2% were treated with Ranibizumab, 15.8% with Aflibercept, and 2% with Pegaptanib. During the follow-up, the mean/annual anti-VEGF prescription [3.6 (first-year)–0.8 (third-year)] and the total expenditure [5799.84 € (first-year)–3212.84 € (third-year)] decreased. Other ocular diseases-cohort. Overall, 2646 patients were enclosed; 85.9% were treated with Ranibizumab, 13.5% with Aflibercept, and 0.6% with Pegaptanib. During the follow-up, the mean/annual anti-VEGF prescription [3.3 (first-year)–0.5 (third-year)] and the total cost [7196.83 € (first-year)–5162.68 € (third-year)] decreased. This observational study highlighted a decline in anti-VEGF prescriptions over time in both cohorts, suggesting a trend of under-treatment that could worsen the patients’ clinical outcomes and increase health care resource consumption.
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Affiliation(s)
- Valentina Perrone
- CliCon S.r.l. Società Benefit Health, Economics & Outcomes Research, 40121 Bologna, Italy; (M.D.); (C.V.); (L.D.E.)
- Correspondence:
| | - Melania Dovizio
- CliCon S.r.l. Società Benefit Health, Economics & Outcomes Research, 40121 Bologna, Italy; (M.D.); (C.V.); (L.D.E.)
| | - Chiara Veronesi
- CliCon S.r.l. Società Benefit Health, Economics & Outcomes Research, 40121 Bologna, Italy; (M.D.); (C.V.); (L.D.E.)
| | - Rita Citraro
- Unita’ Operativa di Farmacologia Clinica e Farmacovigilanza, Azienda Ospedaliero-Universitaria “Mater Domini”, Università Magna Grecia di Catanzaro, 88100 Catanzaro, Italy; (R.C.); (A.D.F.)
| | - Adele De Francesco
- Unita’ Operativa di Farmacologia Clinica e Farmacovigilanza, Azienda Ospedaliero-Universitaria “Mater Domini”, Università Magna Grecia di Catanzaro, 88100 Catanzaro, Italy; (R.C.); (A.D.F.)
| | - Stefania Dell’Orco
- Azienda Sanitaria Locale (ASL) Roma 6, Albano Laziale, 00100 Rome, Italy; (S.D.); (G.D.M.)
| | - Gianluca Di Manno
- Azienda Sanitaria Locale (ASL) Roma 6, Albano Laziale, 00100 Rome, Italy; (S.D.); (G.D.M.)
| | - Arrigo Paciello
- Agenzia di Tutela della Salute (ATS) Bergamo, 24100 Bergamo, Italy;
| | - Anna Maria Resta
- Struttura Complessa di Farmacia Territoriale Area Vasta 1, 61032 Fano, Italy;
| | - Fabrizio Quarta
- U.O. Epidemiologia e Statistica, Azienda Sanitaria Locale (ASL) Lecce, 73100 Lecce, Italy;
| | - Nicola Ferrante
- Novartis Farma S.p.A., Origgio, 21100 Varese, Italy; (N.F.); (D.R.)
| | | | - Luca Degli Esposti
- CliCon S.r.l. Società Benefit Health, Economics & Outcomes Research, 40121 Bologna, Italy; (M.D.); (C.V.); (L.D.E.)
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Perrone V, Losi S, Filippi E, Antonelli S, Giovannitti M, Giacomini E, Sangiorgi D, Degli Esposti L. Analysis of the prevalence of ankylosing spondylitis and treatment patterns and drug utilization among affected patients: an Italian real-world study. Expert Rev Pharmacoecon Outcomes Res 2022; 22:327-333. [DOI: 10.1080/14737167.2022.2032663] [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: 11/04/2022]
Affiliation(s)
- Valentina Perrone
- CliCon Srl Società Benefit, Health Economics and Outcomes Research, Bologna, Italy
| | - Serena Losi
- Eli Lilly Italy S.p.A., Sesto Fiorentino, Italy
| | | | | | | | - Elisa Giacomini
- CliCon Srl Società Benefit, Health Economics and Outcomes Research, Bologna, Italy
| | - Diego Sangiorgi
- CliCon Srl Società Benefit, Health Economics and Outcomes Research, Bologna, Italy
| | - Luca Degli Esposti
- CliCon Srl Società Benefit, Health Economics and Outcomes Research, Bologna, Italy
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Degli Esposti L, Perrone V, Sangiorgi D, Andretta M, Bartolini F, Cavaliere A, Ciaccia A, Dell'orco S, Grego S, Salzano S, Ubertazzo L, Vercellone A, Gatti D, Fassio A, Viapiana O, Rossini M, Adami G. The Use of Oral Amino-Bisphosphonates and Coronavirus Disease 2019 (COVID-19) Outcomes. J Bone Miner Res 2021; 36:2177-2183. [PMID: 34405441 PMCID: PMC8420492 DOI: 10.1002/jbmr.4419] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/24/2021] [Accepted: 08/03/2021] [Indexed: 01/06/2023]
Abstract
The determinants of the susceptibility to severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection and severe coronavirus disease 2019 (COVID-19) manifestations are yet not fully understood. Amino-bisphosphonates (N-BPs) have anti-inflammatory properties and have been shown to reduce the incidence of lower respiratory infections, cardiovascular events, and cancer. We conducted a population-based retrospective observational cohort study with the primary objective of determining if oral N-BPs treatment can play a role in the susceptibility to development of severe COVID-19. Administrative International Classification of Diseases, Ninth Revision, Clinical ModificationI (ICD-9-CM) and anatomical-therapeutic chemical (ATC) code data, representative of Italian population (9% sample of the overall population), were analyzed. Oral N-BPs (mainly alendronate and risedronate) were included in the analysis, zoledronic acid was excluded because of the low number of patients at risk. Incidence of COVID-19 hospitalization was 12.32 (95% confidence interval [CI], 9.61-15.04) and 11.55 (95% CI, 8.91-14.20), of intensive care unit (ICU) utilization because of COVID-19 was 1.25 (95% CI, 0.38-2.11) and 1.42 (95% CI, 0.49-2.36), and of all-cause death was 4.06 (95% CI, 2.50-5.61) and 3.96 (95% CI, 2.41-5.51) for oral N-BPs users and nonusers, respectively. Sensitivity analyses that excluded patients with prevalent vertebral or hip fragility fractures and without concomitant glucocorticoid treatment yielded similar results. In conclusion, we found that the incidence of COVID-19 hospitalization, intensive care unit (ICU) utilization, and COVID-19 potentially related mortality were similar in N-BPs-treated and nontreated subjects. Similar results were found in N-BPs versus other anti-osteoporotic drugs. We provide real-life data on the safety of oral N-BPs in terms of severe COVID-19 risk on a population-based cohort. Our results do not support the hypothesis that oral N-BPs can prevent COVID-19 infection and/or severe COVID-19; however, they do not seem to increase the risk. © 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
| | | | - Diego Sangiorgi
- CliCon S.r.l. Health, Economics & Outcomes Research, Bologna, Italy
| | - Margherita Andretta
- UOC Assistenza Farmaceutica Territoriale, Azienda ULSS 8 Berica, Vicenza, Italy
| | | | | | | | | | - Stefano Grego
- Dipartimento Tecnico-Amministrativo, ASL 3 Genovese, Genova, Italy
| | - Sara Salzano
- UOC Farmacia Territoriale, ASL Roma 4, Rome, Italy
| | | | | | - Davide Gatti
- Rheumatology Unit, University of Verona, Verona, Italy
| | - Angelo Fassio
- Rheumatology Unit, University of Verona, Verona, Italy
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Antonini G, Habetswallner F, Inghilleri M, Mantegazza R, Rodolico C, Saccà F, Sgarzi M, De Ruyck F, Paci S, Phillips G, Crippa L, Perrone V, Esposti LD. Estimation of myasthenia gravis prevalence in Italy using real-world data. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.118340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Morieri ML, Perrone V, Veronesi C, Degli Esposti L, Andretta M, Plebani M, Fadini GP, Vigili de Kreutzenberg S, Avogaro A. Improving statin treatment strategies to reduce LDL-cholesterol: factors associated with targets' attainment in subjects with and without type 2 diabetes. Cardiovasc Diabetol 2021; 20:144. [PMID: 34271920 PMCID: PMC8283985 DOI: 10.1186/s12933-021-01338-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/06/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND This cross-sectional study aimed to identify actionable factors to improve LDL-cholesterol target achievement and overcome underuse of lipid-lowering treatments in high- or very-high-cardiovascular risk patients. METHODS We evaluated healthcare records of 934,332 subjects from North-Italy, including subjects with available lipid profile and being on statin treatments up to December 2018. A 6-month-period defined adherence with proportion-of-days-covered ≥ 80%. Treatment was classified as high-intensity-statin (HIS) + ezetimibe, HIS-alone, non-HIS (NHIS) + ezetimibe or NHIS alone. RESULTS We included 27,374 subjects without and 10,459 with diabetes. Among these, 30% and 36% were on secondary prevention, respectively. Adherence was high (78-100%) and increased with treatment intensity and in secondary prevention. Treatment intensity increased in secondary prevention, but only 42% were on HIS. 2019-guidelines LDL-cholesterol targets were achieved in few patients and more often among those with diabetes (7.4% vs. 10.7%, p < 0.001). Patients in secondary prevention had mean LDL-cholesterol levels aligned slightly above 70 mg/dl (range between 68 and 73 mg/dl and between 73 and 85 mg/dl in patients with and without diabetes, respectively). Moreover, the differences in mean LDL-cholesterol levels observed across patients using treatments with well-stablished different LDL-lowering effect were null or much smaller than expected (HIS vs. NHIS from - 3 to - 11%, p < 0.001, HIS + ezetimibe vs. HIS-from - 4 to + 5% n.s.). These findings, given the observational design of the study, might suggest that a "treat to absolute LDL-cholesterol levels" approach (e.g., targeting LDLc of 70 mg/dl) was mainly used by physicians rather than an approach to also achieve the recommended 50% reduction in LDL-cholesterol levels. Our analyses suggested that female sex, younger age, higher HDL-c, and elevated triglycerides are those factors delaying prescription of statin treatments, both in patients with and without diabetes and in those on secondary prevention. CONCLUSIONS Among patients on statin treatment and high adherence, only a small proportion of patients achieved LDL-cholesterol targets. Late initiation of high-intensity treatments, particularly among those with misperceived low-risk (e.g., female subjects or those with high HDL-cholesterol), appears as pivotal factors needing to be modified to improve CVD prevention.
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Affiliation(s)
- Mario Luca Morieri
- Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padua, Italy. .,University Hospital of Padova , Padova, Italy.
| | | | - Chiara Veronesi
- CliCon S.R.L. Health Economics & Outcomes Research, Bologna, Italy
| | | | | | - Mario Plebani
- Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padua, Italy
| | - Gian Paolo Fadini
- Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padua, Italy.,University Hospital of Padova , Padova, Italy
| | - Saula Vigili de Kreutzenberg
- Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padua, Italy.,University Hospital of Padova , Padova, Italy
| | - Angelo Avogaro
- Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padua, Italy.,University Hospital of Padova , Padova, Italy
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Perrone V, Sangiorgi D, Andretta M, Ducci G, Forti B, Francesa Morel PC, Gambera M, Maina G, Mencacci C, Mennini FS, Zanalda E, Degli Esposti L. Healthcare Resource Consumption and Related Costs of Patients Estimated with Treatment-Resistant Depression in Italy. Clinicoecon Outcomes Res 2021; 13:629-635. [PMID: 34262308 PMCID: PMC8275098 DOI: 10.2147/ceor.s314111] [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: 04/07/2021] [Accepted: 06/17/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To analyse the healthcare resource consumption and related costs for the Italian National Health System of patients estimated to be affected by treatment-resistant depression (TRD) in Italy. Patients and Methods This was an observational retrospective study based on administrative databases, including those related to residential/semiresidential structures, of Veneto Region and the Local Health Unit of Bergamo in Italy (for a total of around 6 million health-assisted subjects). Between July 2011 and December 2017, all adult patients with a third antidepressant (AD) after ≥2 AD (each one with at least ≥4 weeks duration, ≥1 prescription at maximum dosage reported in datasheets, a grace period ≤30 days when switching AD and treatment maintained ≥9 months) were included. Overall and psychiatry-related healthcare resources consumption and related costs were estimated on a 12-months based analysis. Data were re-proportioned to the Italian population. Results We have previously estimated a total of 101,455 patients with TRD in Italy (130,049 considering the mean maximum dosage of AD). Of them, 44.2% had at least a psychiatric hospitalization/visit or accessed a residential/semiresidential structure, and 31% added another AD or a mood stabilizer/antipsychotic drug. Patients with at least one psychiatry-related hospitalization increased over the number of antidepressant lines from 12.0% during first line up to 24.5% during fourth line. Direct healthcare costs increased from €4,405 for first line to €9,251 from fifth line onwards. Psychiatry-related costs went from €1,817 (first line) to €4,606 (fifth line onwards) and were mainly driven by residential/semiresidential structures and hospitalizations. Conclusion An upward trend with number of AD lines was observed for all healthcare resource utilization and consequently for all direct costs, thus indicating an increasing burden for patients as they move forward AD lines.
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Affiliation(s)
- Valentina Perrone
- CliCon S.r.l., Health, Economics & Outcomes Research, Bologna, Italy
| | - Diego Sangiorgi
- CliCon S.r.l., Health, Economics & Outcomes Research, Bologna, Italy
| | - Margherita Andretta
- UOC Assistenza Farmaceutica Territoriale, Azienda ULSS 8 Berica, Vicenza, Italy
| | | | - Bruno Forti
- Mental Health Department - Azienda ULSS n 1 "Dolomiti", Veneto Region, Italy
| | | | - Marco Gambera
- "OSPEDALE P. PEDERZOLI" Casa di Cura Privata S.p.A., Peschiera del Garda, Verona, Italy
| | - Giuseppe Maina
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, University Hospital San Luigi Gonzaga, Turin, Italy
| | - Claudio Mencacci
- Department of Neuroscience, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Francesco Saverio Mennini
- EEHTA - CEIS (Centre for Economic and International Studies), Faculty of Economics, University of Rome "Tor Vergata", Rome, Italy.,Institute for Leadership and Management in Health Care, Kingston University, London, UK
| | - Enrico Zanalda
- Department of Mental Health ASL TO3 & AOU San Luigi Gonzaga, Collegno, TO, Italy
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Mangia A, Scaglione F, Toniutto P, Pirisi M, Coppola N, Di Perri G, Alvarez Nieto G, Calabrese S, Hernandez C, Perrone V, Degli Esposti L, Fagiuoli S. Drug-Drug Interactions in Italian Patients with Chronic Hepatitis C Treated with Pangenotypic Direct Acting Agents: Insights from a Real-World Study. Int J Environ Res Public Health 2021; 18:7144. [PMID: 34281080 PMCID: PMC8296917 DOI: 10.3390/ijerph18137144] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/25/2021] [Accepted: 06/25/2021] [Indexed: 12/22/2022]
Abstract
This Italian observational real-world study aims to assess in chronic hepatitis C virus (HCV) patients treated with pangenotypic direct acting agents (pDAAs) glecaprevir/pibrentasvir (GLE/PIB) or sofosbuvir/velpatasvir (SOF/VEL) the potential drug-drug interactions (DDIs) with concomitant medications prescribed, with a focus on cardiovascular and system nervous (CNS) co-medications. Data were collected from administrative databases covering 6.9 million health-assisted individuals. All patients prescribed SOF/VEL or GLE/PIB between 11/2017 and 12/2018 were included. Patients were analyzed while on DAA. DDIs were identified according to the Liverpool University tool. Overall, 3181 HCV patients were included: 1619 in the GLE/PIB cohort and 1562 in the SOF/VEL cohort. SOF/VEL patients were generally older than GLE/PIB ones (mean age 58.4 vs. 53.1, p < 0.001) and had more cardiovascular and CNS comorbidities (58% vs. 42%, p < 0.001 and 33% vs. 28%, p = 0.002, respectively). Contraindications due to DDIs in the GLE/PIB cohort affected 9.3% and 3.2% of patients before and on DAA, respectively, while the percentages in the SOF/VEL cohort were 3.2% before and 0.4% after pDAAs initiation. Among GLE/PIB patients, 2.7% had cardiovascular drugs (all statins) contraindicated while on DAA. The potential DDIs between cardiovascular drugs and SOF/VEL were mainly with statins (5%). SOF/VEL was prescribed in patients with older age and with more cardiovascular and CNS comorbidities. Despite this, a proportion of contraindicated drugs lower than that of GLE/PIB was registered.
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Affiliation(s)
- Alessandra Mangia
- Liver Unit, Fondazione “Casa Sollievo Della Sofferenza” IRCCS, 71013 San Giovanni Rotondo, Italy;
| | - Francesco Scaglione
- Department of Oncology and Onco-Hematology, University of Milan, 20122 Milan, Italy;
| | - Pierluigi Toniutto
- Hepatology and Liver Transplantation Unit, Azienda Ospedaliero Universitaria, 33100 Udine, Italy;
| | - Mario Pirisi
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale, 28100 Novara, Italy;
| | - Nicola Coppola
- Department of Mental Health and Public Medicine–Infectious Diseases Unit, University of Campania Luigi Vanvitelli, 81100 Caserta, Italy;
| | - Giovanni Di Perri
- Department of Medical Sciences, University of Turin, 10124 Turin, Italy;
| | - Gema Alvarez Nieto
- Gilead Sciences, Medical Affairs Italy, 202124 Milan, Italy; (G.A.N.); (S.C.)
| | - Stefano Calabrese
- Gilead Sciences, Medical Affairs Italy, 202124 Milan, Italy; (G.A.N.); (S.C.)
| | - Candido Hernandez
- Gilead Sciences, Global Medical Affairs, Stockley Park, London UB11 1BD, UK;
| | - Valentina Perrone
- CliCon S.r.l. Health, Economics & Outcomes Research, 40137 Bologna, Italy;
| | - Luca Degli Esposti
- CliCon S.r.l. Health, Economics & Outcomes Research, 40137 Bologna, Italy;
| | - Stefano Fagiuoli
- Gastroenterology and Transplant Hepatology, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy;
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Del Casale A, Rossi-Espagnet MC, Napolitano A, Lucignani M, Bonanni L, Kotzalidis GD, Buscajoni A, Manelfi L, Perrone V, Gualtieri I, Brugnoli R, De Pisa E, Girardi P, Romano A, Ferracuti S, Bozzao A, Pompili M. Cerebral cortical thickness and gyrification changes in first-episode psychoses and multi-episode schizophrenia. Arch Ital Biol 2021; 159:3-20. [PMID: 34159573 DOI: 10.12871/00039829202111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Cortical thickness (CT) and local gyrification index (LGI) in psychotic disorders may show modifications that relate to clinical course. This observational study aimed to analyse such variables in patients with schizophrenia, compared to healthy controls (HCs). We compared CT and LGI of 18 patients with first-episode psychosis with that of 21 with multi-episode schizophrenia and 16 HCs. CT corrected for false-positive cases (Family-Wise Error Rate) showed a reduction in the multi-episode group compared to HCs in left temporal and parietal, and right temporal, parietal, occipital, and hippocampal cortices. Family-wise corrected LGI was increased in the left inferior and middle frontal cortices, and in the right fusiform gyrus, cingulate, lingual, and parahippocampal gyri in first onset patients compared to HCs. Increased LGI was absent from later stages of psychosis, suggesting that specific CT and LGI alterations may underlie different stages of illness.
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Affiliation(s)
- A Del Casale
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University, Rome; Unit of Psychiatry, 'Sant'Andrea' University Hospital, Via di Grottarossa 1035-1039, 00189 Rome, Italy -
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Perrone V, Giacomini E, Andretta M, Arenare L, Cillo MR, Latini M, Mecozzi A, Pagliaro R, Vercellone A, Degli Esposti L. Italian Real-World Analysis of a Tyrosine Kinase Inhibitor Administration as First- or Second-Line of Therapy in Patients with Chronic Myeloid Leukemia. Ther Clin Risk Manag 2021; 17:617-622. [PMID: 34135589 PMCID: PMC8197625 DOI: 10.2147/tcrm.s309342] [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: 03/05/2021] [Accepted: 05/17/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To date, litte evidence is reported about the real-life dosage of tyrosine kinase inhibitors prescribed in Italy. The present observational retrospective study aimed to evaluate the mean daily dose of nilotinib prescribed as first- and second-line therapy among patients suffering from chronic myeloid leukemia (CML) in settings of clinical practice in Italy. PATIENTS AND METHODS Data were obtained from the administrative databases of a sample of Italian entities. All adult patients prescribed nilotinib were included from January 2013 to December 2016 if they were using it as first-line and from January 2015 to December 2018 as second-line therapy. The mean daily dose was calculated considering the dosage between first and last nilotinib prescription date or last BCR/ABL test date. RESULTS Among CML patients treated with nilotinib as first-line (N=87), the mean daily dose of nilotinib was 500.5 mg during a mean treatment duration of 798.9 days and of 498.54 mg considering the last determination of BCR/ABL test (mean duration of 811 days). A total of 103 CML patients were prescribed nilotinib as second-line therapy; of them, 80.6% had previously received imatinib, 17.5% dasatinib. The mean daily dose of nilotinib was found to be 566.3 mg with a mean time duration of 302.8 days, while when the last BCR/ABL test was taken into account (mean duration of 323.1 days), a mean daily dose of 565.2 mg was detected. CONCLUSION The study reported on the real-world dosage pattern of a TKI for CML management. Our results compared with the dosage of nilotinib reported in datasheet (600 mg and 800 mg for first- and second-line, respectively) showed a trend of mean daily dose prescribed in clinical practice settings lower than the dosage currently indicated.
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Affiliation(s)
| | - Elisa Giacomini
- CliCon S.r.l. Health, Economics & Outcomes Research, Bologna, Italy
| | - Margherita Andretta
- UOC Assistenza Farmaceutica Territoriale, Azienda ULSS 8 Berica, Vicenza, Italy
| | - Loredana Arenare
- UOC Farmaceutica e Territoriale e Integrativa– Asl Latina, Latina, Italy
| | | | - Marisa Latini
- U.O.C. Farmaceutica Territoriale – Asl Roma 5, Roma, Italy
| | | | | | - Adriano Vercellone
- Department of Pharmacy, Local Health Unit (LHU) Naples 3 South, Napoli, Italy
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Di Rienzo P, Snijder R, Degli Esposti L, Perrone V, Todorova L. MO548PREVALENCE AND INCIDENCE OF ANAEMIA IN PATIENTS WITH NON-DIALYSIS DEPENDENT (NDD) CHRONIC KIDNEY DISEASE (CKD), AND EVALUATION OF TREATMENT PATTERNS WITH ERYTHROPOIESIS-STIMULATING AGENTS (ESAS): A RETROSPECTIVE DATABASE STUDY IN ITALY. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab085.0011] [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: 11/13/2022] Open
Abstract
Abstract
Background and Aims
Anaemia is a common complication in patients with NDD-CKD, and its prevalence increases with advancing CKD stage.1,2 It is a risk factor for both CKD progression and other adverse outcomes, including major adverse cardiac events, hospitalisation and all-cause mortality.1 We aim to report the prevalence of NDD-CKD stage 3a–5 in Italy, and to evaluate the prevalence and incidence of anaemia among patients with NDD-CKD. Of those patients with anaemia, we seek to establish the size of the patient pool eligible for ESAs, and consequently, the proportion of patients treated with ESAs.
Method
Patients ≥18 years of age with a record of NDD-CKD stage 3a–5 between 1 January 2014 and 31 December 2016 were identified from databases of five Local Health Units (LHUs) across Italy. NDD-CKD stage 3a–5 in our study was defined as either ≥1 hospitalisation record with discharge diagnosis of CKD (ICD-9-CM 585.x, where x = 3, 4, or 5) or ≥1 record of estimated glomerular filtration rate (eGFR) <60 mL/min. eGFR values were estimated using the Modification of Diet in Renal Disease method and were as reported by LHUs. Patient classification into CKD stage 3a–5 based on eGFR was done according to KDIGO guidelines.3 Anaemia was defined as Hb <13 g/dL (males) or <12 g/dL (females). Prevalence was defined as the presence of ≥1 record of NDD-CKD stage 3a–5 or anaemia in the entire period preceding the timepoint of interest, or as incident NDD-CKD/anaemia; incidence was defined as a first record of the condition in the year of interest (no record of the condition in the patient’s history). Point prevalence (at 31 December of each reported year) and annual incidence were age- and sex-standardised using census data from 1 January of the following year. Among patients with anaemia of NDD-CKD stage 3a–5, eligibility for ESA was defined as at least one record of Hb <10 g/dL,4 and patients with a record of ESA prescription were categorised as ESA treated.
Results
For 2016, the prevalence of NDD-CKD stage 3a–5 in the population aged ≥18 years was 5.6% (83,625/1,507,391): CKD stage 3a was the most common (4.2%; 62,683/1,507,391), while the prevalence of each of the stages 3b–5 was ≤1.0% (Table). The prevalence and incidence of anaemia among patients with NDD-CKD stage 3a–5 in 2016 was 33.8% and 11.4%, respectively. The prevalence of anaemia increased with CKD stage: from 28.2% among patients with stage 3a to 78.9% among those with stage 5. A similar trend was observed for incidence, which increased from 9.3% for stage 3a to 32.8% for stage 5. The proportion of patients with NDD-CKD stage 3a–5 and anaemia who were eligible for ESA treatment from 2014–2016 ranged from 51.9% to 75.6% across the CKD stages. In 2016, the proportion of patients with incident NDD-CKD anaemia who were eligible for ESAs but not treated was 42.3%. This proportion was similar across the CKD stages, except for stage 5, for which the proportion of patients who were eligible but not ESA treated was 51.1%.
Conclusion
In Italy, we found that higher CKD stages are associated with increased prevalence and incidence of anaemia in NDD-CKD, a finding which is supported by previous research in other countries worldwide.1,2 Despite this, almost half of patients with anaemia of NDD-CKD stage 3a–5 were eligible for ESA treatment but did not receive ESAs. This suggests that anaemia may not be adequately controlled in patients with NDD-CKD stage 3a–5, and may need further attention and treatment.
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Affiliation(s)
| | | | - Luca Degli Esposti
- CliCon Srl Health, Economics & Outcomes Research, Addlestone, United Kingdom
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Perrone V, Losi S, Rogai V, Antonelli S, Fakhouri W, Giovannitti M, Giacomini E, Sangiorgi D, Degli Esposti L. Treatment Patterns and Pharmacoutilization in Patients Affected by Rheumatoid Arthritis in Italian Settings. Int J Environ Res Public Health 2021; 18:5679. [PMID: 34073179 PMCID: PMC8197884 DOI: 10.3390/ijerph18115679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/20/2021] [Accepted: 05/23/2021] [Indexed: 01/02/2023]
Abstract
This study aimed to evaluate the treatment patterns and pharmacoutilization of patients with rheumatoid arthritis (RA) in real-world settings in Italy. This retrospective observational analysis was based on administrative databases of selected Italian entities. All adult patients with RA diagnosis confirmed by ≥1 discharge diagnosis of RA (ICD-9-CM code = 714.0) or an active exemption code (006.714.0) were enrolled in 2019. Two cohorts were created: one included patients prescribed baricitinib, the other those prescribed biological disease-modifying antirheumatic drugs (bDMARDs). Overall, 47,711 RA patients were identified, most of them without DMARD prescription. As a first-line prescription, 43.2% of patients were prescribed conventional synthetic DMARDs (csDMARDs), 5.2% bDMARDs and 0.3% baricitinib. In 2019, 82.6% of csDMARD users continued with the same DMARD category, 15.9% had a bDMARD, while 1.5% had baricitinib as second-line therapy. Overall, 445 patients used baricitinib during 2019. During follow-up, baricitinib was prescribed as monotherapy to 31% of patients, as cotreatment with csDMARDs and corticosteroids to 27% of patients, with corticosteroids to 28% of patients and with csDMARDs to 14% of patients. In line with previous findings, a trend of bDMARD undertreatment was observed. The treatment patterns of baricitinib patients could help to better characterize patients eligible for new therapeutic options that will be available in the future.
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Affiliation(s)
- Valentina Perrone
- CliCon S.r.l., Health Economics and Outcomes Research, 40141 Bologna, Italy; (E.G.); (D.S.); (L.D.E.)
| | - Serena Losi
- Eli Lilly Italy S.p.A., 50019 Sesto Fiorentino, Italy; (S.L.); (V.R.); (S.A.)
| | - Veronica Rogai
- Eli Lilly Italy S.p.A., 50019 Sesto Fiorentino, Italy; (S.L.); (V.R.); (S.A.)
| | - Silvia Antonelli
- Eli Lilly Italy S.p.A., 50019 Sesto Fiorentino, Italy; (S.L.); (V.R.); (S.A.)
| | | | | | - Elisa Giacomini
- CliCon S.r.l., Health Economics and Outcomes Research, 40141 Bologna, Italy; (E.G.); (D.S.); (L.D.E.)
| | - Diego Sangiorgi
- CliCon S.r.l., Health Economics and Outcomes Research, 40141 Bologna, Italy; (E.G.); (D.S.); (L.D.E.)
| | - Luca Degli Esposti
- CliCon S.r.l., Health Economics and Outcomes Research, 40141 Bologna, Italy; (E.G.); (D.S.); (L.D.E.)
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Degli Esposti L, Perrone V, Sangiorgi D, Sinigaglia L. Assessment of patients affected by rheumatoid arthritis eligible for biotechnological agents and evaluation of their healthcare resource utilization and related costs. Reumatismo 2021; 73:5-14. [PMID: 33874642 DOI: 10.4081/reumatismo.2021.1329] [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] [Received: 08/01/2020] [Accepted: 02/15/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To provide estimates of patients with rheumatoid arthritis (RA) eligible for biotechnological therapy and to evaluate their healthcare costs. METHOD An observational analysis was performed based on data-linkage between administrative databases of selected Italian Regional/Local healthcare departments. Data were then re-proportioned to the Italian population. Patients with RA diagnosis defined by discharge diagnosis and/or exemption code during 01/01/2013- 31/12/2017 were included. The criteria applied to evaluate the elegibility for biotechnological therapy were: 1) methotrexate (MTX)-treatment failure ≥6 months and start of a different conventional-synthetic diseasemodifying antirheumatic drugs (csDMARD); 2) corticosteroid ≥6 months with dosage ≥7.5 mg/die; 3) MTX-contraindication (therapy or hospitalization for renal damage/interstizial lung disease/hepatic failure). Mean annual costs per patient included drugs, hospitalizations, outpatient services. RESULTS Data re-proportioned to the Italian population estimated 318,328 RA patients: 43,361 with, 274,967 without biotechnological agents. Among the latter, 26,487(9.6%) patients met ≥1 criteria applied for eligibility: 1,896 had MTX-treatment failure and started another csDMARD; 15,833 received corticosteroid ≥7.5 mg/die; 7,788 had MTX-contraindication. Regarding patients fulfilling two criteria, 107 had MTX-treatment failure followed by another csDMARDs and corticosteroid ≥7.5 mg/die, 53 were treated with another csDMARDs after MTX-treatment failure and also presented MTX-contraindication, 810 had corticosteroid ≥7.5 mg/die and MTX-contraindication. Mean total annual costs for patients estimated eligible for biotechnological therapy was € 3,132, of which € 177 related to drugs indicated for RA and € 2,955 related to other direct costs. CONCLUSIONS According to our estimates, around 10% RA patients not currently treated with biotechnological agents are eligible for such therapies, highlighting a trend of under-use in clinical practice for RA management.
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Affiliation(s)
- L Degli Esposti
- Clicon S.r.l., Health Economics and Outcomes Research, Bologna.
| | - V Perrone
- Clicon S.r.l., Health Economics and Outcomes Research, Bologna.
| | - D Sangiorgi
- Clicon S.r.l., Health Economics and Outcomes Research, Bologna.
| | - L Sinigaglia
- Department of Rheumatology, Gaetano Pini Institute, Milan.
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Giacomini E, Perrone V, Alessandrini D, Paoli D, Nappi C, Degli Esposti L. Evidence of Antibiotic Resistance from Population-Based Studies: A Narrative Review. Infect Drug Resist 2021; 14:849-858. [PMID: 33688220 PMCID: PMC7937387 DOI: 10.2147/idr.s289741] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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] [Received: 11/05/2020] [Accepted: 02/11/2021] [Indexed: 12/23/2022] Open
Abstract
The 20th century witnessed the dawn of the antibiotic revolution and is now facing the rising phenomenon of antibiotic resistance. In this narrative review, we aim to describe antibiotic resistance in clinical practice settings through population-based studies from different countries reporting the role of misuse of antibiotics in the development of resistance and the clinical and economic burden associated. The misuse of antibiotics was documented in the wide population as well as in hospitals and care facilities. It was mainly reported as over-use and inappropriate prescribing. Improper dosage regimens and longer treatment duration were regarded as pivotal factors related to antibiotic resistance; the emerging strategy of "antibiotic-de-escalation" could be the key to overcome these issues. The investigation of the self-medication attitude revealed widespread antibiotic use without following medical instructions or medical consultation. Moreover, several studies established the association of antibiotic resistance with increased risk of longer hospitalizations and mortality, highlighting the heavy clinical and economic burden of this phenomenon. In this narrative review, the widespread inappropriate use of antibiotics emerged as one of the main causes of antibiotic resistance, which negative outcomes call for the development of antibiotic stewardship programs and global surveillance networks.
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Affiliation(s)
- Elisa Giacomini
- CliCon S.r.l. Health, Economics & Outcomes Research, Ravenna, Italy
| | | | | | - Daniela Paoli
- CliCon S.r.l. Health, Economics & Outcomes Research, Ravenna, Italy
| | - Carmela Nappi
- CliCon S.r.l. Health, Economics & Outcomes Research, Ravenna, Italy
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Volterrani M, Perrone V, Degli Esposti L. Reply to the letter regarding the article 'Effects of hyperkalaemia and non-adherence to renin-angiotensin-aldosterone system inhibitor therapy in patients with heart failure in Italy: a propensity-matched study'. Eur J Heart Fail 2021; 23:496-497. [PMID: 33559297 DOI: 10.1002/ejhf.2123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 11/07/2022] Open
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Perrone V, Losi S, Filippi E, Sangiorgi D, Degli Esposti L. Pattern of drug use in patients with psoriatic arthritis in Italy: study in a real-world setting. Expert Rev Pharmacoecon Outcomes Res 2021; 21:721-727. [PMID: 33472454 DOI: 10.1080/14737167.2021.1880322] [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: 10/22/2022]
Abstract
Background: The aim of this study is to assess treatment patterns and pharmaco-utilization in patients with psoriatic arthritis (PsA) in Italy.Methods: A retrospective analysis using administrative databases of six Local Health Units was performed. All adult patients with PsA diagnosis and ≥1 prescription for biologic/targeted-synthetic (b/ts) disease-modifying antirheumatic drugs (DMARDs) from January 2010 to March 2017 were included. The date of first b/tsDMARD prescription was defined index-date. Follow-up lasted 1-year post index-date. Patients without b/tsDMARDs prescription pre index-date were defined bionaïve.Results: Of the 1,056 patients included, 33% received adalimumab, 30% etanercept, 10% golimumab, 9% secukinumab, 7% infliximab, 6% ustekinumab, 4% certolizumab, and 1% apremilast. During follow-up, persistence with b/tsDMARDs was observed in 79.8% of patients, 10.8% switched therapies, dose change occurred in 15.8% of patients, 47.4% received an add-on. Among bionaïve patients (n = 591), 67.0% were persistent with b/tsDMARDs, 10.1% switched therapy, 14.5% required a dose change and 45.8% an add-on. Discontinuation was observed in 10.6% of total PsA population and in 24.8% of bionaïve patients.Conclusion: This analysis provided insights on drug utilization patterns for PsA in an Italian real-world setting. Our results show that treatment regimen changes occur in a high proportion of PsA patients.
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Affiliation(s)
- Valentina Perrone
- Clicon S.r.l., Health Economics and Outcomes Research, Ravenna Italy
| | - Serena Losi
- Eli Lilly Italy S.p.A., Sesto Fiorentino, Italy
| | | | - Diego Sangiorgi
- Clicon S.r.l., Health Economics and Outcomes Research, Ravenna Italy
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Degli Esposti L, Buda S, Nappi C, Paoli D, Perrone V. Implications of COVID-19 Infection on Medication Adherence with Chronic Therapies in Italy: A Proposed Observational Investigation by the Fail-to-Refill Project. Risk Manag Healthc Policy 2020; 13:3179-3185. [PMID: 33408540 PMCID: PMC7779805 DOI: 10.2147/rmhp.s265264] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 05/30/2020] [Accepted: 12/03/2020] [Indexed: 01/16/2023] Open
Abstract
Poor medication adherence leads to worsening of clinical outcomes and increases healthcare costs, especially in the context of chronic conditions. The effects of new COVID-19 infection and the measures taken in response to the outbreak are further increasing the concerns about medication adherence. Patients with chronic diseases, many of whom are older adults, have been strongly recommended to stay at home and avoid social contacts even with family members, who often provide support for regular use of therapies. Moreover, the mobilization of health personnel to the frontline of the COVID-19 infection could limit access to healthcare services. Within the Health-DB project, the Fail-To-Refill monitoring system was designed to evaluate the lack of adherence to chronic therapies in Italian clinical practice settings. Considering the date and dose coverage of last prescription, all patients due to refill this prescription for a chronic therapy in the last month were identified, and it was verified if they had the refill. The proposed future analysis, based on the data linkage between the current administrative flows of the Italian Local Health Units involved, will be carried out on a monthly basis from the beginning of the infection, and the "post-Covid-19" results will be compared with "pre-COVID-19" results, calculated for the last three years for patients with chronic therapies. Preliminary data herein presented showed a trend of increased failed refill during the months of lockdown for lipid-lowering and biologic therapies. The pre-COVID-19 trend compared to that of post-COVID-19 in the next months will be useful to estimate the percentage of failure to refill truly related to COVID-19 and on the measures adopted. The identification of patients that do not refill their prescriptions allows healthcare professionals to put in place actions aimed to promptly correct the lack of adherence, thus reducing the associated negative outcomes.
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Affiliation(s)
| | - Stefano Buda
- CliCon S.r.l. – Health, Economics & Outcome Research, Ravenna, Italy
| | - Carmela Nappi
- CliCon S.r.l. – Health, Economics & Outcome Research, Ravenna, Italy
| | | | - Valentina Perrone
- CliCon S.r.l. – Health, Economics & Outcome Research, Ravenna, Italy
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