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Masutti S, Falivena C, Purba FD, Jommi C, Mukuria C, Finch AP. Content validity of the EQ-HWB and EQ-HWB-S in a sample of Italian patients, informal caregivers and members of the general public. J Patient Rep Outcomes 2024; 8:36. [PMID: 38519577 PMCID: PMC10959916 DOI: 10.1186/s41687-024-00706-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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 02/23/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND The EuroQol Group recently developed two new instruments, the EQ Health and Wellbeing (EQ-HWB) and the EQ Health and Wellbeing short version (EQ-HWB-S). The EQ-HWB and EQ-HWB-S are intended to capture a broad range of health and broader quality of life aspects, which may be relevant to general public members, patients, their families, social care users and informal carers. This study assesses the content validity of the Italian version of the two instruments in a sample of Italian patients, social care users and informal carers. METHODS Participants were recruited using a convenience sampling approach. One-on-one interviews were carried out using video-conferencing interviews. A semi-structured topic guide was used to guide the interview procedures, with open-ended questions supplemented by probes. Participants were asked to explain important aspects of their health and quality of life, to complete the questionnaires and verbalize their thoughts. RESULTS Twenty participants comprising of patients (n = 9), informal carers (n = 6), and members of the general public (n = 5) participated to the study. Content validity was summarized into six main themes: comprehension, interpretation, acceptability, relevance, response options and recall period. All participants found the instruments easy or quite easy to understand and to respond to. Items were relevant for all three groups of participants, and response options appropriate. CONCLUSIONS The Italian version of the EQ-HWB showed content validity in measuring health and wellbeing in a mixed Italian population.
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Affiliation(s)
| | - Camilla Falivena
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Bocconi University, Milan, Italy
| | | | - Claudio Jommi
- Department of Pharmaceutical Sciences, University of Eastern Piedmont, Novara, Italy
| | - Clara Mukuria
- Sheffiled Centre of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Aureliano Paolo Finch
- EuroQol Office, EuroQol Research Foundation, Rotterdam, The Netherlands
- Health Values Research and Consultancy, Amsterdam, The Netherlands
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Rossini EE, Galeone C, Lucchetti C, Jommi C. Correction: From Indication-Based Pricing to Blended Approach: Evidence on the Price and Reimbursement Negotiation in Italy. Pharmacoecon Open 2024; 8:345. [PMID: 38345722 PMCID: PMC10883899 DOI: 10.1007/s41669-024-00475-w] [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] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Affiliation(s)
| | - Carlotta Galeone
- Bicocca Applied Statistics Center (B-ASC), Università degli Studi di Milano-Bicocca, Milan, Italy
- Patient Access, Pharmalex Italy Spa, Milan, Italy
| | | | - Claudio Jommi
- Department of Pharmaceutical Sciences, Università del Piemonte Orientale, Novara, Italy
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Rossini EE, Galeone C, Lucchetti C, Jommi C. From Indication-Based Pricing to Blended Approach: Evidence on the Price and Reimbursement Negotiation in Italy. Pharmacoecon Open 2024; 8:251-261. [PMID: 38228997 PMCID: PMC10883902 DOI: 10.1007/s41669-023-00467-2] [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] [Subscribe] [Scholar Register] [Accepted: 12/14/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND New indications for existing medicines are increasing over time. In most countries, drug pricing and reimbursement conditions are renegotiated every time a new indication is approved. There is a growing interest in the price negotiation model for new indications, specifically comparing an indication-based versus blended approach. However, little evidence currently exists regarding the complexity of these negotiations and their impact on actual prices. Italy has recently transitioned from an indication-based approach to a blended price model. This study aims to measure the impact of price and reimbursement negotiation of new indications on discounts (i.e. actual prices) and on the negotiation duration, used as a proxy of its complexity. METHODS We considered new indications approved through a European centralized procedure from January 2013 to March 2022 for which the price and reimbursement status was approved in Italy between January 2015 and March 2022, amounting to 52 new indications. Data on the timeframe of the Italian price and reimbursement process and its phases were obtained from publicly available sources. Discounts for the first indication and their subsequent increases for new indications were estimated by comparing ex-factory prices and tendered prices. To calculate p-values, we employed the Mann-Whitney test, and multiple regression models were utilized to examine correlations between negotiation time and the characteristics of the medicines. RESULTS The mean time to reimbursement was 603 days, in contrast to 583 days for the first launch. Price negotiation took longer for rare diseases, cancer drugs, and in case of therapies with minor added therapeutic value. On average, the additional discount (on top of discounts for prior indications) was 13%, significantly lower than the mean discount for the first indications approved (24.9%). The discounts increment was lower, but negotiation took longer if a Managed Entry Agreement accompanied the final agreement. Additionally, discounts have increased over the years. CONCLUSION The negotiation for new indications takes longer than the first one, and provides, on average, an additional discount of 13%. While our findings bear the potential for significant policy implications, they necessitate prudent interpretation due to a limited number of observations. The increasing trend in additional discounts over time applied to all indications in recent negotiations, may suggest a descending trend of value for new indications and a shift from an indication-based pricing approach to a blended model. Otherwise, budget impact considerations might have outweighed a value-based approach in the recent negotiations. If so, two potential options for restoring a value-based approach are returning to an indication-based pricing or giving explicit and higher weight to value within a blended model.
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Affiliation(s)
| | - Carlotta Galeone
- Bicocca Applied Statistics Center (B-ASC), Università degli Studi di Milano-Bicocca, Milan, Italy
- Patient Access, Pharmalex Italy Spa, Milan, Italy
| | | | - Claudio Jommi
- Department of Pharmaceutical Sciences, Università del Piemonte Orientale, Novara, Italy
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Cavallo MC, Cavazza M, Bonifazi F, Casadei B, Cutini I, Tonietti B, Saccardi R, Zinzani P, Jommi C. Cost of implementing CAR-T activity and managing CAR-T patients: an exploratory study. BMC Health Serv Res 2024; 24:121. [PMID: 38254079 PMCID: PMC10804568 DOI: 10.1186/s12913-023-10443-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 12/05/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Chimeric antigen receptor T cells (CAR-T) represent an innovation but raise issues for healthcare payers because of the uncertainty on impact at market launch, high cost and important organisational impact. The literature has focused on their assessment, appraisal and market access solutions. No evidence on the costs sustained to implement CAR-T is available and a few studies reported the cost of the CAR-T clinical pathway, including the activities that are remunerated through inpatient or outpatient fee-for-service/episode. This paper aims at filling the information gap, assessing the cost of implementing CAR-T activity and the full cost of managing the CAR-T clinical pathway. METHODS Cost analysis relied on the Activity Based Costing approach, which was applied to two Italian healthcare organisations, both CAR-T Centres authorized by the regional governments with a minimum of 20 patients treated with the first two CAR-T therapies launched on the market. RESULTS The cost of implementing CAR-T was estimated at €1.31 million (calculated for one of the organizations with complete data). Most of these costs (77%) were generated by quality assurance activity. The mean cost per patient entering the CAR-T pathway (59 and 27) and surviving at follow-up (21 and 5) ranges from €48K to €57K and from €96K to €106K, respectively. Fees for hospitalization and infusion of gene therapy accounts for more than 70% of these costs. The actual hospitalisation cost varies greatly across patients and is in general lower than the fee-for-episode paid by the region to the hospital. CONCLUSIONS Despite its limitations (exploratory nature; the time spent by staff on activities which are not remunerated through fees was estimated through interviews with the CAR-T coordinators; cost items are not fully comparable), this research highlighted the relevant organisational and economic impact of CAR-T and provided important insights for policy makers and healthcare managers: the necessity to invest resources in CAR-T implementation; the need for assessing activities which are not remunerated through fees for service / episode; the opportunity to shift from fee-for-episode / service to bundled payments for CAR-T clinical pathway.
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Affiliation(s)
- Maria Caterina Cavallo
- Cergas, Centre for Research on Health and Social Care Management, SDA Bocconi School of Management, Bocconi University, Via Sarfatti, 10, Milano, 20136, Italy
| | - Marianna Cavazza
- Cergas, Centre for Research on Health and Social Care Management, SDA Bocconi School of Management, Bocconi University, Via Sarfatti, 10, Milano, 20136, Italy
| | - Francesca Bonifazi
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, 40138, Italy
| | - Beatrice Casadei
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, 40138, Italy
| | - Ilaria Cutini
- Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, Firenze, 50134, Italy
| | - Barbara Tonietti
- Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, Firenze, 50134, Italy
| | - Riccardo Saccardi
- Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, Firenze, 50134, Italy
| | - PierLuigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, 40138, Italy
| | - Claudio Jommi
- Department of Pharmaceutical Sciences, Università del Piemonte Orientale, Largo Donegani, 2, Novara, 28100, Italy.
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Bortolami A, Jommi C, Bresciani F, Piccoli L, Sangiorgi E, Scroccaro G. Prontuari Terapeutici Regionali in Italia: stato dell’arte e prospettive future. Glob Reg Health Technol Assess 2024; 11:68-74. [PMID: 38504973 PMCID: PMC10949060 DOI: 10.33393/grhta.2024.2677] [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: 10/04/2023] [Accepted: 01/22/2024] [Indexed: 03/21/2024] Open
Abstract
Regional Formularies (RF) are considered part of pharmaceutical policies implemented by regions to govern access of medicines to regional market. However, they have been actually challenged, because of their presumed impact on differences of patient’s access across the regions. The paper aimed at investigating the current status of RF and Regional Therapeutic Committees (CTR) and at suggesting/recommending possible reforms. The current status was investigated through a questionnaire administered to the regional pharmaceutical departments. Recommendations were retrieved from a multi-stakeholder work group carried out on 30-31 March 2023, embedded into a Forum focused on the regional pharmaceutical policies. Nineteen out of twenty-one regions responded to the survey: 12 use RF, mainly managed by the CTR; the RF frequency of update and the time needed for drugs listing greatly vary across regions; pharmacists, specialists and general practitioners are always represented in CTR, whereas other healthcare professionals and experts are more rarely involved; in 3 regions the CTR does not publish any RF update; the CTR mainly rely, to take decisions, on the dimension of the target population, the cost of therapy compared to alternative treatments and the impact on pharmaceutical expenditure. The working group recommended to overcome the RFs, if they are merely considered a list of available drugs at regional level, focusing CTR activities to ensure market access and to govern the prescribing behaviour, and strengthening/anticipating the flow of information from the Italian Medicines Agency (AIFA) to the regions, to enable a more efficient approach to local access to drugs.
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Affiliation(s)
- Alberto Bortolami
- Direzione Farmaceutico-Protesica Dispositivi Medici, Area Sanità e Sociale, Regione del Veneto, Venezia - Italy
| | - Claudio Jommi
- Dipartimento di Scienze del Farmaco, Università del Piemonte Orientale, Novara - Italy
| | | | - Luca Piccoli
- Direzione Farmaceutico-Protesica Dispositivi Medici, Area Sanità e Sociale, Regione del Veneto, Venezia - Italy
| | - Elisa Sangiorgi
- Area Governo del Farmaco e dei Dispositivi medici, Regione Emilia Romagna - Italy
| | - Giovanna Scroccaro
- Direzione Farmaceutico-Protesica Dispositivi Medici, Area Sanità e Sociale, Regione del Veneto, Venezia - Italy
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Marzano AV, Alberti-Violetti S, Maronese CA, Avallone G, Jommi C. Vitiligo: Unmet Need, Management and Treatment Guidelines. Dermatol Pract Concept 2023; 13:dpc.1304S2a316S. [PMID: 38241398 PMCID: PMC10824320 DOI: 10.5826/dpc.1304s2a316s] [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] [Accepted: 12/11/2023] [Indexed: 01/21/2024] Open
Abstract
Vitiligo is a chronic depigmenting disorder characterized by characteristic, non-scaly, chalky-white skin macules and patches, due to the loss of skin pigment. Its exact pathogenesis is still not fully understood but it seems to be an autoimmune disease where the combination of genetic, environmental, and immune factors contributes to the destruction of melanocytes in the epidermis. Vitiligo is classified into different types based on its clinical characteristics and distribution patterns. The two main forms of vitiligo are non-segmental vitiligo (NSV) and segmental vitiligo (SV). NSV is the predominant form, characterized by symmetrical skin patches, that tend to evolve over time. In contrast, SV has unilateral or band-shaped lesions that progress rapidly but often stabilize early. Herein, current unmet needs in terms of psychosocial consequences and relative lack of valid therapeutic approaches are critically analyzed and put in perspective in the Italian prescribing scenario. Finally, available management guidelines are illustrated and briefly compared, to provide context for upcoming treatment options.
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Affiliation(s)
- Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Silvia Alberti-Violetti
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Carlo Alberto Maronese
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Gianluca Avallone
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- Department of Medical Sciences, University of Turin, Dermatology Clinic, Turin, Italy
| | - Claudio Jommi
- Department of Pharmaceutical Sciences, Università del Piemonte Orientale, Novara, Italy
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Arenare L, Porta C, Barberio D, Terzolo S, Zagonel V, Pisconti S, Del Mastro L, Pinto C, Bilancia D, Cinieri S, Rizzo M, Migliaccio G, Montesarchio V, Del Campo L, De Lorenzo F, Iannelli E, Traclò F, Gitto L, Vaccaro MC, Frontini L, Giannarelli D, Bryce J, Piccirillo MC, Jommi C, Efficace F, Riva S, Di Maio M, Gallo C, Perrone F. Confirmatory validation analysis of the PROFFIT questionnaire to assess financial toxicity in cancer patients. ESMO Open 2023; 8:102192. [PMID: 38052104 PMCID: PMC10774953 DOI: 10.1016/j.esmoop.2023.102192] [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: 10/16/2023] [Revised: 11/03/2023] [Accepted: 11/07/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND The Patient Reported Outcome for Fighting FInancial Toxicity (PROFFIT) questionnaire was developed to measure financial toxicity (FT) and identify its determinants. The aim of the present study was to confirm its validity in a prospective cohort of patients receiving anticancer treatment. PATIENTS AND METHODS From March 2021 to July 2022, 221 patients were enrolled at 10 Italian centres. Selected items of the EORTC-QLQ-C30 questionnaire represented the anchors, specifically, question 28 (Q-28) on financial difficulties, and questions 29-30 measuring global health status/quality of life (HR-QOL). The study had 80% power to detect a 0.20 correlation coefficient (r) between anchors and PROFFIT-score (items 1-7, range 0-100, 100 indicating maximum FT) with bilateral alpha 0.05 and 80% power. Confirmatory factor analysis was conducted. FT determinants (items 8-16) were described. RESULTS Median age of patients was 65 years, 116 (52.5%) were females, 96 (43.4%) had low education level. Confirmatory factor analysis confirmed goodness of fit of the PROFFIT-score. Significant partial correlation of PROFFIT-score was found with Q-28 (r = 0.51) and HR-QOL (r = -0.23). Mean (SD) PROFFIT-score at baseline was 36.5 (24.9); it was statistically significantly higher for patients living in South Italy, those with lower education level, those who were freelancer/unemployed at diagnosis and those who reported significant economic impact from the COVID-19 pandemic. Mean (SD) scores of determinants ranged from 17.6 (27.1) for item 14 (support from medical staff) to 49.0 (36.3) for item 10 (expenses for medicines or supplements). PROFFIT-score significantly increased with worsening response to determinants. CONCLUSIONS External validation of PROFFIT-score in an independent sample of patients was successful. The instrument is now being used in clinical studies.
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Affiliation(s)
- L Arenare
- Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - C Porta
- Interdisciplinary Department of Medicine, Università degli Studi 'A. Moro', Bari, Italy; Polyclinic Consortium University Hospital, Bari, Italy
| | - D Barberio
- Departmental Structure of Clinical Psycho-oncology, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - S Terzolo
- Department of Oncology, Università di Torino, AO Ordine Mauriziano, Torino, Italy
| | - V Zagonel
- Oncology Unit 1, Istituto Oncologico Veneto, IOV, IRCCS, Padova, Italy
| | - S Pisconti
- Oncology Unit, Ospedale S. G. Moscati, Statte TA, Italy
| | - L Del Mastro
- Medical Oncology, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Internal Medicine and Medical Specialties (DIMI), Università di Genova, Genova, Italy
| | - C Pinto
- Medical Oncology, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - D Bilancia
- Medical Oncology, Azienda Ospedaliera San Carlo, Potenza, Italy
| | - S Cinieri
- Medical Oncologiy, Ospedale Perrino, Brindisi, Italy
| | - M Rizzo
- Polyclinic Consortium University Hospital, Bari, Italy
| | - G Migliaccio
- Departmental Structure of Clinical Psycho-oncology, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - V Montesarchio
- Medical Oncology, Azienda Ospedaliera Specialistica dei Colli, Napoli, Italy
| | - L Del Campo
- Federazione Italiana delle Associazioni di Volontariato in Oncologia (FAVO), Rome, Italy
| | - F De Lorenzo
- Federazione Italiana delle Associazioni di Volontariato in Oncologia (FAVO), Rome, Italy; European Cancer Patient Coalition (ECPC), Brussels, Italy
| | - E Iannelli
- Federazione Italiana delle Associazioni di Volontariato in Oncologia (FAVO), Rome, Italy; Associazione Italiana Malati di Cancro (AIMAC), Roma, Italy
| | - F Traclò
- Associazione Italiana Malati di Cancro (AIMAC), Roma, Italy
| | - L Gitto
- Department of Economy, Università degli Studi di Messina, Messina, Italy
| | - M C Vaccaro
- Welfare and Health Department, Centro Studi Investimenti Sociali (CENSIS), Roma, Italy
| | - L Frontini
- Federation of Italian Cooperative Oncology Groups (FICOG), Milano, Italy
| | - D Giannarelli
- Epidemiology and Biostatistics, GSTeP, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - J Bryce
- Ascension St. John Clinical Research Institute, Tulsa, USA
| | - M C Piccirillo
- Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
| | - C Jommi
- Department of Pharmaceutical Sciences, Università del Piemonte Orientale, Novara, Italy
| | - F Efficace
- Gruppo Italiano per le Malattie Ematologiche dell'Adulto (GIMEMA) Health Outcomes Research Unit, Roma, Italy
| | - S Riva
- St Mary's University, Twickenham, London, UK
| | - M Di Maio
- Department of Oncology, Università di Torino, AO Ordine Mauriziano, Torino, Italy
| | - C Gallo
- Professor Emeritus Medical Statistics, Università degli Studi della Campania 'Luigi Vanvitelli', Napoli, Italy
| | - F Perrone
- Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy.
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Giovannelli L, Bari E, Jommi C, Tartara F, Armocida D, Garbossa D, Cofano F, Torre ML, Segale L. Mesenchymal stem cell secretome and extracellular vesicles for neurodegenerative diseases: Risk-benefit profile and next steps for the market access. Bioact Mater 2023; 29:16-35. [PMID: 37456581 PMCID: PMC10338239 DOI: 10.1016/j.bioactmat.2023.06.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [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: 05/03/2023] [Revised: 06/01/2023] [Accepted: 06/19/2023] [Indexed: 07/18/2023] Open
Abstract
Neurodegenerative diseases represent a growing burden on healthcare systems worldwide. Mesenchymal stem cells (MSCs) have shown promise as a potential therapy due to their neuroregenerative, neuroprotective, and immunomodulatory properties, which are, however, linked to the bioactive substances they release, collectively known as secretome. This paper provides an overview of the most recent research on the safety and efficacy of MSC-derived secretome and extracellular vesicles (EVs) in clinical (if available) and preclinical models of Alzheimer's disease, Parkinson's disease, amyotrophic lateral sclerosis, multiple sclerosis, Huntington's disease, acute ischemic stroke, and spinal cord injury. The article explores the biologically active substances within MSC-secretome/EVs, the mechanisms responsible for the observed therapeutic effects, and the strategies that may be used to optimize MSC-secretome/EVs production based on specific therapeutic needs. The review concludes with a critical discussion of current clinical trials and a perspective on potential future directions in translating MSC-secretome and EVs into the clinic, specifically regarding how to address the challenges associated with their pharmaceutical manufacturing, including scalability, batch-to-batch consistency, adherence to Good Manufacturing Practices (GMP) guidelines, formulation, and storage, along with quality controls, access to the market and relative costs, value for money and impact on total expenditure.
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Affiliation(s)
- Lorella Giovannelli
- Department of Pharmaceutical Sciences, University of Piemonte Orientale, 28100, Novara, Italy
| | - Elia Bari
- Department of Pharmaceutical Sciences, University of Piemonte Orientale, 28100, Novara, Italy
| | - Claudio Jommi
- Department of Pharmaceutical Sciences, University of Piemonte Orientale, 28100, Novara, Italy
| | | | - Daniele Armocida
- A.U.O, Policlinico Umberto I, Neurosurgery Division, Human Neurosciences Department, Sapienza University, 00135, Roma, Italy
| | - Diego Garbossa
- Department of Neuroscience Rita Levi Montalcini, Neurosurgery Unit, University of Turin, 10126, Turin, Italy
| | - Fabio Cofano
- Department of Neuroscience Rita Levi Montalcini, Neurosurgery Unit, University of Turin, 10126, Turin, Italy
| | - Maria Luisa Torre
- Department of Pharmaceutical Sciences, University of Piemonte Orientale, 28100, Novara, Italy
- PharmaExceed S.r.l, 27100, Pavia, Italy
| | - Lorena Segale
- Department of Pharmaceutical Sciences, University of Piemonte Orientale, 28100, Novara, Italy
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Casilli G, Lidonnici D, Jommi C, De Nigris M, Genazzani AA. Do France, Germany, and Italy agree on the added therapeutic value of medicines? Int J Technol Assess Health Care 2023; 39:e54. [PMID: 37580971 DOI: 10.1017/s026646232300048x] [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] [Indexed: 08/16/2023]
Abstract
OBJECTIVES The Health Technology Assessment (HTA) of medicines is performed separately at the country level with some differences, but Italy, France, and Germany have implemented price and reimbursement systems strongly focused on the Added Therapeutic Value (ATV). This study investigates the level of agreement on ATV assessments by Agenzia Italiana del Farmaco (AIFA), Haute Autorité de Santé (HAS), and Gemeinsamer Bundesausschuss (G-BA). METHODS A database was created collecting all information about drugs with innovativeness status requests in Italy from July 2017 to December 2022 and populated with the corresponding HAS and G-BA ATV assessments. The primary comparative analysis was conducted by grouping the ATV ratings into "higher added value" and "lower or no added value", while a secondary analysis considered the Italian innovativeness status as a criterion to include the quality of evidence assessment. The concordance between ATV assessments was investigated through percentage agreement and unweighted Cohen k-value. RESULTS 189 medicines/indications were included. The greatest agreement was found when comparing G-BA versus HAS (82 percent; k = 0.61, substantial agreement). Lower levels of agreements were observed for AIFA versus HAS and AIFA versus G-BA (respectively 52 percent; k = 0.17 and 57 percent; k = 0.25). The secondary analysis led to a reconciliation to moderate agreement for AIFA versus HAS (72 percent; k = 0.45) and AIFA versus G-BA (74 percent; k = 0.47). CONCLUSIONS A high degree of concordance between HTA organizations is reached when considering jointly ATV and quality of evidence, suggesting that the system is extensively mature to make a Joint Clinical Assessment, avoiding duplications and reducing access inequalities.
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Affiliation(s)
| | | | - Claudio Jommi
- Department of Pharmaceutical Sciences, Università del Piemonte Orientale "Amedeo Avogadro", Novara, Italy
| | | | - Armando A Genazzani
- Department of Pharmaceutical Sciences, Università del Piemonte Orientale "Amedeo Avogadro", Novara, Italy
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Vingiani A, Agnelli L, Duca M, Lorenzini D, Damian S, Proto C, Niger M, Nichetti F, Tamborini E, Perrone F, Piccolo A, Manoukian S, Azzollini J, Brambilla M, Colombo E, Lopez S, Vernieri C, Marra F, Conca E, Busico A, Capone I, Bozzi F, Angelini M, Devecchi A, Salvatori R, De Micheli V, Baggi A, Pasini S, Jommi C, Ladisa V, Apolone G, De Braud F, Pruneri G. Molecular Tumor Board as a Clinical Tool for Converting Molecular Data Into Real-World Patient Care. JCO Precis Oncol 2023; 7:e2300067. [PMID: 37487147 PMCID: PMC10581623 DOI: 10.1200/po.23.00067] [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] [Received: 02/08/2023] [Revised: 03/28/2023] [Accepted: 06/12/2023] [Indexed: 07/26/2023] Open
Abstract
PURPOSE The investigation of multiple molecular targets with next-generation sequencing (NGS) has entered clinical practice in oncology, yielding to a paradigm shift from the histology-centric approach to the mutational model for personalized treatment. Accordingly, most of the drugs recently approved in oncology are coupled to specific biomarkers. One potential tool for implementing the mutational model of precision oncology in daily practice is represented by the Molecular Tumor Board (MTB), a multidisciplinary team whereby molecular pathologists, biologists, bioinformaticians, geneticists, medical oncologists, and pharmacists cooperate to generate, interpret, and match molecular data with personalized treatments. PATIENTS AND METHODS Since May 2020, the institutional MTB set at Fondazione IRCCS Istituto Nazionale Tumori of Milan met weekly via teleconference to discuss molecular data and potential therapeutic options for patients with advanced/metastatic solid tumors. RESULTS Up to October 2021, among 1,996 patients evaluated, we identified >10,000 variants, 43.2% of which were functionally relevant (pathogenic or likely pathogenic). On the basis of functionally relevant variants, 711 patients (35.6%) were potentially eligible to targeted therapy according to European Society of Medical Oncology Scale for Clinical Actionability of Molecular Targets tiers, and 9.4% received a personalized treatment. Overall, larger NGS panels (containing >50 genes) significantly outperformed small panels (up to 50 genes) in detecting actionable gene targets across different tumor types. CONCLUSION Our real-world data provide evidence that MTB is a valuable tool for matching NGS data with targeted treatments, eventually implementing precision oncology in clinical practice.
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Affiliation(s)
- Andrea Vingiani
- Department of Diagnostic Innovation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Luca Agnelli
- Department of Diagnostic Innovation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Matteo Duca
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Daniele Lorenzini
- Department of Diagnostic Innovation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Silvia Damian
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Claudia Proto
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Monica Niger
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Federico Nichetti
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
- Computational Oncology Group, Molecular Precision Oncology Program, National Center for Tumor Diseases (NCT) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Elena Tamborini
- Department of Diagnostic Innovation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Federica Perrone
- Department of Diagnostic Innovation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alberta Piccolo
- Department of Diagnostic Innovation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Siranoush Manoukian
- Unit of Medical Genetics, Department of Medical Oncology and Hematology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Jacopo Azzollini
- Unit of Medical Genetics, Department of Medical Oncology and Hematology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Marta Brambilla
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Elena Colombo
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Salvatore Lopez
- Gynecologic Oncology, Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Claudio Vernieri
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
- IFOM ETS, The AIRC Institute of Molecular Oncology, Milan, Italy
| | - Francesca Marra
- Department of Diagnostic Innovation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elena Conca
- Department of Diagnostic Innovation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Adele Busico
- Department of Diagnostic Innovation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Iolanda Capone
- Department of Diagnostic Innovation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Fabio Bozzi
- Department of Diagnostic Innovation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marta Angelini
- Department of Diagnostic Innovation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrea Devecchi
- Department of Diagnostic Innovation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Rebecca Salvatori
- Department of Diagnostic Innovation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Precision Cancer Therapeutics Program, Center for Individualized Medicine, Mayo Clinic, Rochester, MN
| | | | - Anna Baggi
- Business Integration Partners S.p.A., Milan, Italy
| | | | - Claudio Jommi
- Department of Pharmaceutical Sciences, Università del Piemonte Orientale, Novara, Italy
| | - Vito Ladisa
- Hospital Pharmacy, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Giovanni Apolone
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Filippo De Braud
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Giancarlo Pruneri
- Department of Diagnostic Innovation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Canales Albendea MÁ, Canonico PL, Cartron G, Deiters B, Jommi C, Marks R, Rioufol C, Sancho Cia JM, Santoro A, Wagner-Drouet EM. Comparative analysis of CAR T-cell therapy access for DLBCL patients: associated challenges and solutions in the four largest EU countries. Front Med (Lausanne) 2023; 10:1128295. [PMID: 37324138 PMCID: PMC10263061 DOI: 10.3389/fmed.2023.1128295] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 04/25/2023] [Indexed: 06/17/2023] Open
Abstract
Introduction CAR T-cell therapy has emerged as a promising new immuno-oncology treatment that engages the patient's immune system to fight certain hematological malignancies, including diffuse large B-cell lymphoma (DLBCL). In the European Union (EU), CAR T-cell therapies have been approved for relapsed/refractory (R/R) DLBCL patients since 2018, but patient access is often still limited or delayed. This paper is aimed at discussing challenges to access and possible solutions in the largest four EU countries. Methods The analysis relied on literature review, market data collection, since homogeneous data coming from registries were not available, and discussion with experts coming from all four countries. Results We calculated that in 2020, between 58% and 83% of R/R DLBCL patients (EMA approved label population) or between 29% and 71% of the estimated medically eligible R/R DLBCL patients, were not treated with a licensed CAR T-cell therapy. Common challenges along the patient journey that may result in limited access or delays to CAR T-cell therapy were identified. These include timely identification and referral of eligible patients, pre-treatment funding approval by authorities and payers, and resource needs at CAR T-cell centers. Discussion These challenges, existing best practices and recommended focus areas for health systems are discussed here, with the aim to inform necessary actions for overcoming patient access challenges for current CAR T-cell therapies as well as for future cell and gene therapies.
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Affiliation(s)
| | - Pier Luigi Canonico
- Department of Pharmaceutical Sciences, Università del Piemonte Orientale, Novara, Italy
| | - Guillaume Cartron
- Centre Hospitalier Universitaire de Montpellier, UMR-CNRS 5535, Montpellier, France
| | | | - Claudio Jommi
- Department of Pharmaceutical Sciences, Università del Piemonte Orientale, Novara, Italy
| | - Reinhard Marks
- Department of Medicine I, Medical Center, University of Freiburg, Freiburg, Germany
| | - Catherine Rioufol
- Department of Pharmacy, Lyon Sud Hospital, Hospices Civils de Lyon, Lyon, France
- EA 3738 Center for Innovation in Cancerology of Lyon (CICLY)-Claude Bernard University Lyon I, Lyon, France
| | | | - Armando Santoro
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Milan, Italy
| | - Eva M. Wagner-Drouet
- Department of Hematology and Oncology, University Medical Center, Mainz, Germany
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Tarantola A, Otto MH, Armeni P, Costa F, Malandrini F, Jommi C. Early access programs for medicines: comparative analysis among France, Italy, Spain, and UK and focus on the Italian case. J Pharm Policy Pract 2023; 16:67. [PMID: 37198599 DOI: 10.1186/s40545-023-00570-z] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/02/2023] [Indexed: 05/19/2023] Open
Abstract
Early access programs (EAPs) generally refer to patient access to medicines/indications before marketing authorization, possibly extended to price and reimbursement approval. These programs include compassionate use, which is usually covered by pharmaceutical companies, and EAPs reimbursed by third-party payers. This paper aims at comparing EAPs in four European countries (France, Italy, Spain, UK) and providing empirical evidence on EAPs in Italy. The comparative analysis was conducted through a literature review (including scientific and grey literature), complemented by 30-min semi-structured interviews with local experts. The Italian empirical analysis employed data available on the National Medicines Agency website. Although EAPs are very different across countries, they exhibit some common features: (i) eligibility criteria refer to the absence of valid therapeutic alternatives and a presumed favourable risk-benefit profile; (ii) payers do not allocate a pre-determined budget to these programs; (iii) total spending on EAPs is unknown. The French EAPs seem to be the most structured, financed through social insurance, covering pre-marketing, post-marketing and pre-reimbursement phases and providing for data collection. Italy's approach to EAPs has been varied, with several programs covered by different payers, including the cohort-based 648 List (for both early access and off-label use), the nominal-based 5% Fund, and Compassionate Use. Most applications to EAPs are from the Antineoplastic and immunomodulating drug class (ATC L). Some 62% of indications in the 648 List are either not under clinical development or have never been approved (pure off-label use). For those subsequently approved, most approved indications coincide with those covered through EAPs. Only the 5% Fund provides data on economic impact (€ 81.2 million in 2021; average cost per patient € 61.5K). Diverse EAPs are a possible source of inequalities in access to medicines across Europe. A harmonization of these programs, though difficult to achieve, could be modelled on the French EAPs and provide key advantages, not least of which a common effort to collect real-world data in parallel with clinical trials and clear separation between EAPs and off-label use programs.
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Affiliation(s)
- Alice Tarantola
- SDA Bocconi School of Management, Centre for Research on Health and Social Care Management (CERGAS), Milan, Italy.
| | - Monica Hildegard Otto
- SDA Bocconi School of Management, Centre for Research on Health and Social Care Management (CERGAS), Milan, Italy
- Department of Social and Political Science, Bocconi University, Milan, Italy
| | - Patrizio Armeni
- SDA Bocconi School of Management, Centre for Research on Health and Social Care Management (CERGAS), Milan, Italy
| | - Francesco Costa
- SDA Bocconi School of Management, Centre for Research on Health and Social Care Management (CERGAS), Milan, Italy
| | - Francesco Malandrini
- SDA Bocconi School of Management, Centre for Research on Health and Social Care Management (CERGAS), Milan, Italy
| | - Claudio Jommi
- Department of Pharmaceutical Sciences, Università del Piemonte Orientale, Largo Guido Donegani, 2, 28100, Novara, Italy
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Drummond M, Ciani O, Fornaro G, Jommi C, Dietrich ES, Espin J, Mossman J, de Pouvourville G. How are health technology assessment bodies responding to the assessment challenges posed by cell and gene therapy? BMC Health Serv Res 2023; 23:484. [PMID: 37179322 PMCID: PMC10182681 DOI: 10.1186/s12913-023-09494-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 11/04/2022] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND The aims of this research were to provide a better understanding of the specific evidence needs for assessment of clinical and cost-effectiveness of cell and gene therapies, and to explore the extent that the relevant categories of evidence are considered in health technology assessment (HTA) processes. METHODS A targeted literature review was conducted to identify the specific categories of evidence relevant to the assessment of these therapies. Forty-six HTA reports for 9 products in 10 cell and gene therapy indications across 8 jurisdictions were analysed to determine the extent to which various items of evidence were considered. RESULTS The items to which the HTA bodies reacted positively were: treatment was for a rare disease or serious condition, lack of alternative therapies, evidence indicating substantial health gains, and when alternative payment models could be agreed. The items to which they reacted negatively were: use of unvalidated surrogate endpoints, single arm trials without an adequately matched alternative therapy, inadequate reporting of adverse consequences and risks, short length of follow-up in clinical trials, extrapolating to long-term outcomes, and uncertainty around the economic estimates. CONCLUSIONS The consideration by HTA bodies of evidence relating to the particular features of cell and gene therapies is variable. Several suggestions are made for addressing the assessment challenges posed by these therapies. Jurisdictions conducting HTAs of these therapies can consider whether these suggestions could be incorporated within their existing approach through strengthening deliberative decision-making or performing additional analyses.
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Affiliation(s)
- Michael Drummond
- Centre for Health Economics, University of York, York, UK.
- CERGAS, SDA Bocconi School of Management, Milan, Italy.
| | - Oriana Ciani
- CERGAS, SDA Bocconi School of Management, Milan, Italy
| | | | - Claudio Jommi
- CERGAS, SDA Bocconi School of Management, Milan, Italy
| | | | - Jaime Espin
- Andalusian School of Public Health, Andalusia, Spain
| | - Jean Mossman
- Patient Representative and Visiting Senior Research Associate in the Medical Technology Research Group, LSE Health, London School of Economics, London, UK
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Jommi C, Galeone C. The Evaluation of Drug Innovativeness in Italy: Key Determinants and Internal Consistency. Pharmacoecon Open 2023; 7:373-381. [PMID: 36763319 PMCID: PMC10169980 DOI: 10.1007/s41669-023-00393-3] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/16/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND Innovative medicines are provided with dedicated funds and immediate market access in Italy. Innovativeness evaluation considers unmet need, added therapeutic value, and quality of the evidence. OBJECTIVE We aimed to evaluate the internal consistency and drivers of the innovativeness appraisal process. METHODS Appraisal reports on innovativeness refer to 1997-2021. We used both a descriptive approach and probabilistic multivariate analysis, using logistic regression models to compute odds ratios and 95% confidence intervals. The dependent variable is innovativeness status (innovative vs. non-innovative; full innovativeness vs. conditional innovativeness). Explanatory variables, besides the three above-mentioned domains, are the year of evaluation, drug type, target disease and population, and the number and type of available studies. RESULTS Among the 141 medicines scrutinized, 31.9%, 29.8%, and 38.3% were evaluated as fully innovative, conditionally innovative, and non-innovative, respectively. Added therapeutic value and the quality of the evidence were associated with the odds of receiving innovative status, and full compared with conditional innovativeness; unmet need was not a predictive variable. Other factors played a minor role: medicines for both solid tumours and rare diseases are more likely to be judged innovative; conditional innovativeness is more probable for medicines for rare diseases. CONCLUSIONS Innovativeness status is driven by the added therapeutic value and quality of evidence. The appraisal process is internally consistent and predictable. This provides industry with a clear indication of what is needed to ensure that access to their medicines is prioritized.
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Affiliation(s)
- Claudio Jommi
- Department of Pharmaceutical Sciences, Università del Piemonte Orientale, Novara, Italy.
- Cergas (Centre for Research on Health and Social Care Management), SDA Bocconi, Bocconi University, Milan, Italy.
| | - Carlotta Galeone
- Biostatistics & Outcome Research, Statinfo, Milan, Italy
- Bicocca Applied Statistics Center (B-ASC), Università degli Studi di Milano-Bicocca, Milan, Italy
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Abstract
OBJECTIVES This study aimed to provide normative data obtained in response to the EQ-5D-5L questionnaire in Italy and compare this with data from other countries. METHODS A sample of the Italian adult population (aged ≥ 18 years) was recruited and interviewed online using videoconferencing software (Zoom) between November 2020 and February 2021. The distribution of answers was estimated as per the descriptive system of the EQ-5D-5L, and descriptive statistics were calculated for the EQ VAS score and EQ-5D-5L index value in the whole sample and relevant subgroups. An ordinary least square (OLS) regression was performed to evaluate the impact of sociodemographic variables on EQ-5D-5L results. Lastly, a comparison was made with EQ-5D-5L population norms of other countries. Data analysis was performed using Microsoft Excel and Stata 13. RESULTS Overall, 1182 people representative of the Italian population (2020) in terms of sex and geographical area responded to the survey. Of the 3125 potential EQ-5D-5L health states, only 106 (3.4%) were selected, and the '11111' and '11112' states were chosen by half of the participants. In terms of EQ-5D-5L dimensions, the frequency of any problems (from slight to extreme) associated with anxiety and depression was high among the very young (18-24 years, 56.0%) and in women of all ages (49.7%). The mean index value (± standard deviation [SD]) was 0.93 (± 0.11) for the entire sample and gradually decreased with age, moving from 0.95 (± 0.06) in the youngest group (18-24 years) to 0.91 (± 0.13) in the oldest age group (≥ 75 years). Similarly, the mean EQ VAS score (± SD) was 81.8 (± 13.5), and decreased from 87.0 (± 8.9) in the 18-24 years age group to 75.1 (± 16.4) among participants > 75 years of age. The existence of self-reported chronic conditions (e.g., cardiovascular disease), female sex, and social assistance recipiency were negatively associated with the EQ-5D index value, while the EQ VAS score was significantly lower in people with chronic conditions and aged > 55 years. Conversely, higher income levels had a positive impact on both the EQ-5D index value and the EQ VAS score. Lastly, both the EQ-5D index value and EQ VAS score in Italy were, on average, higher than in most European countries. CONCLUSIONS EQ-5D-5L population norms provide useful insights into the health status of the Italian population and can be used as a reference for other surveys using the same instrument.
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Affiliation(s)
| | | | - Aureliano Paolo Finch
- EuroQol Office, EuroQol Research Foundation, Rotterdam, The Netherlands
- Health Values Research and Consultancy, Amsterdam, The Netherlands
| | - Oriana Ciani
- CERGAS, SDA Bocconi School of Management, Milan, Italy
| | - Claudio Jommi
- CERGAS, SDA Bocconi School of Management, Milan, Italy
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Di Brino E, Jommi C. Prezzo e rimborso dei farmaci in caso di estensione delle indicazioni: i risultati di una survey sui soci di ISPOR Italy Rome Chapter. Glob Reg Health Technol Assess 2023; 10:40-45. [PMID: 37151229 PMCID: PMC10158496 DOI: 10.33393/grhta.2023.2562] [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: 01/15/2023] [Accepted: 04/25/2023] [Indexed: 05/09/2023] Open
Abstract
Multi-indication pricing models for medicines and some international impact evidence are available in the literature. Data on the Italian context are more limited. This paper illustrates the results of a study aimed at gathering the opinion on this topic of experts, members of the ISPOR Italy Rome Chapter. The opinion was collected through a structured questionnaire, validated by two potential responders, and administered online in the period October/July 2022. There were 45 responders (20% of the members); 67% of responders work in pharmaceutical companies and 13% in consultancy firms. The remainder belongs to regulators/payers and universities. The survey highlighted a preference for (i) non-automatic models, as automatic approaches are mainly based on price cuts/discount increases in relation to an increase in volumes, (ii) an “indication-based-pricing” model (where prices are differentiated by indication through discounts/risk sharing agreements), since it is more consistent with a value-based approach, even if more complex to manage, (iii) a mix of discounts/agreements according to existing evidence. The opinion collected is consistent with the opinions available in the literature, but not consistent with the Italian trend, where, compared to the past, a blended approach is prevailing. A blended pricing envisages a renegotiation of the single price for all indications, essentially based on a change in the discount. Our hope is that in the future the experts’ opinion will be taken into consideration and that a targeted indication-based-pricing will be adopted again.
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Affiliation(s)
- Eugenio Di Brino
- Alta Scuola di Economia e Management dei Sistemi Sanitari, Università Cattolica del Sacro Cuore, Roma - Italy
| | - Claudio Jommi
- Dipartimento di Scienze del Farmaco, Università del Piemonte Orientale, Novara - Italy
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Jommi C, Meregaglia M, Pinto C. Il bisogno insoddisfatto: definizioni, evidenze di letteratura e implicazioni per l’HTA. Glob Reg Health Technol Assess 2023; 10:70-78. [PMID: 37811344 PMCID: PMC10551671 DOI: 10.33393/grhta.2023.2624] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 08/28/2023] [Indexed: 10/10/2023] Open
Abstract
The present paper illustrates the definition of unmet need provided by the peer-reviewed literature and the Health Technology Assessment (HTA) authorities across Europe in the assessment and appraisal process and within the early access schemes for medicines. The analysis relied on a descriptive review of the peer-reviewed literature and HTA documents on the definition of need (disease severity) and the way it is satisfied (existence and validity of alternatives). HTA agencies were found using (i) a narrow definition of need, focused on the clinical impact and the impact on health-related quality of life of the disease and (ii) a broad definition of comparators, including treatments used off-label in the clinical practice. Most of the contributions of the literature advocated for a broader definition of need, including additional dimensions (for example, the socio-economic impact of the disease) and the effects of existing treatments beyond their risk-benefit profile (for example, acceptability to patients). On the one hand, these contributions should be considered by HTA agencies, considering its multi-disciplinary and multi-stakeholder nature. On the other one, the explicit inclusion of the unmet need domains, at present disregarded, should depend on the decisions taken on the ground of the assessment.
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Affiliation(s)
- Claudio Jommi
- Dipartimento di Scienze del Farmaco, Università del Piemonte Orientale, Novara - Italy
| | - Michela Meregaglia
- Dipartimento di Scienze del Farmaco, Università del Piemonte Orientale, Novara - Italy
- Cergas, SDA Bocconi School of Management, Università Bocconi - Italy
| | - Carmine Pinto
- Oncologia Medica, Comprehensive Cancer Centre, AUSL-IRCCS Arcispedale di Reggio Emilia - Italy
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Jommi C, Bramanti S, Pani M, Ghirardini A, Santoro A. CAR T-Cell Therapies in Italy: Patient Access Barriers and Recommendations for Health System Solutions. Front Pharmacol 2022; 13:915342. [PMID: 35837293 PMCID: PMC9275825 DOI: 10.3389/fphar.2022.915342] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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] [Received: 04/07/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
CAR T-cell therapy has emerged as a potentially transformative immunotherapy for certain B-cell malignancies including relapsed/refractory diffuse large B-cell lymphoma (DLBCL). Unhindered and appropriate access for eligible patients is essential to enable optimal outcomes and depends on effective interplay of stakeholders and processes along the patient’s therapeutic journey. In Italy, CAR T-cell therapies have been awarded innovation status by the Italian Medicines Agency (AIFA) and were integrated into routine patient care under specific criteria. However, our analysis indicates that fewer than one in five DLBCL patients eligible under the EMA authorization, or around one in three DLBCL patients eligible under the AIFA criteria, received treatment with a licensed CAR T-cell therapy product in 2020. This publication describes key patient access barriers to CAR T-cell therapies in Italy and provides recommendations on potential solutions at the health system level.
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Affiliation(s)
- Claudio Jommi
- CERGAS (Centre for Research on Health and Social Care Management), SDA Bocconi School of Management), Bocconi University, Milan, Italy
- *Correspondence: Claudio Jommi,
| | - Stefania Bramanti
- IRCCS Humanitas Research Hospital- Humanitas Cancer Center, Rozzano, Italy
| | | | - Alessandro Ghirardini
- Istituto Superiore di Sanità, Rome, Italy
- National Center for Telemedicine and New Assistive Technologies, National Institute of Health, Rome, Italy
| | - Armando Santoro
- IRCCS Humanitas Research Hospital- Humanitas Cancer Center, Rozzano, Italy
- Humanitas University Pieve Emanuele, Milan, Italy
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Caprari F, Alfano A, Buzzetti G, Consoli A, de Braud F, Patarnello F, Pitrelli A, Riccaboni M, Rossi G, Samele R, Scaduto D, Viale P, Jommi C, Popoli P. [Unmet clinical need and new therapeutic options.]. Recenti Prog Med 2022; 113:161-166. [PMID: 35315445 DOI: 10.1701/3761.37480] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The debate around unmet clinical need (UCN) is still very much alive. How do we define UCN? How does it influence the definition of clinically relevant outcomes in a therapeutic area? Who defines UCN? What are the consequences of recognizing different grading of UCN? In this paper we will address these questions and finally formulate proposals for the Italian context. The paper is based on a discussion within a panel of experts. This topic is even more stimulating as this work takes place in a historical period which, on the one hand, sees the start of a new course of negotiation rules recently published by AIFA and, on the other hand, poses unprecedented challenges that emerged during the pandemic crisis. The working group formulated suggestions and proposals to further enhance the role of the UCN in decision-making processes, also in the light of the new negotiation procedure, and to help refine the tools for grading the UCN and the value of medicines in the interests of patients and society as a whole.
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Affiliation(s)
| | | | | | | | - Filippo de Braud
- Fondazione IRCCS Istituto Nazionale dei Tumori, Università di Milano
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20
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Abstract
BACKGROUND Compassionate use programs (CUP) for medicines respond to the ethical imperative of providing access to medicines before marketing approval to patients not recruited in trials. The economic impact of clinical trials has previously been investigated. No evidence on the net economic benefit of CUP exists. This research aims to address this information gap by estimating the economic consequences of 11 CUP in Italy conducted between March 2015 and December 2020 from the perspective of public health care system in Italy (National Health Service). Eight programs concern cancer treatments, two refer to spinal muscular atrophy, and one is indicated for multiple sclerosis. METHODS Since CUP medicines are covered by the industry, the net economic benefit includes: (i) avoided costs of the Standard of Care (SoC) the patients would have received had they not joined the CUP, (ii) costs not covered by the pharmaceutical industry sponsor, but instead sustained by payers, such as those associated with adverse events (only severe side effects resulting in hospitalisation and attributable to CUP medicines), and (iii) costs for combination therapies and diagnostic procedures not used with the SoC. The SoC costing relied on publicly available data. Information on adverse events and diagnostic procedures was retrieved from the CUP and monetized using the relevant fee for episode or service. One CUP was excluded since a SoC was not identified. RESULTS 2,713 patients were treated in the 11 CUP where a SoC was identified. The SoC mean cost per patient ranged from €11,415 to €20,299. The total cost of the SoC ranged between €31.0 and €55.1 million. The mean cost per patient covered by hospitals hosting CUP was equal to €1,646, with a total cost of €4.5 million. The net economic benefit ranged €26.5 million - €50.6 million. CONCLUSIONS Despite research limitations, this paper illustrates for the first time the net economic impact of CUP from a public payer perspective. It is important to integrate these estimates with the prospective effects of CUP implementation, i.e., the economic value of the comparative benefit profile of medicines used in CUP versus the SoC, including effects from a societal perspective.
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Affiliation(s)
- Claudio Jommi
- Centre for Research on Health and Social Care Management, SDA Bocconi School of Management, CERGAS, Bocconi University, Via Sarfatti 25, 20136 Milano, MI Italy
| | | | - Lisa Stagi
- ROCHE Spa, Viale GB Stucchi 110, MB 20900 Monza, Italy
| | - Maria Verykiou
- Centre for Research on Health and Social Care Management, SDA Bocconi School of Management, CERGAS, Bocconi University, Via Sarfatti 25, 20136 Milano, MI Italy
| | - Marianna Cavazza
- Centre for Research on Health and Social Care Management, SDA Bocconi School of Management, CERGAS, Bocconi University, Via Sarfatti 25, 20136 Milano, MI Italy
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21
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Jommi C, Armeni P, Costa F, Alberti C, Bandello F, Bordonaro R, Caprodossi A, Di Maio M, Gaudioso A, Giuliani G, Langella R, Marata AM, Patarnello F, Pinto C, Rasi G, Villa F. [Early access programs and managed entry agreements for medicines in Italy: results of a Focus Group (Early Access Programs and Managed Entry Agreement).]. Recenti Prog Med 2021; 112:749-756. [PMID: 34782810 DOI: 10.1701/3696.36853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Early access of medicines occurs with an uncertainty in the evidence even higher than the one experienced when price and reimbursement status is negotiated. Our aim is discussing the role of managed entry agreements (MEA) within early access programs (EAP) in Italy. METHODS The discussion relied on a Focus Group, participated by twelve experts, including clinicians and representatives of regulatory authorities, regional and local pharmaceutical departments, pharmaceutical companies, and an association advocating for active citizenship. RESULTS The Focus Group emphasised that the topic under discussion should be embedded into a more general reform of EAP in Italy. The 648 List mostly includes mature products and indications that are rarely launched into the market afterwards. The 5% Fund is affected by an important administrative burden uncertainty of the timing of reimbursement. CONCLUSIONS Starting from the discussion on MEA and EAP, the Focus Group recommended a new legislation better regulating EAP, that early access concerns specific classes of medicines selected on the grounds of the need to guarantee a rapid access and to collect real world data, that early access can be accompanied by outcome-based and population-based MEA, and that MEA are embedded into the subsequent price and reimbursement negotiation.
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Affiliation(s)
- Claudio Jommi
- Cergas, SDA Bocconi School of Management, Università Bocconi, Milano
| | - Patrizio Armeni
- Cergas, SDA Bocconi School of Management, Università Bocconi, Milano
| | - Francesco Costa
- Cergas, SDA Bocconi School of Management, Università Bocconi, Milano
| | - Chiara Alberti
- UOC Azienda Ospedaliera Universitaria Integrata di Verona
| | | | | | | | - Massimo Di Maio
- Dipartimento di Oncologia, Università di Torino; AO Ordine Mauriziano, Torino
| | | | | | | | - Anna Maria Marata
- Servizio assistenza territoriale, Area farmaci e dispositivi medici, Regione Emilia-Romagna, Bologna
| | | | - Carmine Pinto
- Oncologia Medica, Comprehensive Cancer Centre, AUSL-IRCCS di Reggio Emilia
| | - Guido Rasi
- Dipartimento di Medicina Sperimentale, Università di Roma Tor Vergata
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Riva S, Arenare L, Di Maio M, Efficace F, Montesarchio V, Frontini L, Giannarelli D, Bryce J, Del Campo L, De Lorenzo F, Iannelli E, Traclò F, Gitto L, Jommi C, Vaccaro CM, Barberio D, Cinieri S, Porta C, Del Mastro L, Zagonel V, Cogoni AA, Bordonaro R, Gimigliano A, Piccirillo MC, Guizzaro L, Gallo C, Perrone F. Cross-sectional study to develop and describe psychometric characteristics of a patient-reported instrument (PROFFIT) for measuring financial toxicity of cancer within a public healthcare system. BMJ Open 2021; 11:e049128. [PMID: 34670762 PMCID: PMC8529986 DOI: 10.1136/bmjopen-2021-049128] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To measure and explain financial toxicity (FT) of cancer in Italy, where a public healthcare system exists and patients with cancer are not expected (or only marginally) to pay out-of-pocket for healthcare. SETTING Ten clinical oncological centres, distributed across Italian macroregions (North, Centre, South and Islands), including hospitals, university hospitals and national research institutes. PARTICIPANTS From 8 October 2019 to 11 December 2019, 184 patients, aged 18 or more, who were receiving or had received within the previous 3 months active anticancer treatment were enrolled, 108 (59%) females and 76 (41%) males. INTERVENTION A 30-item prefinal questionnaire, previously developed within the qualitative tasks of the project, was administered, either electronically (n=115) or by paper sheet (n=69). PRIMARY AND SECONDARY OUTCOME MEASURES According to the protocol and the International Society for Pharmacoeconomics and Outcomes Research methodology, the final questionnaire was developed by mean of explanatory factor analysis and tested for reliability, internal consistency (Cronbach's α test and item-total correlation) and stability of measurements over time (test-retest reliability by intraclass correlation coefficient and weighted Cohen's kappa coefficient). RESULTS After exploratory factor analysis, a score measuring FT (FT score) was identified, made by seven items dealing with outcomes of FT. The Cronbach's alpha coefficient for the FT score was 0.87 and the item-total correlation coefficients ranged from 0.53 to 0.74. Further, nine single items representing possible determinants of FT were also retained in the final instrument. Test-retest analysis revealed a good internal validity of the FT score and of the 16 items retained in the final questionnaire. CONCLUSIONS The Patient-Reported Outcome for Fighting FInancial Toxicity (PROFFIT) instrument consists of 16 items and is the first reported instrument to assess FT of cancer developed in a country with a fully public healthcare system. TRIAL REGISTRATION NUMBER NCT03473379.
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Affiliation(s)
- Silvia Riva
- Psychology and Pedagogic Science, St Mary's University, Twickenham, London, UK
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University Hospital of Milan, Milano, Italy
| | - Laura Arenare
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - Massimo Di Maio
- Dipartimento di Oncologia, AO Ordine Mauriziano, Università degli Studi di Torino, Torino, Italy
| | - Fabio Efficace
- Health Outcomes Research Unit, Gruppo Italiano per le Malattie Ematologiche dell'Adulto (GIMEMA), Roma, Italy
| | | | - Luciano Frontini
- Federation of Italian Cooperative Oncology Groups (FICOG), Milano, Italy
| | - Diana Giannarelli
- Unità di Biostatistica, Istituto Nazionale per lo Studio e la Cura dei Tumori Regina Elena, IRCCS, Roma, Italy
| | - Jane Bryce
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
- Dipartimento di Biomedicina e Prevenzione, Università degli Studi di Roma "Tor Vergata", Roma, Italy
- Clinical Research Institute, Ascension St. John Clinical Research Institute, Tulsa, Oklahoma, USA
| | - Laura Del Campo
- Federazione Italiana delle Associazioni di Volontariato in Oncologia (FAVO), Roma, Italy
| | - Francesco De Lorenzo
- Associazione Italiana Malati di Cancro (AIMAC), Roma, Italy
- European Cancer Patient Coalition (ECPC), Brussels, Belgium
| | - Elisabetta Iannelli
- Federazione Italiana delle Associazioni di Volontariato in Oncologia (FAVO), Roma, Italy
| | | | - Lara Gitto
- Dipartimento di Economia, Università degli Studi di Messina, Messina, Italy
| | - Claudio Jommi
- CERGAS (Centre for Health and Social Care Management), Università Bocconi, Milano, Italy
| | | | - Daniela Barberio
- Psiconcologia Clinica, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | | | - Camillo Porta
- Oncologia Medica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Dipartimento di Scienze Biomediche ed Oncologia Umana, Università degli Studi di Bari, Bari, Italy
| | - Lucia Del Mastro
- Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Dipartimento di Medicina Interna e Medicina Specialistica (DIMI), Università di Genova, Genova, Italy
| | | | | | | | - Anna Gimigliano
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - Maria Carmela Piccirillo
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - Lorenzo Guizzaro
- Statistica Medica, Università degli Studi della Campania Luigi Vanvitelli, Napoli, Italy
| | - Ciro Gallo
- Statistica Medica, Università degli Studi della Campania Luigi Vanvitelli, Napoli, Italy
| | - Francesco Perrone
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
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Jommi C, Listorti E, Villa F, Ghislandi S, Genazzani A, Cangini A, Trotta F. Variables affecting pricing of orphan drugs: the Italian case. Orphanet J Rare Dis 2021; 16:439. [PMID: 34666819 PMCID: PMC8527608 DOI: 10.1186/s13023-021-02022-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 03/14/2021] [Accepted: 09/20/2021] [Indexed: 12/12/2022] Open
Abstract
Background and aim Evidence on determinants of prices for orphan medicines is scarce and not available for Italy. The aim of this paper is to provide an evidence on variables affecting the annual treatment cost of orphan drugs in Italy, testing the hypothesis of a negative correlation with the dimension of the target population and a positive correlation with the added therapeutic value of the drug and the quality of the evidence of pivotal studies. Methods Drugs with a European orphan designation reimbursed in Italy in the last 6 years (2014–2019) were considered. Univariate, cluster analysis and multiple regression models were used to investigate the correlation between the annual treatment cost and, as explanatory variables, the dimension of the target population, the existence of Randomized Clinical Trials as a proxy of the quality of the pivotal studies, the added therapeutic value. Results In the univariate analysis prevalence and added therapeutic value, as expected, have a negative and positive correlation with cost respectively. The correlation with RCT is not significant. In the multivariate model, coefficients for prevalence and added value are confirmed but for the latter are not significant anymore. We also found, through an interaction analysis, that the existence of an RCT has a positive impact on annual treatment cost when the target population is very small. Conclusions Our results suggest that value arguments and sustainability (dimension of the target population and its impact on budget impact) issues are considered for orphan drugs pricing: the role played by sustainability is systematically supported by our results. A more transparent and reproducible price negotiation process for orphan drugs is needed in Italy. This paper has contributed to highlight the implicit drivers of this process.
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Affiliation(s)
- Claudio Jommi
- Cergas (Centre for Research on Health and Social Care Management), SDA Bocconi, Bocconi University, Via Sarfatti 10, 20136, Milan, Italy.
| | - Elisabetta Listorti
- Cergas (Centre for Research on Health and Social Care Management), SDA Bocconi, Bocconi University, Via Sarfatti 10, 20136, Milan, Italy
| | - Federico Villa
- Aifa (Italian Medicines Agency), Via del Tritone 181, 00187, Rome, Italy.,Department of Pharmaceutical Sciences, Università del Piemonte Orientale, Largo Guido Donegani, 2, 28100, Novara, Italy
| | - Simone Ghislandi
- Cergas (Centre for Research on Health and Social Care Management), SDA Bocconi, Bocconi University, Via Sarfatti 10, 20136, Milan, Italy.,Department of Social and Political Sciences, Bocconi University, Via Rontgen 1, 20136, Milan, Italy
| | - Armando Genazzani
- Department of Pharmaceutical Sciences, Università del Piemonte Orientale, Largo Guido Donegani, 2, 28100, Novara, Italy
| | - Agnese Cangini
- Aifa (Italian Medicines Agency), Via del Tritone 181, 00187, Rome, Italy
| | - Francesco Trotta
- Aifa (Italian Medicines Agency), Via del Tritone 181, 00187, Rome, Italy
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Pruneri G, De Braud F, Sapino A, Aglietta M, Vecchione A, Giusti R, Marchiò C, Scarpino S, Baggi A, Bonetti G, Franzini JM, Volpe M, Jommi C. Next-Generation Sequencing in Clinical Practice: Is It a Cost-Saving Alternative to a Single-Gene Testing Approach? Pharmacoecon Open 2021; 5:285-298. [PMID: 33660227 PMCID: PMC8160052 DOI: 10.1007/s41669-020-00249-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/12/2020] [Indexed: 05/25/2023]
Abstract
OBJECTIVES This study aimed to compare the costs of a next-generation sequencing-based (NGS-based) panel testing strategy to those of a single-gene testing-based (SGT-based) strategy, considering different scenarios of clinical practice evolution. METHODS Three Italian hospitals were analysed, and four different testing pathways (paths 1, 2, 3, and 4) were identified: two for advanced non-small-cell lung cancer (aNSCLC) patients and two for unresectable metastatic colon-rectal cancer (mCRC) patients. For each path, we explored four scenarios considering the current clinical practice and its expected evolution. The 16 testing cases (4 scenarios × 4 paths) were then compared in terms of differential costs between the NGS-based and SGT-based approaches considering personnel, consumables, equipment, and overhead costs. Break-even and sensitivity analyses were performed. Data gathering, aimed at identifying the hospital setup, was performed through a semi-structured questionnaire administered to the professionals involved in testing activities. RESULTS The NGS-based strategy was found to be a cost-saving alternative to the SGT-based strategy in 15 of the 16 testing cases. The break-even threshold, the minimum number of patients required to make the NGS-based approach less costly than the SGT-based approach, varied across the testing cases depending on molecular alterations tested, techniques adopted, and specific costs. The analysis found the NGS-based approach to be less costly than the SGT-based approach in nine of the 16 testing cases at any volume of tests performed; in six cases, the NGS-based approach was found to be less costly above a threshold (and in one case, it was found to be always more expensive). Savings obtained using an NGS-based approach ranged from €30 to €1249 per patient; in the unique testing case where NGS was more costly, the additional cost per patient was €25. CONCLUSIONS An NGS-based approach may be less costly than an SGT-based approach; also, generated savings increase with the number of patients and different molecular alterations tested.
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Affiliation(s)
- Giancarlo Pruneri
- Department of the Pathology and Laboratory Medicine, Fondazione IRCCS-Istituto Nazionale dei Tumori, Milan, Italy
- School of Medicine, University of Milan, Milan, Italy
| | - Filippo De Braud
- Department of Oncology, Fondazione IRCCS-Istituto Nazionale dei Tumori, Milan, Italy
- School of Medicine, University of Milan, Milan, Italy
| | - Anna Sapino
- Pathology Unit, Candiolo Cancer Institute-FPO-IRCCS-Candiolo, Turin, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Massimo Aglietta
- Medical Oncology, Candiolo Cancer Institute-FPO-IRCCS-Candiolo, Turin, Italy
- Department of Oncology, University of Torino, Turin, Italy
| | - Andrea Vecchione
- Pathology Unit, Department of Clinical and Molecular Medicine, St. Andrea University Hospital, University of Rome La Sapienza, Rome, Italy
| | - Raffaele Giusti
- Medical Oncology Unit, St. Andrea University Hospital, Rome, Italy
| | - Caterina Marchiò
- Pathology Unit, Candiolo Cancer Institute-FPO-IRCCS-Candiolo, Turin, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Stefania Scarpino
- Pathology Unit, Department of Clinical and Molecular Medicine, St. Andrea University Hospital, University of Rome La Sapienza, Rome, Italy
| | - Anna Baggi
- Life Sciences Division, Business Integration Partners, Milan, Italy
| | - Giuseppe Bonetti
- Life Sciences Division, Business Integration Partners, Milan, Italy
| | | | - Marco Volpe
- Life Sciences Division, Business Integration Partners, Milan, Italy
| | - Claudio Jommi
- Cergas, Centre for Research on Health and Social Care Management, SDA Bocconi School of Management, Bocconi University, Milan, Italy.
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Abstract
e18840 Background: The economic impact of clinical trials in the perspective of trial sites has been already investigated. Instead, there is no evidence on the economic net benefit of compassionate use programs for medicines (CUP). This research aims to fill the information gap, investigating the economic consequences of 8 CUP in Italy carried out from May 2015 to December 2020 in the hospitals’ perspective. These programs concern five cancer medicines (alectinib, atezolizumab, cobimetinib, polatuzumab vedotin, trastuzumab emtansine TDM-1), for a total of 8 programs. Methods: Economic net benefit includes avoided costs for standard of care (SoC) the patient would have received if he/she has not joined the CUP and costs not covered by the pharmaceutical industry and sustained by the hospital hosting CUP. The latter include costs of adverse event (only severe sides effects generating hospitalisation and ascribed to medicines used in CUP), combination therapies and diagnostic procedures not covered by the sponsor. SoC costing relied on publicly available estimation. Adverse events and diagnostic procedures were retrieved from the CUP and monetized using the relevant fee for episode. Results: 1635 cancer patients were treated in eight CUPs. The SoC mean cost per patient ranges from €13355 to €28098 for all cancer drugs. The total cost of the SoC ranges from €21.8 - €45.9 million. The mean cost per patient covered by hospitals hosting CUP was equal to €2732 for cancer drugs, with a total cost of €4.5 million. The net economic benefit ranges from €17.4 million to €41.5 million for cancer treatments. Conclusions: Despite its limitations this paper illustrates for the first time the net economic impact of CUP in oncology patients in the perspective of payers. Additional evaluations are ongoing to better understand the overall effects of CUP implementation, i.e. the economic value of the comparative benefit profile of medicines used in CUP versus the SoC, including potential effects on indirect costs.
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Ronco V, Dilecce M, Lanati E, Canonico PL, Jommi C. Price and reimbursement of advanced therapeutic medicinal products in Europe: are assessment and appraisal diverging from expert recommendations? J Pharm Policy Pract 2021; 14:30. [PMID: 33741076 PMCID: PMC7980570 DOI: 10.1186/s40545-021-00311-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 02/25/2021] [Indexed: 11/30/2022] Open
Abstract
Background Advanced therapy medicinal products (ATMPs) represent an important cornerstone for innovation in healthcare. However, uncertainty on the value, the high average cost per patient and their one-shot nature has raised a debate on their assessment and appraisal process for pricing and reimbursement (P&R) purposes. This debate led experts providing for recommendations on this topic. Our primary objective is to investigate the ATMPs P&R process in the main five European countries and to understand if this process is consistent with published P&R expert recommendations. We also investigated the current ATMP pipelines to understand if future ATMPs will create challenges for their P&R process. Methods P&R framework for ATMPs in the European Major five (EU5) countries was investigated through a literature search on PubMed, institutional websites of National Health Authorities and grey literature. The ATMPs pipeline database was populated from a clinical trial database (clinicaltrials.gov), relying on inclusion and exclusion criteria retrieved from the literature. Results Reimbursement status of ATMPs is different across the EU5 countries, with the exception of CAR-Ts which are reimbursed in all countries. Standard P&R process in place for other medicinal products is extended to ATMPs, with the exception of some cases in Germany. List prices, where available, are high and, tend to be aligned across countries. Outcome-based Managed Entry Agreements (MEAs) have been extensively used for ATMPs. Extra-funds for hospitals managing ATMPs were provided only in Germany and, as additional fund per episode, in France. The accreditation process of hospitals for ATMPs management was in most countries managed by the national authorities. As far as ATMPs pipeline is concerned, ATMPs in development are mostly targeting non-rare diseases. Conclusions Expert recommendations for ATMPs P&R were partially applied: the role of outcome-based MEAs has increased and the selection process of the centres authorized to use these treatments has been enhanced; additional funding for ATMPs management to accredited centres has not been completely considered and annuity payment and broader perspective in cost considerations are far from being put in place. These recommendations should be considered for future P&R negotiations to pursue rational resource allocation and deal with budget constraints.
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Affiliation(s)
- Virginia Ronco
- Market Access Provider Srl, Via V. Monti, 3, 20123, Milan, Italy.
| | - Myriam Dilecce
- Market Access Provider Srl, Via V. Monti, 3, 20123, Milan, Italy
| | - Elena Lanati
- Market Access Provider Srl, Via V. Monti, 3, 20123, Milan, Italy
| | - Pier Luigi Canonico
- Dipartimento di Scienze del Farmaco, Università del Piemonte Orientale, Largo Donegani 2, 28100, Novara, Italy
| | - Claudio Jommi
- SDA Bocconi School of Management, Università Bocconi, Via Sarfatti 10, 20136, Milano, Italy
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27
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Rognoni C, Bertolani A, Jommi C. Second-Generation Antipsychotic Drugs for Patients with Schizophrenia: Systematic Literature Review and Meta-analysis of Metabolic and Cardiovascular Side Effects. Clin Drug Investig 2021; 41:303-319. [PMID: 33686614 PMCID: PMC8004512 DOI: 10.1007/s40261-021-01000-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [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: 01/15/2021] [Indexed: 12/28/2022]
Abstract
Background and Objectives Second-generation antipsychotics (SGAs) for schizophrenia show different risk profiles, whose evidence has been evaluated through comparative reviews on randomized controlled trials (RCTs) and observational studies. Methods We performed a systematic review and meta-analysis of weight gains, metabolic and cardiovascular side effects of SGAs, relying on both RCTs and observational studies, by comparing variations between the start of treatment and the end of follow-up. The systematic review refers to papers published from June 2009 to November 2020. PRISMA criteria were followed. No restrictions on heterogeneity level have been considered for meta-analysis. A test for the summary effect measure and heterogeneity (I2 metric) was used. Results Seventy-nine papers were selected from 3076 studies (61% RCTs, 39% observational studies). Olanzapine and risperidone reported the greatest weight gain and olanzapine the largest BMI increase. Paliperidone showed the highest increase in total cholesterol, but is the only drug reporting an increase in the HDL cholesterol. Quetiapine XR showed the highest decrease in fasting glucose. Lurasidone showed the lowest increase in body weight and a reduction in BMI and was also the only treatment reporting a decrease in total cholesterol and triglycerides. The highest increase in systolic and diastolic blood pressure was reported by quetiapine XR. Conclusions Despite some limitations (differences in the mean dosages per patient and other side effects not included) this paper provides the first complete meta-analysis on SGAs in variations on metabolic risk profile between start of treatment and end of follow-up, with useful results for clinical practice and possibly for future economic evaluation studies. Supplementary Information The online version contains supplementary material available at 10.1007/s40261-021-01000-1.
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Affiliation(s)
- Carla Rognoni
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Bocconi University, Via Roentgen 1, 20136, Milan, Italy.
| | - Arianna Bertolani
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Bocconi University, Via Roentgen 1, 20136, Milan, Italy
| | - Claudio Jommi
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Bocconi University, Via Roentgen 1, 20136, Milan, Italy
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Abstract
OBJECTIVE In 2017, the Italian Medicines Agency (Agenzia Italiana del Farmaco, AIFA) introduced a standardised process to appraise innovativeness of medicines. Innovative medicines are provided speeder market access and dedicated funds. Innovativeness criteria are: unmet therapeutic need, added therapeutic value and quality of the evidence (Grading of Recommendations Assessment, Development and Evaluation method). We investigated the role played by these three criteria on the final decision aimed to understand how the new Italian innovativeness appraisal framework was implemented. DESIGN A desk research gathered AIFA's appraisal reports on innovativeness and data analyses were conducted. No patients were directly involved in this study. SETTING AND PARTICIPANTS We scrutinised all 77 appraisal reports available on AIFA's website (2017-2020). PRIMARY AND SECONDARY OUTCOME MEASURES The impact of the three domains on final decision was investigated through a series of univariate analyses. RESULTS Among 77 appraisal reports on innovativeness available, 49 (64%) and 28 (36%) were for oncology and non-oncology medicines, respectively. The appraisals were equally distributed among 'fully innovative' (36%), 'conditionally innovative' (30%) and 'not innovative' (34%). Added therapeutic value was the most important driver on innovativeness decision, followed by quality of the evidence. Drugs for rare diseases and with paediatric/mixed indications were appraised 'innovative' by a larger proportion, but no statistical significance was found. CONCLUSIONS Despite some limitations, including the moderate number of appraisals, this paper provides an insight into the determinants of innovativeness appraisals for medicines in Italy and the accuracy of the appraisal process. This has important implications in terms of transparency and accountability in the prioritisation process applied to innovative medicines.
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Affiliation(s)
- Carlotta Galeone
- Bicocca Applied Statistics Center (B-ASC), Università degli Studi di Milano-Bicocca, Milano, Lombardia, Italy
- Biostatistics & Outcome Research, Statinfo, Renate, Lombardia, Italy
| | - Paolo Bruzzi
- Department of Clinical Epidemiology, IRCCS AOU San Martino, Genova, Liguria, Italy
| | - Claudio Jommi
- CERGAS (Centre for Research on Health and Social Care Management), SDA Bocconi School of Management, Bocconi University, Milano, Lombardia, Italy
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Abstract
Study Objectives: Different policies have been implemented to enhance uptake of biosimilars. Regarding policies focussing on the demand-side, the literature has mainly concentrated on interchangeability and substitutability recommendations, issued by national or regional policymakers. Information on actions taken by healthcare organisations (HCOs) regarding prescribing behaviour is limited. Furthermore, there is no evidence on whether local authorities implemented a policy framework aimed to appropriately reallocate resources gained through patent expiration. This paper aims to fill these gaps, investigating policies on biosimilars implemented at the local level in the Italian National Health Service. Materials and Methods: Data were retrieved through a structured, validated questionnaire, administered online to all 199 public HCOs. Results: Seventy-six organizations in 16 of 21 Italian regions completed the survey, 89% of HCOs implemented information/educational initiatives on biosimilars. Prescription targets on biosimilars versus originators and off-patent versus in-patent molecules were introduced in 62% and 75% of HCOs, respectively. Prescribers reaching targets are mostly rewarded through monetary incentives. 75% of HCOs performed systematic impact evaluation of biosimilars. However, only 21% of HCOs detect patient under-treatment due to budget constraints and how availability of cheaper drugs could help. Furthermore, according to 25% of respondents, their HCO is involved in studies on biosimilars, but respondents did not provide any evidence of these studies. Discussion and conclusions: The study shows a high level of proactivity by Italian HCOs regarding actions on prescribing behaviour for off-patent biologicals. However, it seems that structured actions aimed at appropriately reallocating resources gained through patent expiration are still lacking.
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Villa F, Jommi C, Altamura G, Antignani S, Cangini A, Fortino I, Melazzini M, Trotta F, Tafuri G. [Establishing the value of new drugs in Italy.]. Recenti Prog Med 2020; 111:65-69. [PMID: 32089554 DOI: 10.1701/3309.32795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Italy was used as a case study to investigate the determinants of the difference between the price proposal for medicines submitted by the industry and the final negotiated price (∆P). Data was gathered through the information system used by Italian Medicines Agency (AIFA) and the time-frame for this analysis is 2013-2017. Factors influencing the delta price were analyzed through a regression analysis. Forty four orphan drugs and 89 new other molecular entities obtained reimbursement in the period considered. Following the negotiation process, prices proposed by Marketing Authorization Holders (MAH) were lowered during the negotiation process by 25.1% and 28.6% on average for orphan drugs and other molecules respectively. The price reduction was higher for innovative drugs (-32.2%). Statistically significant determinants associated to higher price reduction were: i) the implementation of a product specific monitoring registry, ii) the negotiation of a financial-based (FB) Managed Entry Agreement, iii) a target population larger than 20,000 patients, iv) an expected National Health Service expenditure larger than € 200 million. The impact of some variables on the delta price was predictable (e.g. for drugs with an expected higher budget impact and a larger target population), others were more surprising (e.g. a significant price reduction for "innovative" drugs). The implementation of FB agreements, which often rely on confidential arrangements, was one of the determinants with higher impact on price reduction.
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Normanno N, Curigliano G, Jommi C, Martini N, Marchetti A, Marchetti P, Pedrini A, Pruneri G. The new mutational model in oncology. What changes in welfare, clinical practice, research, and regulatory procedures? Ann Oncol 2019. [DOI: 10.1093/annonc/mdz263.028] [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: 11/13/2022] Open
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Riva S, Maio MD, Efficace F, Frontini L, Gallo C, Giannarelli D, Montesarchio V, De Lorenzo F, Del Campo L, Iannelli E, Traclò F, Gitto L, Jommi C, Vaccaro C, Bryce J, Gimigliano A, Sparavigna L, Perrone F. Measuring financial toxicity of cancer in the Italian health care system: Initial results of the patient reported outcome for fighting financial toxicity of cancer project (proFFiT). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz263.034] [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: 11/14/2022] Open
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Bryce J, Riva S, Di Maio M, Efficace F, Frontini L, Gallo C, Giannarelli D, Montesarchio V, De Lorenzo F, Del Campo L, Iannelli E, Traclò F, Gitto L, Jommi C, Vaccaro CM, Gimigliano A, Sparavigna L, Perrone F. Measuring financial toxicity of cancer in the Italian health care system: Initial results of the patient reported outcome for fighting financial toxicity of cancer project (proFFiT). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.27_suppl.91] [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: 11/20/2022] Open
Abstract
91 Background: Financial toxicity in cancer patients has been initially reported in the United States and subsequently in other countries, including Italy, despite its health care system is grounded on universal coverage. Considering that the way healthcare and welfare systems are shaped does impact on financial problems faced by cancer patients, we are developing an instrument for evaluating occurrence, gravity, and consequences of financial toxicity in Italy, and hopefully for fighting it. Methods: Concept elicitation, item generation and qualitative analyses represented the initial tasks of the project. Literature review, focus groups with 34 cancer patients or caregivers in three regions located in nothern, central, and southern Italy, and semi-structured interviews with 97 oncologists were conducted for concept elicitation. A recursive process was used to identify themes in the data to inform instrument until saturation was reached. Importance analysis questionnaires were administered to further 44 cancer patients to evaluate and revise the draft item pool. A multi-disciplinary committee (including oncologists, psychologists, statisticians, patient association’s representatives, nurses, social science researchers and economists) oversights the project. Results: Overall, 156 concepts were distributed among 10 themes (bureaucracy, medical care, domestic economy, emotion, family, job, health workers, welfare state, free time, transportation). After controlling for redundancy, 55 candidate items were generated and 30 items, with at least one per each theme, remained after importance analysis. Out of the 30 items, 23 (77%) refer to material conditions, 4 (13%) to psychological response and 3 (10%) to coping behaviors. Conclusions: The first results of the proFFiT project show that most of the items selected by patients are related to material conditions that cause, or derive from, financial hardship. The final questionnaire will be ready by the end of 2019. Supported by Fondazione AIRC IG grant 2017-20402. Clinical trial information: NCT03473379 .
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Affiliation(s)
- Jane Bryce
- Istituto Nazionale per lo Studio e la Cura dei Tumori, IRCCS Fondazione Pascale, Naples, Italy
| | - Silvia Riva
- University of Wolverhampton, Wolverhampton, United Kingdom
| | - Massimo Di Maio
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, Torino, Italy
| | | | - Luciano Frontini
- Federation of Italian Cooperative Oncology Groups (FICOG), Milan, Italy
| | - Ciro Gallo
- Università Della Campania "Luigi Vanvitelli", Naples, Italy
| | | | | | | | | | | | | | | | | | | | - Anna Gimigliano
- Istituto Nazionale per lo Studio e la Cura dei Tumori, IRCCS Fondazione Pascale, Naples, Italy
| | - Lucia Sparavigna
- Istituto Nazionale per lo Studio e la Cura dei Tumori, IRCCS Fondazione Pascale, Naples, Italy
| | - Francesco Perrone
- Istituto Nazionale per lo Studio e la Cura dei Tumori, IRCCS Fondazione Pascale, Naples, Italy
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Riva S, Bryce J, De Lorenzo F, Del Campo L, Di Maio M, Efficace F, Frontini L, Giannarelli D, Gitto L, Iannelli E, Jommi C, Montesarchio V, Traclò F, Vaccaro CM, Gallo C, Perrone F. Development and validation of a patient-reported outcome tool to assess cancer-related financial toxicity in Italy: a protocol. BMJ Open 2019; 9:e031485. [PMID: 31501130 PMCID: PMC6738930 DOI: 10.1136/bmjopen-2019-031485] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Financial toxicity (FT) is a well-recognised problem in oncology. US-based studies have shown that: (a) cancer patients have a 2.7 times risk of bankruptcy; (b) patients who declare bankruptcy have a 79% greater hazard of death; (c) financial burden significantly impairs quality of life (QoL) and (d) reduces compliance and adherence to treatment prescriptions. The aim of the project is to develop and validate a patient-reported-outcome (PRO) measure to assess FT of cancer patients in Italy, where, despite the universal health coverage provided by the National Health Service, FT is an emerging issue. METHODS AND ANALYSIS Our hypothesis is that a specific FT measure, which considers the relevant sociocultural context and healthcare system, would allow us to understand the main determinants of cancer-related FT in Italy, in order to address and reduce these factors. According to the International Society for Pharmaco-economics and Outcomes Research guidelines on PROs, the project will include the following steps: (1) concept elicitation (from focus groups with patients and caregivers; literature; oncologists; nurses) and analysis, creating a coding library; (2) item generation (using a format that includes a question and a response on a 4-point Likert scale) and analysis through patients' cognitive interviews of item importance within different coding categories to produce the draft instrument; (3) factor analysis and internal validation (with Cronbach's alpha and test-retest for reliability) to produce the final instrument; (4) external validation with QoL anchors and depression scales. The use of the FT measure in prospective trials is also planned. ETHICS AND DISSEMINATION The protocol is approved by the ethical committees of all the participating centres. The project will tentatively produce a validated tool by the spring 2021. The project might also represent a model and the basis for future cooperation with other European countries, with different healthcare systems and socioeconomic conditions. TRIAL REGISTRATION NUMBER NCT03473379.
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Affiliation(s)
- Silvia Riva
- Department of Psychology and Pedagogical Science, Faculty of Sport, Health and Applied Science, St.Mary's University, Twickenham, London, UK
- Dipartimento di Medicina Interna, IRCCS Ca' Granda Foundation, Università di Milano, Milano, Italy
| | - Jane Bryce
- Unità Sperimentazioni Cliniche, Istituto Nazionale per lo Studio e la Cura dei Tumori, IRCCS Fondazione Pascale, Napoli, Italy
- St. John Clinical Research Institute, St. John Medical Center, Tulsa, Oklahoma, USA
- Departmento di Biomedicina e Prevenzione, Università degli Studi di Roma Tor Vergata, Roma, Italy
| | - Francesco De Lorenzo
- Associazione Italiana Malati di Cancro (AIMAC), Roma, Italy
- European Cancer Patient Coalition (ECPC), Brussels, Belgium
| | - Laura Del Campo
- Federazione italiana delle Associazioni di Volontariato in Oncologia (FAVO), Roma, Italy
| | - Massimo Di Maio
- Dipartimento di Oncologia, AO Ordine Mauriziano, Università degli Studi di Torino, Torino, Italy
| | - Fabio Efficace
- Health Outcomes Research Unit, Fondazione GIMEMA, Roma, Italy
| | - Luciano Frontini
- Federation of Italian Cooperative Oncology Groups (FICOG), Milano, Italy
| | - Diana Giannarelli
- Unità di Biostatistica, Istituto Nazionale per lo Studio e la Cura dei Tumori Regina Elena, IRCCS, Roma, Italy
| | - Lara Gitto
- Dipartimento di Economia, Università degli Studi di Messina, Messina, Italy
| | - Elisabetta Iannelli
- Federazione italiana delle Associazioni di Volontariato in Oncologia (FAVO), Roma, Italy
| | - Claudio Jommi
- Practice, Government, Health and Not for Profit Division, SDA Bocconi School of Management, Milano, Italy
| | | | | | | | - Ciro Gallo
- Statistica Medica, Università degli Studi della Campania Luigi Vanvitelli, Napoli, Italy
| | - Francesco Perrone
- Unità Sperimentazioni Cliniche, Istituto Nazionale per lo Studio e la Cura dei Tumori, IRCCS Fondazione Pascale, Napoli, Italy
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Abstract
OBJECTIVES Oral nutritional supplements (ONS) represent a cost-effective method for treating malnutrition. The aim of this study was to investigate the effects of public policies on patient access to ONS, using the Italian regionalized health care system as a case study, subsequently compared with the centralized British National Health Service. METHODS Regional policies in the nine largest Italian regions and British policies were gathered through a literature review; interviews with officers responsible for clinical nutrition policies at the regional level in Italy were also conducted. Total ONS regional sales in Italy were gathered from industry sources. RESULTS Regulation by Italian regions focused on patient access and local prescribing issues (facilities and specialists allowed to prescribe reimbursed ONS, clinical pathways for malnutrition or disease-related malnutrition, length of prescriptions, and distribution of ONS). British policies focused on organizational issues (clinical governance through multidisciplinary Nutrition Support Teams, Nutrition Steering Committees and Clinical Commissioning Groups), education and referral by health care professionals. Neither per capita reimbursed ONS expenditure nor the proportion covered by public funds seem dependent on policies implemented at the regional level in Italy. There is no cutting-edge evidence that British policies produced broader diffusion of ONS, but they appear to have standardized their use within a more homogenous framework. CONCLUSION As no clear relation between regional policies and variation in patient access to ONS emerges in Italy, national policies should be encouraged to enhance awareness of malnutrition among health care professionals and encourage the diffusion of multidisciplinary nutrition teams in health care organizations.
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Affiliation(s)
- Marianna Cavazza
- Cergas (Centre for Research on Health and Social Care Management), SDA Bocconi School of Management, Milano Italy.
| | - Helen Banks
- Cergas (Centre for Research on Health and Social Care Management), SDA Bocconi School of Management, Milano Italy
| | | | - Mariangela Rondanelli
- IRCCS Mondino Foundation, Pavia, Italy; Department of Public Health, Experimental and Forensic Medicine, Unit of Human Nutrition, University of Pavia, Pavia
| | - Emanuela Zandonà
- Secondary Care Unit, Health Care Department of Piedmont Region, Torino, Italy
| | - Claudio Jommi
- Cergas (Centre for Research on Health and Social Care Management), SDA Bocconi School of Management, Milano Italy
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Otto MH, Pillarella C, Jommi C. Corrigendum: The Economic Impact of a Switch From Prescription-Only to Non-prescription Drugs in Italy. Front Pharmacol 2019; 10:129. [PMID: 30890931 PMCID: PMC6412142 DOI: 10.3389/fphar.2019.00129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 02/05/2019] [Indexed: 11/16/2022] Open
Affiliation(s)
- Monica Hildegard Otto
- Centre for Research on Health and Social Care Management (CERGAS) SDA Bocconi School of Management, Milan, Italy.,Department of Social and Political Sciences, Bocconi University, Milan, Italy
| | | | - Claudio Jommi
- Centre for Research on Health and Social Care Management (CERGAS) SDA Bocconi School of Management, Milan, Italy.,Department of Pharmaceutical Sciences, Università del Piemonte Orientale, Novara, Italy
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Jommi C, Cavazza M. Management of patients eligible for proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors: economic impact and reform proposals. Global & Regional Health Technology Assessment 2019. [DOI: 10.1177/2284240319861375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: PCSK9 inhibitors are indicated for primary hypercholesterolemia (heterozygous familial and non-familial) and for homozygous familial hypercholesterolemia (only evolocumab). They are subject to a drug registry for patient eligibility and follow-up. Patient access to PCSK9 inhibitors is still very limited and varies across regions. Aim: This paper aimed to investigate the cost of the PCSK9-treated patient pathway and main barriers to patient access to medicines and to suggest some changes to this pathway. Methods: The research was conducted through a literature review and an expert panel, which was surveyed through a Delphi approach. The panel included seven clinicians and five pharmacists. Results: If patients are exempt from co-payment, the Italian National Health Service spends €169.70 and €276.93 per year to manage the PCSK9-treated patient pathway, depending on registry coverage (six or three treatment months, respectively). Non-exempt patients pay €176,43 and €271.53 (for six and three months of coverage, respectively) per year. The referral process and the length of the pre-PCSK9 treatment period were considered the main barriers to access. The panelists suggested that the pre-PCSK9 treatment period be shortened to three months; they recommended six months of registry coverage, thereby decreasing the costs compared to three months’ coverage; and they advised that outpatient specialists also be authorized to manage the follow-up. These actions may reduce pathway costs and enhance awareness of the disease. Discussion: The study shows that the pathway of patients eligible for PCSK9 inhibitors can be improved. The surveyed experts integrated pathway-specific recommendations with broader advice to increase awareness on hypercholesterolemia in both citizens and general practitioners.
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Affiliation(s)
- Claudio Jommi
- Professor of Government, Health and Not-for-Profit Organizations, CERGAS (Centre for Research on Health and Social Care Management), SDA Bocconi, Milano, Italy
| | - Marianna Cavazza
- Researcher, CERGAS (Centre for Research on Health and Social Care Management), SDA Bocconi, Milano, Italy
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Espin J, Schlander M, Godman B, Anderson P, Mestre-Ferrandiz J, Borget I, Hutchings A, Flostrand S, Parnaby A, Jommi C. Projecting Pharmaceutical Expenditure in EU5 to 2021: Adjusting for the Impact of Discounts and Rebates. Appl Health Econ Health Policy 2018; 16:803-817. [PMID: 30088251 PMCID: PMC6244625 DOI: 10.1007/s40258-018-0419-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Within (European) healthcare systems, the predominant goal for pharmaceutical expenditure is cost containment. This is due to a general belief among healthcare policy makers that pharmaceutical expenditure-driven by high prices-will be unsustainable unless further reforms are enacted. OBJECTIVE The aim of this paper is to provide more realistic expectations of pharmaceutical expenditure for all key stakeholder groups by estimating pharmaceutical expenditure at 'net' prices. We also aim to estimate any gaps developing between list and net pharmaceutical expenditure for the EU5 countries (i.e. France, Germany, Italy, Spain, and the UK). METHODS We adjusted an established forecast of pharmaceutical expenditure for the EU5 countries, from 2017 to 2021, by reflecting discounts and rebates not previously considered, i.e. we moved from 'list' to 'net' prices, as far as data were available. RESULTS We found an increasing divergence between expenditure measured at list and net prices. When the forecasts for the five countries were aggregated, the EU5 (unweighted) average historical growth (2010-2016) rate fell from 3.4% compound annual growth rate at list to 2.5% at net. For the forecast, the net growth rate was estimated at 1.5 versus 2.9% at list. CONCLUSIONS Our results suggest that future growth in pharmaceutical expenditure in Europe is likely to be (1) lower than previously understood from forecasts based on list prices and (2) below predicted healthcare expenditure growth in Europe and in line with long-term economic growth rates. For policy makers concerned about the sustainability of pharmaceutical expenditure, this study may provide some comfort, in that the perceived problem is not as large as expected.
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Affiliation(s)
- Jaime Espin
- Andalusian School of Public Health, Granada, Spain
| | - Michael Schlander
- Division of Health Economics, German Cancer Research Center (DKFZ), University of Heidelberg, Heidelberg, Germany
- Institute for Innovation & Valuation in Health Care (InnoVal-HC), Wiesbaden, Germany
| | - Brian Godman
- Division of Clinical Pharmacology, Karolinska Institutet, Stockholm, Sweden
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK
| | | | | | - Isabelle Borget
- Gustave Roussy, Service de Biostatistique et d'Epidémiologie, Villejuif, France
- University Paris-Saclay, University Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
- GRADES, University Paris-Sud, Chatenay-Malabry, France
| | | | | | | | - Claudio Jommi
- Università del Piemonte Orientale, Novara, Italy
- Cergas (Centre for Research on Health and Social Care Management), SDA Bocconi School of Management, Milan, Italy
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Jommi C, Armeni P, Battista M, di Procolo P, Conte G, Ronco C, Cozzolino M, Costanzo AM, di Luzio Paparatti U, Concas G, Remuzzi G. The Cost of Patients with Chronic Kidney Failure Before Dialysis: Results from the IRIDE Observational Study. Pharmacoecon Open 2018; 2:459-467. [PMID: 29623638 PMCID: PMC6249198 DOI: 10.1007/s41669-017-0062-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Chronic kidney disease (CKD) is an important public health problem. Most of the evidence on its costs relates to patients receiving dialysis or kidney transplants, which shows that, in these phases, CKD poses a high burden to payers. Less evidence is available on the costs of the predialytic phase. OBJECTIVE The aim of this study was to estimate the annual cost of patients with CKD not receiving dialysis treatment, using the Italian healthcare system perspective and a prospective approach. METHODS A 3-year observational study (December 2010-September 2014) was carried out to collect data on resource consumption for 864 patients with CKD. Costs were estimated for both patients who completed the follow-up and dropouts. RESULTS The mean annual total (healthcare) cost per patient equalled €2723 (95% confidence interval 2463.0-2983.3). Disease severity (higher CKD stage), multiple comorbidities, dropout status and belonging to the southern region are predictive of higher costs. Pharmaceuticals, hospitalisation, and outpatient services account for 71.5, 18.8 and 9.7% of total healthcare expenditure, respectively. Recent estimates of Italian costs of patients receiving dialysis are nine times the unit costs of CKD for patients estimated in this study. Unit costs at stage 5 CKD (the highest level of severity) equals 4.7 times the costs for patients at stage 1 CKD. CONCLUSION Despite its limitations, this study provides further evidence on the opportunity to invest in the first phases of CKD to avoid progression and an increase in healthcare costs.
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Affiliation(s)
- Claudio Jommi
- Department of Pharmaceutical Sciences, Università del Piemonte Orientale, Largo Donegani 2, Novara, Italy.
- Centre for Research in Health and Social Care Management (CERGAS), SDA School of Management Bocconi, Via Roentgen 1, Milan, Italy.
| | - Patrizio Armeni
- Centre for Research in Health and Social Care Management (CERGAS), SDA School of Management Bocconi, Via Roentgen 1, Milan, Italy
| | - Margherita Battista
- Department of Pharmaceutical Sciences, Università del Piemonte Orientale, Largo Donegani 2, Novara, Italy
| | - Paolo di Procolo
- Department of Pharmaceutical Sciences, Università del Piemonte Orientale, Largo Donegani 2, Novara, Italy
| | - Giuseppe Conte
- Nephrology Division, School of Medicine, Second University of Naples, Via Santa Maria di Costantinopoli, 104, Naples, Italy
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, Viale Ferdinando Rodolfi, 37, Vicenza, Italy
| | - Mario Cozzolino
- Renal Division, Department of Health Sciences, ASST Santi Paolo e Carlo, University of Milan, Via A. Di Rudinì, 8, Milan, Italy
| | | | | | - Gabriella Concas
- Struttura Complessa Territoriale Nefrologia e Dialisi-ASL 8 Cagliari, Via Is Mirrionis, 92, Cagliari, Italy
| | - Giuseppe Remuzzi
- IRCCS, Istituto di Ricerche Farmacologiche Mario Negri, Via GB Camozzi 3, Ranica, Bergamo, Italy
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Otto MH, Pillarella C, Jommi C. The Economic Impact of a Switch From Prescription-Only to Non-prescription Drugs in Italy. Front Pharmacol 2018; 9:1069. [PMID: 30386233 PMCID: PMC6199397 DOI: 10.3389/fphar.2018.01069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 09/03/2018] [Indexed: 11/23/2022] Open
Abstract
The paper analyses the potential economic impact of switching drugs from prescription-only to over the counter status, using Italy as a case-study. The study assumes a societal perspective, investigating the effects of switches (and consequent delisting) on drugs spending, avoided visits by GPs (General Practitioners) and avoided time spent by patients for these visits. It overcomes the main pitfalls of previous studies, providing a rational for listing switchable products and applying both a static (no impact of switch on prices and volumes consumed) and a dynamic approach (impact on pricing policies and volumes depending on price-elasticity). Different scenarios were assumed including shorter/longer time spent for visits and inclusion/exclusion of the economic value of time of retiree patients. Results show that switching policy provides with societal savings ranging from 1 to 2.1 1 billion Euro. The economic impact on patients is less straightforward and depends on the scenarios used. If a longer time is spent on visits, the economic value of this time will compensate the cost of the switch to patients due to delisting. Despite the net economic benefit should be carefully interpreted, the results demonstrate how switching can contribute to the sustainability of the health care system in the middle-long run thanks to the more rational use of resources, combined with an increased awareness and responsibility of the involved stakeholders.
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Affiliation(s)
- Monica Hildegard Otto
- Centre for Research on Health and Social Care Management (CERGAS) SDA Bocconi School of Management, Milan, Italy.,Department of Social and Political Sciences, Bocconi University, Milan, Italy
| | | | - Claudio Jommi
- Centre for Research on Health and Social Care Management (CERGAS) SDA Bocconi School of Management, Milan, Italy.,Department of Pharmaceutical Sciences, Università del Piemonte Orientale, Novara, Italy
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Federici C, Cavazza M, Costa F, Jommi C. Health care costs of influenza-related episodes in high income countries: A systematic review. PLoS One 2018; 13:e0202787. [PMID: 30192781 PMCID: PMC6128484 DOI: 10.1371/journal.pone.0202787] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 08/09/2018] [Indexed: 11/18/2022] Open
Abstract
Introduction This study systematically reviews costing studies of seasonal influenza-like illness (ILI) in high-income countries. Existing reviews on the economic impact of ILI do not report information on drug consumption and its costs, nor do they provide data on the overall cost per episode. Methods The PRISMA-P checklist was used to design the research protocol. Studies included were cost of illness analysis (COI) and modeling studies that estimated the cost of ILI episodes. Records were searched from January 2000 to December 2016 in electronic bibliographic databases including Medline, Embase, Science Direct, the Cochrane Library, the Centre for Reviews and Disseminations of the University of York, and Google scholar. References from the included studies were hand-searched for completion. Abstract screening, full-text analysis and data extraction were performed by two reviewers independently and discrepancies were resolved by discussion with a third reviewer. A standardized, pre-piloted form was used for data extraction. All costs were converted to 2015 US$ Purchasing Power Parities. Results The literature search identified 5,104 records. After abstract and title screening, 76 studies were analyzed full-text and 27 studies were finally included in the review. Full estimates of the cost per episode range from US$19 in Korea to US$323 in Germany. Particularly, the cost per episode of laboratory confirmed influenza cases was estimated between US$64 and US$73. Inpatient and outpatient services account for the majority of the costs. Differences in the estimates may reflect country-specific characteristics, as well as other study-specific features including study design, identification strategy of ILI cases, study populations and types of costs included in the analysis. Children usually register higher costs, whereas evidence for the elderly is less conclusive. Patients risk-profile, co-morbidities and complications are the other important cost-drivers. None of the papers considered appropriateness in resource use (e.g. abuse of antibiotics). Despite cost of illness studies have ultimately a descriptive role, evidence on (in)appropriateness is useful for policy-makers.
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Affiliation(s)
- Carlo Federici
- Cergas (Centre for Research on Health and Social Care Management), SDA Bocconi School of Management, Milan, Italy
| | - Marianna Cavazza
- Cergas (Centre for Research on Health and Social Care Management), SDA Bocconi School of Management, Milan, Italy
| | - Francesco Costa
- Cergas (Centre for Research on Health and Social Care Management), SDA Bocconi School of Management, Milan, Italy
| | - Claudio Jommi
- Cergas (Centre for Research on Health and Social Care Management), SDA Bocconi School of Management, Milan, Italy
- Department of Pharmaceutical Sciences, Università del Piemonte Orientale, Novara, Italy
- * E-mail:
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42
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Villa F, Jommi C, Genazzani A, Antignani S, Montilla S, Melazzini M. Accesso precoce al mercato: dalle approvazioni condizionate di EMA agli accordi negoziali particolari di AIFA. Global & Regional Health Technology Assessment 2018. [DOI: 10.1177/2284240318792447] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Federico Villa
- Agenzia Italiana del Farmaco, Roma, Italy
- Universiti degli Studi del Piemonte Orientale “Amedeo Avogadro”, Italy
| | - Claudio Jommi
- Universiti degli Studi del Piemonte Orientale “Amedeo Avogadro”, Italy
| | - Armando Genazzani
- Universiti degli Studi del Piemonte Orientale “Amedeo Avogadro”, Italy
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Cozzolino M, Bolasco P, Ronco C, Conte G, Menè P, Mereu MC, Di Luca M, Roccatello D, Rosati A, Jommi C, Costanzo AM, Gualberti G, di Luzio Paparatti U, Remuzzi G. Clinical Management of Chronic Kidney Disease Patients in Italy: Results from the IRIDE Study. Nephron Clin Pract 2018; 140:39-47. [PMID: 30016767 DOI: 10.1159/000490769] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 06/03/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Lack of adequate management of chronic kidney disease (CKD) often results in delayed diagnosis and inadequate treatment. This study assessed the clinical management and outcome of stages 1-5 CKD patients. METHODS Patients were prospectively followed for 3 years in 25 nephrology centers across Italy. Clinical characteristics were measured at baseline and every 6 months. Outcome measures included CKD staging, presence of comorbidities, treatment, mineral bone disorder (MBD) parameters, and patient outcomes. RESULTS Of 884 enrolled patients (59.7% males, aged 66.2 ± 14.6 years), 587 (66.4%) completed the study. The majority of patients were referred by a general practitioner (44.7%) and had stage 3 or 4 CKD (40.9 and 23.8% respectively). Data reveal that 91.3% of patients had at least 1 concomitant disease, most frequently hypertension (80.1%) and dyslipidemia (42.5%); 94.6% of patients were receiving cardiovascular medication and 52.6% were receiving lipid-lowering medication. Approximately 40% of patients had proteinuria and intact parathyroid hormone levels outside the normal range. As expected, stages 4 and 5 CKD patients had a higher prevalence of proteinuria (68 and 74%), MBD (59 and 88%) and anemia (28 and 73%), as well as a higher risk of hospitalization (34.3 and 51.9%) and need for dialysis (69.5 and 70%). The overall probability of survival over 36 months was 90.6%. CONCLUSIONS This is the first Italian prospective study performed with a large cohort of CKD patients over a 3-year period. Considering the multifactorial burden of diseases associated with CKD patients, the need for greater attention to CKD and related disorders is paramount.
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Affiliation(s)
- Mario Cozzolino
- Renal Division, Department of Health Sciences, University of Milan, San Paolo Hospital, Milan, Italy
| | | | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, Vicenza, Italy
| | - Giuseppe Conte
- Nephrology Division School of Medicine-Second University of Naples, Naples, Italy
| | - Paolo Menè
- Department of Clinical and Molecular Medicine, Division of Nephrology, Sapienza University of Rome, Rome, Italy
| | - Maria Cristina Mereu
- U.O. Nefrologia e Dialisi, Ospedale NS di Bonaria, San Gavino Monreale, Cagliari, Italy
| | - Marina Di Luca
- Nephrology and Dialysis Unit, A.O Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Dario Roccatello
- Department of Clinical and Biologic Sciences, University of Turin, G. Bosco Hospital, Turin, Italy
| | - Alberto Rosati
- Nephrology and Dialysis Unit, Lucca Hospital, Lucca, Italy
| | - Claudio Jommi
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi University, Milan, Italy.,Department of Pharmaceutical Sciences, Università del Piemonte Orientale, Novara, Italy
| | | | | | | | - Giuseppe Remuzzi
- IRCCS, Istituto di Ricerche Farmacologiche Mario Negri, Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Bergamo, Italy.,Unit of Nephrology, Azienda Socio-Sanitaria Territoriale (ASST) Papa Giovanni XXIII, Bergamo, Italy.,Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
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44
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Rognoni C, Bertolani A, Jommi C. Budget impact analysis of rituximab biosimilar in Italy from the hospital and payer perspectives. Global & Regional Health Technology Assessment 2018. [DOI: 10.1177/2284240318784289] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Carla Rognoni
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi University, Milan, Italy
| | - Arianna Bertolani
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi University, Milan, Italy
| | - Claudio Jommi
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi University, Milan, Italy
- Department of Pharmaceutical Sciences, Università del Piemonte Orientale, Novara, Italy
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45
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Otto M, Armeni P, Jommi C. Variations in non-prescription drug consumption and expenditure: Determinants and policy implications. Health Policy 2018; 122:614-620. [PMID: 29478875 DOI: 10.1016/j.healthpol.2018.01.012] [Citation(s) in RCA: 3] [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: 01/28/2016] [Revised: 01/14/2018] [Accepted: 01/17/2018] [Indexed: 10/18/2022]
Abstract
This paper analyses the determinants of cross-regional variations in expenditure and consumption for non-prescription drugs using the Italian Health Care Service as a case study. This research question has never been posed in other literature contributions. Per capita income, the incidence of elderly people, the presence of distribution points alternative to community pharmacies (para-pharmacies and drug corners in supermarkets), and the disease prevalence were included as possible explanatory variables. A trade-off between consumption of non-prescription and prescription-only drugs was also investigated. Correlation was tested through linear regression models with regional fixed-effects. Demand-driven variables, including the prevalence of the target diseases and income, were found to be more influential than supply-side variables, such as the presence of alternative distribution points. Hence, the consumption of non-prescription drugs appears to respond to needs and is not induced by the supply. The expected trade-off between consumption for prescription-only and non-prescription drugs was not empirically found: increasing the use of non-prescription drugs did not automatically imply savings on prescription-only drugs covered by third payers. Despite some caveats (the short period of time covered by the longitudinal data and some missing monthly data), the regression model revealed a high explanatory power of the variability and a strong predictive ability of future values.
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Affiliation(s)
- Monica Otto
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Bocconi University, via Roentgen, 1, 20136, Milano, Italy.
| | - Patrizio Armeni
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Bocconi University, via Roentgen, 1, 20136, Milano, Italy
| | - Claudio Jommi
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Bocconi University, Università del Piemonte Orientale, Largo Donegani, 2/3, 28100, Novara, Italy
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Nayroles G, Frybourg S, Gabriel S, Kornfeld Å, Antoñanzas-Villar F, Espín J, Jommi C, Martini N, de Pouvourville G, Tolley K, Wasem J, Toumi M. Unlocking the potential of established products: toward new incentives rewarding innovation in Europe. J Mark Access Health Policy 2017; 5:1298190. [PMID: 28740616 PMCID: PMC5508393 DOI: 10.1080/20016689.2017.1298190] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 02/10/2017] [Indexed: 06/07/2023]
Abstract
Background: Many established products (EPs - marketed for eight years or more) are widely used off-label despite little evidence on benefit-risk ratio. This exposes patients to risks related to safety and lack of efficacy, and healthcare providers to liability. Introducing new indications for EPs may represent a high societal value; however, manufacturers rarely invest in R&D for EPs. The objective of this research was to describe incentives and disincentives for developing new indications for EPs in Europe and to investigate consequences of current policies. Methods: Targeted literature search and expert panel meetings. Results: Within the current European-level and national-level regulatory framework there are limited incentives for development of new indications with EPs. Extension of indication normally does not allow the price to be increased or maintained, the market protection period to be extended, or exclusion from a reference price system. New indication frequently triggers re-evaluation, resulting in price erosion, regardless of the level of added value with the new indication. In consequence, manufacturers are more prone to undertake R&D efforts at early to mid-stage of product life cycle rather than with EPs, or to invest in new chemical entities, even in therapeutic areas with broad off-label use. This represents a potentially missed opportunity as developing new indications for EPs offers an alternative to off-label use or lengthy and expensive R&D for new therapies, opens new opportunities for potentially cost-effective treatment alternatives, as well as greater equity in patients' access to treatment options. Conclusion: There are potential benefits from the development of new indications for EPs that are currently not being realized due to a lack of regulatory and pricing incentives in Europe. Incentives for orphan or paediatric drugs have proven to be effective in promoting R&D. Similarly, incentives to promote R&D in EPs should be developed, for the benefit of patients and healthcare systems.
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Affiliation(s)
- Gabrielle Nayroles
- Global Market Access and Pricing, IPSEN Pharma, Boulogne-Billancourt, France
| | - Sandrine Frybourg
- Pricing, Reimbursement and Market Access, Creativ-Ceutical, Paris, France
| | - Sylvie Gabriel
- Global Market Access and Pricing, IPSEN Pharma, Boulogne-Billancourt, France
| | - Åsa Kornfeld
- Pricing, Reimbursement and Market Access, Creativ-Ceutical, Paris, France
| | | | - Jaime Espín
- Andalusian School of Public Health, Granada, Spain
| | - Claudio Jommi
- Department of Pharmaceutical Sciences, University of Eastern Piedmont, Novara, Italy
- Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Milan, Italy
| | | | | | | | - Jürgen Wasem
- Department of Economics, University Duisburg-Essen, Essen, Germany
| | - Mondher Toumi
- Department of Public Health, Aix-Marseille University, Marseille, France
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Callea G, Armeni P, Marsilio M, Jommi C, Tarricone R. The impact of HTA and procurement practices on the selection and prices of medical devices. Soc Sci Med 2017; 174:89-95. [DOI: 10.1016/j.socscimed.2016.11.038] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 10/07/2016] [Accepted: 11/27/2016] [Indexed: 11/17/2022]
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Perrone F, Jommi C, Di Maio M, Gimigliano A, Gridelli C, Pignata S, Ciardiello F, Nuzzo F, de Matteis A, Del Mastro L, Bryce J, Daniele G, Morabito A, Piccirillo M, Rocco G, Guizzaro L, Gallo C. The association of financial difficulties with clinical outcomes in cancer patients: secondary analysis of 16 academic prospective clinical trials conducted in Italy. Ann Oncol 2016; 27:2224-2229. [DOI: 10.1093/annonc/mdw433] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 09/02/2016] [Accepted: 09/08/2016] [Indexed: 11/14/2022] Open
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Armeni P, Jommi C, Otto M. The simultaneous effects of pharmaceutical policies from payers' and patients' perspectives: Italy as a case study. Eur J Health Econ 2016; 17:963-977. [PMID: 26507643 PMCID: PMC5047928 DOI: 10.1007/s10198-015-0739-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 10/02/2015] [Indexed: 05/30/2023]
Abstract
OBJECTIVES This paper aims at covering a literature gap on the effects of copayments, prescription quotas and therapeutic reference pricing on public and private expenditures and volumes (1) When these policies are implemented in different areas at different times, (2) estimating their impact in the short and long run, (3) assessing the extent to which these impacts are interdependent, (4) scrutinising the extent to which the effects are mediated by prescribers' and patients' behaviours. METHODS Monthly regional data on pharmaceutical expenditures, volumes and policies in Italy from 2000 to 2014 are analysed using a difference-in-differences model enriched to capture short- versus long-term effects and simultaneous and interactive effects. Sobel-Goodman test and bootstrap analyses were used to test for mediation. RESULTS The three policies have different short- and long-run effects. Interactions support the hypothesis of reinforcing effects. Behavioural reactions to policies such as reducing the demand or total per capita expenditures mediate the impact of policies, thus explaining the different effects between the short and long term. CONCLUSIONS Evidence on the impact over time of regional policies diversely introduced in different times have important policy implications. First, pharmaceutical policies interact with each other, and the combined effect may be different from what we would expect from the sum of each single policy. Hence, policymakers should be very careful in designing mixed policies for their unexpected combined effects. Second, the impact of policies tends to reduce over time. If longer-term impact is desired, it would be appropriate to introduce some adjustments over time. Third, policies have multiple effects, and this should be considered when they are designed. Finally, pharmaceutical policies may have an unintended impact on health and health care.
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Affiliation(s)
| | - Claudio Jommi
- CERGAS Bocconi, Università del Piemonte Orientale, Largo Donegani, 2/3, 28100, Novara, Italy
| | - Monica Otto
- CERGAS Bocconi, Via Sarfatti, 25, 20136, Milan, Italy
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50
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Perrone F, Jommi C, Di Maio M, Gimigliano A, Gridelli C, Pignata S, Ciardiello F, Nuzzo F, de Matteis A, Del Mastro L, Bryce J, Daniele G, Morabito A, Piccirillo M, Rocco G, Guizzaro L, Gallo C. health economics The effect of financial difficulties on clinical outcomes in Italian cancer patients: A pooled analysis of 16 academic prospective clinical trials. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw435.32] [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: 11/12/2022] Open
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