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Bosco R, Messina G, Aiello B, Guarducci G, Nante N. The Structures and Activities of Health Promotion in the Italian NHS. Healthcare (Basel) 2023; 11:healthcare11010148. [PMID: 36611607 PMCID: PMC9819165 DOI: 10.3390/healthcare11010148] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/22/2022] [Accepted: 12/30/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND In Italy, the Ministry of Health is the main decision-making entity in healthcare. The local health authorities (LHAs) are responsible for health promotion (HP) activities, based on national and regional health plans. Our aim was to investigate the structured activities of HP in Italy at national, regional, and territorial levels. METHODS From February 2020 to July 2021, we searched for online information about the structures, projects, and responsibilities at the different levels mentioned above. The sources were the official sites of the Ministry of Health, the regions, and LHAs. RESULTS During the "prevalence period" of 2014-2021, we found 41 active facilities dedicated to HP: 7 complex operational units and 34 simple units. The other 30 facilities also had HP activities despite the absence of dedicated units. The most discussed topic seemed to be physical activity (63%), followed by addictions (53%), nutrition (48%), and prevention (33%); in the queue appeared dental hygiene and family/parenting (both at 7%). The LHA of the City of Turin and the LHA of Salerno had the most significant number of topics. CONCLUSIONS The results showed great heterogeneity, in the Italian context, concerning HP activities. We assume that the phenomenon depends on reduced attention to the digitalization of information. The Italian Society of Health Promotion is pursuing the goal of the construction of an organic system of HP-with its own articulations, competencies, and scientific and operational goals-at different levels, thus transcending the health care system (which is often powerless in regulatory activity) and providing the one harbinger of the most promising results in terms of cost/benefit.
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Affiliation(s)
- Roberta Bosco
- Post Graduate School of Public Health, University of Siena, 53100 Siena, Italy
| | - Gabriele Messina
- Post Graduate School of Public Health, University of Siena, 53100 Siena, Italy
- Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, Italy
| | - Bruno Aiello
- Italian Society of Health Promotion—SIPS, 80053 Castellammare di Stabia, Italy
| | - Giovanni Guarducci
- Post Graduate School of Public Health, University of Siena, 53100 Siena, Italy
| | - Nicola Nante
- Post Graduate School of Public Health, University of Siena, 53100 Siena, Italy
- Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, Italy
- Correspondence: ; Tel.: +39-0577-234187
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Guarducci G, Messina G, Carbone S, Urbani A, Nante N. Inter-Regional Patients' Migration for Hospital Orthopedic Intensive Rehabilitation: The Italian Experience. Int J Environ Res Public Health 2022; 19:13726. [PMID: 36360606 PMCID: PMC9655827 DOI: 10.3390/ijerph192113726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Following the introduction of administrative federalism in the Italian National Health Service, inter-regional patients' mobility has become increasingly relevant because, in addition to being an indirect index of the quality of care, it has important economic and financial implications. This study aimed to evaluate the fulfillment of the need for hospital orthopedic intensive rehabilitation on site and care-seeking patients' migration to other regions. METHODS From 2011 to 2019, the data of intensive orthopedic rehabilitation extracts from the Hospital Discharge Cards provided by Italian Ministry of Health were analyzed. We studied the hospital networks of every Italian region (catchment areas). The epidemiological flows of inter-regional mobility were analyzed with Gandy's Nomogram, while the financial flows were analyzed through Attraction Absorption and Escape Production Indexes. RESULTS Gandy's Nomogram showed that only Piedmont, Lombardy, A.P. of Trento, E. Romagna, Umbria and Abruzzo had good public hospital planning for intensive orthopedic rehabilitation, with a positive balance for all studied periods. Lombardy, E. Romagna, Piedmont, Veneto and Latium have absorbed approximately 70% of all financial flows (about EUR 60.5 million). CONCLUSIONS Only six regions appear to be able to satisfy the care needs of their residents, with a positive epidemiological and financial balance for all studied periods.
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Affiliation(s)
- Giovanni Guarducci
- Post Graduate School of Public Health, University of Siena, 53100 Siena, Italy
| | - Gabriele Messina
- Post Graduate School of Public Health, University of Siena, 53100 Siena, Italy
- Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, Italy
| | - Simona Carbone
- General Directorate for Health Planning, Ministry of Health, 01144 Rome, Italy
| | - Andrea Urbani
- General Directorate for Health Planning, Ministry of Health, 01144 Rome, Italy
| | - Nicola Nante
- Post Graduate School of Public Health, University of Siena, 53100 Siena, Italy
- Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, Italy
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Perico N, Fagiuoli S, Di Marco F, Laghi A, Cosentini R, Rizzi M, Gianatti A, Rambaldi A, Ruggenenti P, La Vecchia C, Bertolini G, Paglia S, Lorini FL, Remuzzi G. Bergamo and Covid-19: How the Dark Can Turn to Light. Front Med (Lausanne) 2021; 8:609440. [PMID: 33681246 PMCID: PMC7933506 DOI: 10.3389/fmed.2021.609440] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 09/23/2020] [Accepted: 01/28/2021] [Indexed: 12/20/2022] Open
Abstract
The novel coronavirus, SARS-CoV-2, continues to spread rapidly. Here we discuss the dramatic situation created by COVID-19 in Italy, particularly in the province of Bergamo (the most severely affected in the first wave), as an example of how, in the face of an unprecedented tragedy, acting (albeit belatedly)-including imposing a very strict lockdown-can largely resolve the situation within approximately 2 months. The measures taken here ensured that Bergamo hospital, which was confronted with rapidly rising numbers of severely ill COVID-19 patients requiring hospitalization, was able to meet the initial challenges of the pandemic. We also report that local organization and, more important, the large natural immunity against SARS-CoV-2 of the Bergamo population developed during the first wave of the epidemic, can explain the limited number of new COVID-19 cases during the more recent second wave compared to the numbers in other areas of Lombardy. Furthermore, we highlight the importance of coordinating the easing of containment measures to avoid what is currently observed in other countries, especially in the United States, Latin American and India, where this approach has not been adopted, and a dramatic resurgence of COVID-19 cases and an increase in the number of hospitalisations and deaths have been reported.
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Affiliation(s)
- Norberto Perico
- Istituto di Ricerche Farmacologiche Mario Negri, IRCCS, Bergamo, Italy
| | - Stefano Fagiuoli
- Gastroenterology Hepatology and Transplantation, Department of Medicine, ASST-Papa Giovanni XXIII, Bergamo, Italy
| | - Fabiano Di Marco
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Unità di Pneumologia, Department of Medicine ASST-Papa Giovanni XXIII, Bergamo, Italy
| | - Andrea Laghi
- Dipartimento di Scienze Medico Chirurgiche e Medicina Traslazionale, Sapienza Università di Roma, AOU Sant'Andrea, Rome, Italy
| | | | - Marco Rizzi
- Infectious Diseases Department, ASST-Papa Giovanni XXIII, Bergamo, Italy
| | | | - Alessandro Rambaldi
- Hematology Unit, ASST-Papa Giovanni XXIII, Bergamo, Italy
- Department of Oncology and Oncohematology, Università degli Studi di Milano, Milan, Italy
| | - Piero Ruggenenti
- Unit of Nephrology, Dialysis and Transplantation, Department of Medicine, ASST-Papa Giovanni XXIII, Bergamo, Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Guido Bertolini
- Istituto di Ricerche Farmacologiche Mario Negri, IRCCS, Bergamo, Italy
| | | | | | - Giuseppe Remuzzi
- Istituto di Ricerche Farmacologiche Mario Negri, IRCCS, Bergamo, Italy
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Ghetti G, D'Avella MC, Pradelli L. Preliminary Cost-Effectiveness and Cost-Utility Analysis of Cemiplimab in Patients with Advanced Cutaneous Squamous Cell Carcinoma in Italy. Clinicoecon Outcomes Res 2021; 13:121-133. [PMID: 33603419 PMCID: PMC7882423 DOI: 10.2147/ceor.s295605] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 01/23/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Cutaneous squamous cell carcinoma (CSCC) is a common cancer that in most cases is curable with surgery. About 3-5% of patients develop advanced CSCC (aCSCC) and are no longer responsive to surgery or radiation therapy. The aim of this study was to assess the cost-effectiveness and cost-utility of cemiplimab, the first systemic therapy approved in Italy for patients with aCSCC, vs platinum-based chemotherapy from the Italian National Health Service (SSN) perspective. Methods A partitioned survival model, which included three mutually exclusive health states, was developed to estimate costs and outcomes for patients with aCSCC, over a 30-year time horizon (lifetime). No direct evidence of the comparative efficacy and safety of cemiplimab versus other therapies currently exists. Therefore, a simulated treatment comparison (STC) was conducted to estimate the comparative efficacy of cemiplimab versus chemotherapy. Individual patient data for cemiplimab were collected from the EMPOWER-CSCC 1 trial whereas chemotherapy data were derived from a retrospective study. In the STC a regression model was used to predict outcomes for cemiplimab in the population observed in the comparator study. Costs of drug acquisition/administration and management of adverse events were included. Costs and outcomes were discounted at 3% per year. Incremental cost-effectiveness ratio (ICER) and incremental cost-utility ratio (ICUR) were calculated; sensitivity and scenario analyses were performed to assess the robustness of results. Results In the base-case, treatment with cemiplimab was associated with a gain of 4.89 LYs and 3.99 QALYs, compared with a platinum-based chemotherapy regimen, resulting in an estimated ICER of 27,821 €/LY gained and an ICUR of 34,110 €/QALY gained. Both ICER and ICUR were below the commonly used Italian SSN willingness to pay thresholds. Conclusion The use of cemiplimab, compared with a platinum-based chemotherapy regimen, can be considered a cost-effective option for the treatment of aCSCC patients in Italy.
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Affiliation(s)
- Gianni Ghetti
- Department of Health Economics and Outcome Research, AdRes, Turin, Italy
| | | | - Lorenzo Pradelli
- Department of Health Economics and Outcome Research, AdRes, Turin, Italy
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Restelli U, Fabbiani M, Di Giambenedetto S, Nappi C, Croce D. Budget impact analysis of the simplification to atazanavir + ritonavir + lamivudine dual therapy of HIV-positive patients receiving atazanavir-based triple therapies in Italy starting from data of the Atlas-M trial. Clinicoecon Outcomes Res 2017; 9:173-179. [PMID: 28280375 PMCID: PMC5338853 DOI: 10.2147/ceor.s127097] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background This analysis aimed at evaluating the impact of a therapeutic strategy of treatment simplification of atazanavir (ATV)+ ritonavir (r) + lamivudine (3TC) in virologically suppressed patients receiving ATV+r+2 nucleoside reverse transcriptase inhibitors (NRTIs) on the budget of the Italian National Health Service (NHS). Methods A budget impact model with a 5-year time horizon was developed based on the clinical data of Atlas-M trial at 48 weeks (in terms of percentage of patients experiencing virologic failure and adverse events), from the Italian NHS perspective. A scenario in which the simplification strategy was not considered was compared with three scenarios in which, among a target population of 1,892 patients, different simplification strategies were taken into consideration in terms of percentage of patients simplified on a yearly basis among those eligible for simplification. The costs considered were direct medical costs related to antiretroviral drugs, adverse events management, and monitoring activities. Results The percentage of patients of the target population receiving ATV+r+3TC varies among the scenarios and is between 18.7% and 46.9% in year 1, increasing up to 56.3% and 84.4% in year 5. The antiretroviral treatment simplification strategy considered would lead to lower costs for the Italian NHS in a 5-year time horizon between −28.7 million € and −16.0 million €, with a reduction of costs between −22.1% (−3.6 million €) and −8.8% (−1.4 million €) in year 1 and up to −39.9% (−6.9 million €) and −26.6% (−4.6 million €) in year 5. Conclusion The therapy simplification for patients receiving ATV+r+2 NRTIs to ATV+r+3TC at a national level would lead to a reduction of direct medical costs over a 5-year period for the Italian NHS.
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Affiliation(s)
- Umberto Restelli
- Centre for Research on Health Economics, Social and Health Care Management (CREMS), LIUC - Università Cattaneo, Castellanza, Italy; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Carmela Nappi
- Health Economics, Bristol-Myers Squibb S.r.l., Rome, Italy
| | - Davide Croce
- Centre for Research on Health Economics, Social and Health Care Management (CREMS), LIUC - Università Cattaneo, Castellanza, Italy; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Olivadoti S, Cislaghi C. The Health Mobility Is All True Mobility? Comment on "Regional Incentives and Patient Cross-border Mobility: Evidence From the Italian Experience". Int J Health Policy Manag 2015; 4:781-2. [PMID: 26673342 DOI: 10.15171/ijhpm.2015.139] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 07/23/2015] [Indexed: 11/09/2022] Open
Abstract
In their study, Brenna and Spandonaro analyzed the mobility into Italian regions. In particular, it analyzes the situation of 5 regions, with very different backgrounds. With this paper, we try to better define the meaning of health mobility and to find its underlying causes. Furthermore, we propose a strategy that could help in controlling mobility flows that currently are the source of health inequalities.
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Affiliation(s)
| | - Cesare Cislaghi
- Agenzia Nazionale per i Servizi Sanitari Regionali, Rome, Italy
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