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Desideri G, Pegoraro V, Cipelli R, Ripellino C, Miroddi M, Meto S, Gori M, Fabrizzi P. Extemporaneous combination therapy with nebivolol/valsartan for the treatment of hypertension: a study of real-world evidence in Europe. Curr Med Res Opin 2024:1-14. [PMID: 38779703 DOI: 10.1080/03007995.2024.2359027] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 05/20/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVE To explore real-life use of the extemporaneous combination of nebivolol and valsartan (NV-EXC) in adult hypertensive patients in Europe. METHODS Retrospective analysis of patients starting NV-EXC treatment conducted using prescription databases in Italy, Germany, Hungary, and Poland. The selection period during which study patients were identified covered a time span ranging from 3 to 9 years (until June 30, 2020) according to availability of the different data sources. Patient demographics, clinical information, and treatment adherence, measured by proportion of days covered, were evaluated. Additionally, the potential eligibility of Italian patients for the single pill combination (SPC) of nebivolol and valsartan over a one-year period was estimated. RESULTS The study included 170,682 patients initiating NV-EXC across the databases. Most patients were females (from 51% to 60%) and primarily aged over 60 years. Few patients received prescriptions of both available dosages of valsartan (80 and 160 mg) during follow-up (from 3.2% to 8.5%). Common comorbidities included dyslipidemia (19.2%) and diabetes (19.1%). Around 59.5% of patients did not require cardiologic visits during the study period. Adherence to NV-EXC, as indicated by the Italian database, was low in 53.3% of patients, with only 16.1% showing high adherence. The Italian database revealed 680 prevalent NV-EXC users in 2019, estimating a potential 30,222 adult patients eligible for the nebivolol/valsartan SPC. CONCLUSIONS The combination of nebivolol and valsartan is frequently prescribed for hypertension, but adherence remains a challenge. A potential nebivolol/valsartan SPC holds promise in enhancing adherence and optimizing therapeutic outcomes for hypertension management.
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Affiliation(s)
- Giovambattista Desideri
- Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences Sapienza University of Rome, Rome, Italy
| | | | | | | | - Marco Miroddi
- A. Menarini Farmaceutica Internazionale Srl, Florence, Italy
| | - Suada Meto
- A. Menarini Industrie Farmaceutiche Riunite Srl, Florence, Italy
| | | | - Paolo Fabrizzi
- A. Menarini Industrie Farmaceutiche Riunite Srl, Florence, Italy
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Desideri G, Cipelli R, Pegoraro V, Ripellino C, Miroddi M, Meto S, Gori M, Fabrizzi P. Extemporaneous combination therapy with nebivolol/amlodipine for the treatment of hypertension: a real-world evidence study in Europe. Curr Med Res Opin 2024; 40:733-743. [PMID: 38459774 DOI: 10.1080/03007995.2024.2328652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 03/06/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVE The investigation of the real-world use of the extemporaneous combination of nebivolol and amlodipine (NA-EXC) in adult patients diagnosed with hypertension in Europe. METHODS Retrospective analysis of data extracted from seven databases of patient medical records and prescriptions from Italy, Germany, France, Hungary, and Poland, to determine the prevalence and incidence of NA-EXC use and to estimate the number of patients potentially eligible for a single-pill combination of the two antihypertensives. Secondary objectives included: the description of the population of NA-EXC users and the assessment of their adherence to treatment based on the proportion of days covered. RESULTS The use of NA-EXC was found to be common in Europe and ranged between 2.9% to 9.9% of all patients identified in the databases with a prescription of nebivolol and/or amlodipine. The estimated numbers of patients potentially eligible in 2019 for a single-pill combination of nebivolol and amlodipine in Italy and Germany were, respectively, 178,133 and 113,240. Users of NA-EXC were mostly aged 70-79 years, had metabolic disorders and other comorbidities; >70% of them had received ≥2 concomitant medications before starting NA-EXC. Adherence to NA-EXC was defined as high only in 15.6% to 35% of patients. CONCLUSIONS The extemporaneous combination of nebivolol and amlodipine is commonly prescribed in Europe, however adherence to the therapy is poor. The development of a single-pill combination of nebivolol and amlodipine may improve adherence by reducing the number of pills administered to patients and thus simplifying treatment regimens.
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Affiliation(s)
- Giovambattista Desideri
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | | | | | | | - Marco Miroddi
- A. Menarini Farmaceutica Internazionale Srl, Florence, Italy
| | - Suada Meto
- A. Menarini Industrie Farmaceutiche Riunite Srl, Florence, Italy
| | | | - Paolo Fabrizzi
- A. Menarini Industrie Farmaceutiche Riunite Srl, Florence, Italy
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Marchesi F, Terrenato I, Papa E, Tomassi M, Falcucci P, Gumenyuk S, Palombi F, Pisani F, Renzi D, Romano A, Spadea A, Regazzo G, Rizzo MG, De Rienzo M, Ripellino C, Sgromo S, Viggiani C, Ponte E, Kayal R, Cordone I, Foddai ML, Mengarelli A. Efficacy and safety of biosimilar Peg-filgrastim after autologous stem cell transplant in myeloma and lymphoma patients: a comparative study with biosimilar Filgrastim, Lenograstim, and originator Peg-filgrastim. Ann Hematol 2024; 103:947-956. [PMID: 38189833 PMCID: PMC10867069 DOI: 10.1007/s00277-023-05604-9] [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: 11/17/2023] [Accepted: 12/21/2023] [Indexed: 01/09/2024]
Abstract
Data about biosimilar Peg-filgrastim (bioPEG) in autologous stem cell transplant (ASCT) are still scarce. The aim of this study has been to assess efficacy and safety of bioPEG among lymphoma and myeloma patients undergoing ASCT, comparing these data with historical controls receiving other G-CSFs. Furthermore, an economic evaluation has been included to estimate the savings by using bioPEG. This is a prospective cohort study comparing lymphoma and myeloma patients undergoing ASCT and receiving bioPEG (n = 73) with three historical consecutive cohorts collected retrospectively who received other G-CSFs (Lenograstim - Leno - n = 101, biosimilar Filgrastim - bioFIL n = 392, and originator Peg-filgrastim - oriPEG n = 60). We observed a significantly shorter time to neutrophils and platelet engraftment (p < 0.001) in patients treated with bioPEG and oriPEG. Moreover, patients who received bioPEG showed a shorter hospitalization time (p < 0.001) and a lower transfusion need (p < 0.001). We did not observe any significant difference in terms of transplant-related mortality, mucositis, and diarrhea among the four groups. No serious adverse events were associated with bioPEG. Similar data were obtained after running a stratified analysis for lymphomas and myeloma separately conducted by using a propensity score matching. The average total cost per patient of bioPEG was € 18218.9 compared to € 23707.8, € 20677.3 and € 19754.9 of Leno, oriPEG, and bioFIL, respectively. In conclusion, bioPEG seems to be as effective as the originator and more effective than short-acting G-CSFs in terms of post-transplant engraftment in myeloma and lymphoma patients undergoing ASCT. Moreover, bioPEG was cost-effective when compared with the other G-CSFs.
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Affiliation(s)
- Francesco Marchesi
- Hematology Unit, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 55, 00144, Rome, Italy.
| | - Irene Terrenato
- Department of Research, Advanced Diagnostics and Technological Innovation, Clinical Trial Center, Biostatistics and Bioinformatics Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Elena Papa
- Hematology Unit, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 55, 00144, Rome, Italy
| | - Martina Tomassi
- Hematology Unit, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 55, 00144, Rome, Italy
| | - Paolo Falcucci
- Hematology Unit, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 55, 00144, Rome, Italy
| | - Svitlana Gumenyuk
- Hematology Unit, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 55, 00144, Rome, Italy
| | - Francesca Palombi
- Hematology Unit, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 55, 00144, Rome, Italy
| | - Francesco Pisani
- Hematology Unit, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 55, 00144, Rome, Italy
| | - Daniela Renzi
- Hematology Unit, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 55, 00144, Rome, Italy
| | - Atelda Romano
- Hematology Unit, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 55, 00144, Rome, Italy
| | - Antonio Spadea
- Hematology Unit, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 55, 00144, Rome, Italy
| | - Giulia Regazzo
- Department of Research, Advanced Diagnostics and Technological Innovation, Genomic and Epigenetic Unit, Translational Research Area, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Maria Giulia Rizzo
- Department of Research, Advanced Diagnostics and Technological Innovation, Genomic and Epigenetic Unit, Translational Research Area, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Mafalda De Rienzo
- Immuno-Transfusional Medicine Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Simona Sgromo
- Hematology Unit, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 55, 00144, Rome, Italy
| | - Caterina Viggiani
- Hematology Unit, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 55, 00144, Rome, Italy
| | - Eleonora Ponte
- Leukapheresis and Cellular Therapy Unit, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Ramy Kayal
- Radiology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Iole Cordone
- Clinical Pathology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Maria Laura Foddai
- Immuno-Transfusional Medicine Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Andrea Mengarelli
- Hematology Unit, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 55, 00144, Rome, Italy
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De Nicola L, Peach E, Barone S, Ripellino C, Heiman F, Tangri N. MO509: Reveal-CKD: Prevalence of Undiagnosed Stage 3 Chronic Kidney Disease Italy. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac071.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
Chronic kidney disease (CKD) is a serious progressive disease with a substantial impact on global health that affects ∼10% of the world's population. However, CKD remains largely under-recognized. Effective actions to slow disease progression and improve outcomes depend on timely detection and diagnosis before a further decline in estimated glomerular filtration rate (eGFR). The aim of the REVEAL-CKD study is to assess the prevalence of, and factors associated with, undiagnosed early (stage 3) CKD.
METHOD
REVEAL-CKD is a multi-national, multi-regional observational study using secondary data from electronic medical records and claims databases. In this analysis, we extracted data regarding patient demographics, laboratory tests, diagnoses and treatments from an Italian electronic medical record database, the Italian Longitudinal Patients Database (IQVIA, Italy). The Italian Longitudinal Patients Database consists of anonymised patient records collected from routine visits to general practitioners and represents ∼900 general practitioners and 1.2 million patients across Italy. The study cohort included patients aged ≥18 years between 2015–21 with two consecutive estimated glomerular filtration rate (eGFR) results ≥30 and <60 mL/min/1.73 m2 recorded >90 and ≤730 days apart. The date of the second qualifying eGFR was defined as the index date. Patients with no presence of a CKD diagnostic code recorded any time before their first qualifying eGFR and up to 6 months after their second qualifying eGFR were considered to be undiagnosed. The prevalence of undiagnosed CKD was calculated as the ratio of undiagnosed patients to all patients who met the study inclusion criteria.
RESULTS
The study cohort included 65 676 patients who met the eGFR criteria for stage 3 CKD. The mean age at index date was 79 years (standard deviation: 9 years) and 58% were female. The overall prevalence of undiagnosed CKD was 77.0% [95% confidence interval (CI): 76.6–77.3]. The prevalence of undiagnosed CKD was greater in patients with stage 3a CKD (83.0%) compared with those with stage 3b CKD (64.8%). Female patients and those aged > 65 years showed a higher prevalence of undiagnosed CKD, and the prevalence of undiagnosed CKD ranged from 66.6% to 75.7% in patients with pre-existing comorbidities (Table 1). In patients who were undiagnosed at the index date (n = 52 533), 15.5% (n = 8152) were diagnosed with CKD after the index date, with a median time to diagnosis of 404 days (IQR: 389–418 days); 84.5% (n = 44 381) remained undiagnosed.
CONCLUSION
This study indicates that a high proportion of patients with stage 3 CKD are undiagnosed by their general practitioners, with inequity noted for females and older patients. Underdiagnosis of CKD persisted in those with known risk factors for CKD such as diabetes, heart failure and hypertension. With the availability of targeted evidence-based therapies to decrease the risk of disease progression and improve patient outcomes, there is a clear need to proactively detect, diagnose and intervene in patients with early-stage CKD.
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Affiliation(s)
- Luca De Nicola
- Nephrology Unit, University of Campania `Luigi Vanvitelli’, Napoli, Italy
| | - Emily Peach
- CVRM Epidemiology, CVRM Therapy Area, BioPharmaceuticals Medical, AstraZeneca Academy House, Cambridge, UK
| | - Salvatore Barone
- AstraZeneca, Global Medical Affairs, CVRM Therapy Area, BioPharmaceuticals Medical, Gaithersburg, MD, USA
| | | | | | - Navdeep Tangri
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
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Gizzo S, Ferrando M, Lispi M, Ripellino C, Cataldo N, Bühler K. Reply: RE: a cost-effectiveness modeling evaluation comparing a biosimilar follitropin alfa preparation with its reference product for live birth outcome in Germany, Italy, and Spain. J Med Econ 2019; 22:381-382. [PMID: 30691336 DOI: 10.1080/13696998.2019.1576182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Salvatore Gizzo
- a Department of Women and Children's Health SDB , Policlinico Abano Terme , Padova , Italy
| | - Marcos Ferrando
- b Department of Reproductive and Gynaecological Medicine , Instituto Valenciano de Infertilidad (IVI-RMA) , Bilbao , Spain
| | - Monica Lispi
- c Regional Medical Affairs Fertility, Merck Serono S.p.A. , Rome , Italy , an affiliate of Merck KGaA, Darmstadt, Germany
| | | | | | - Klaus Bühler
- f Centre for Gynaecology, Endocrinology, and Reproductive Medicine , Ulm and Stuttgart , Germany
- g Department of Gynaecology , Jena-University Hospital-Friedrich Schiller University , Jena , Germany
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Cataldo N, Pegoraro V, Ripellino C, Bertasi V, Di Turi R, Pastorello M, Gambera M. Non-persistence risk and health care resource utilization of Italian patients with non-valvular atrial fibrillation. Recenti Prog Med 2019; 109:113-121. [PMID: 29493635 DOI: 10.1701/2865.28904] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The aim of this study is to compare discontinuation risk and health care resource utilization between vitamin K antagonists (VKAs) and non-vitamin K antagonist oral anticoagulants (NOACs) in newly treated patients with non-valvular atrial fibrillation (NVAF). Based on administrative databases of five Italian Local Healthcare Units, all patients with a discharge diagnosis of NVAF between 2011 and 2014 were selected. Among them, the incident users of NOACs and VKAs in 2014 were followed-up to from the first prescription date to the occurrence of anyone of the following events: a 90-day gap in therapy, switch to a different molecule or add-on of a different molecule into the regimen, death of patient, end of follow-up (December 2015). All-cause hospitalizations, outpatient visits and examinations within the persistence period were also evaluated. The final cohort was composed of 2909 and 765 incident users of VKA and NOACs, respectively. Cox regression
to model time to non-persistence within 12 months showed a 62% reduction in risk of drug discontinuation in NOAC patients compared to VKA patients (HR,0.38 [0.33-0.44]). In the adjusted analyses with warfarin as reference, apixaban patients (HR, 0.35 [0.24-0.50]) had the lowest risk of non-persistence, followed by rivaroxoban (HR, 0.42 [0.33-0.54]) and dabigatran users (HR, 0.51 [0.43-0.61]). The mean total numbers of all-cause hospitalization records in 12-month persistent patients were significantly less in NOACs users compared with VKA users (0.36 vs 0.47, p-value:0.03). Similarly, the differences in the mean numbers of all-cause visits and examinations were statistically significant between VKA and NOAC patients, who
registered on average 2.33 vs 1.84 visits (p-value: 0.01) and 24.4 vs 9.2 exams referrals (p-value: <0.0001), respectively.
NOACs showed a better profile in terms of both resource utilization and persistence compared with VKAs. In particular, apixaban returned the lowest risk of discontinuation than dabigatran and rivaroxaban.
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Gizzo S, Ferrando M, Lispi M, Ripellino C, Cataldo N, Bühler K. A cost-effectiveness modeling evaluation comparing a biosimilar follitropin alfa preparation with its reference product for live birth outcome in Germany, Italy and Spain. J Med Econ 2018; 21:1096-1101. [PMID: 30113238 DOI: 10.1080/13696998.2018.1511567] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND/OBJECTIVE Although biosimilar drugs may be cheaper to purchase than reference biological products, they may not be the most cost-effective treatment to achieve a desired outcome. The analysis reported here compared the overall costs to achieve live birth using the reference follitropin alfa (GONAL-f) or a biosimilar (Ovaleap) in Spain, Italy and Germany. METHODS Patient and treatment data was obtained from published sources; assisted-reproductive technology, gonadotropin, follow-up and adverse-event-related costs were calculated from tariffs and reimbursement frameworks for each country. Incremental cost-effectiveness ratios (ICERs) were calculated from the difference in costs between reference and biosimilar in each country, divided by the difference in live-birth rates. Mean cost per live birth was calculated as total costs divided by the live-birth rate. RESULTS The published live birth rates were 32.2% (reference) and 26.8% (biosimilar). Drug costs per patient were higher for the reference recombinant human follicle-stimulating hormone in all three countries, with larger cost differences in Germany (€157.38) and Italy (€141.50) than in Spain (€22.41). The ICER for the reference product compared with the biosimilar was €2917.47 in Germany, €415.43 in Spain and €2623.09 in Italy. However, the overall cost per live birth was higher for the biosimilar in all three countries (Germany €8135.04 vs. €9185.34; Italy €8545.22 vs. €9733.37; Spain €14,859.53 vs. €17,767.19). Uncertainty in efficacy, mean gonadotropin dose and costs did not have a strong effect on the ICERs. CONCLUSIONS When considering live birth outcomes, treatment with the reference follitropin alfa was more cost effective than treatment with the biosimilar follitropin alfa.
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Affiliation(s)
- Salvatore Gizzo
- a Department of Women and Children's Health SDB , Policlinico Abano Terme , Padova , Italy
| | - Marcos Ferrando
- b Department of Reproductive and Gynaecological Medicine , Instituto Valenciano de Infertilidad (IVI-RMA) , Bilbao , Spain
| | - Monica Lispi
- c Regional Medical Affairs Fertility, Merck Serono SpA, Rome, Italy, an affiliate of Merck KGaA , Darmstadt , Germany
| | | | | | - Klaus Bühler
- e Centre for Gynaecology, Endocrinology, and Reproductive Medicine , Ulm and Stuttgart , Germany
- f Department of Gynaecology , Jena-University Hospital-Friedrich Schiller University , Jena , Germany
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Malfertheiner P, Ripellino C, Cataldo N. Severe intestinal malabsorption associated with ACE inhibitor or angiotensin receptor blocker treatment. An observational cohort study in Germany and Italy. Pharmacoepidemiol Drug Saf 2018; 27:581-586. [PMID: 29457309 PMCID: PMC6001476 DOI: 10.1002/pds.4402] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 12/27/2017] [Accepted: 01/12/2018] [Indexed: 11/06/2022]
Abstract
Purpose The angiotensin II receptor blocker (ARB) olmesartan has been recently associated with sprue‐like enteropathy (SLE), a gastrointestinal condition characterized by intestinal malabsorption (IM) and severe diarrhea. Whether the increased risk of SLE is substance‐specific or a class effect involving all ARBs is uncertain. The aim of this study is to assess the risk of enteropathy associated with ARBs and angiotensin converting enzyme inhibitors (ACE‐i) by using data from large administrative and claim databases. Methods We obtained data from Italian local health‐care units and a large German claim database and included patients treated with olmesartan, other ARBs, and ACE‐i. In the absence of a specific diagnosis code for SLE, International Classification of Diseases codes for IM were used. Analysis implemented a Poisson regression with robust error variance procedure, which allowed accounting for different clusters (local health‐care units and countries) and correctly estimating the standard error for the relative risk of rare event occurrence. Results Patients were divided into 3 groups: olmesartan (25.591, 5.5%), other ARBs (104.901, 22.5%), and ACE‐i patients (334.951, 72.0%). Baseline characteristics were similar overall. The incidence of unspecified IM in ACE‐i patients was not different compared with that of olmesartan, whereas a higher rate ratio was observed when comparing ARB patients with the olmesartan group (RR: 2.50, 95% CI 1.21 to 5.19, P .01). When International Classification of Diseases codes for coeliac disease were included, no differences were observed. Conclusions We could not confirm previous findings of a higher risk of malabsorption in olmesartan‐only patients, and drug‐induced enteropathy should be considered the result of exposure to the class of ARBs rather than a specific drug‐related effect.
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Affiliation(s)
- Peter Malfertheiner
- Klinik für Gastroenterologie, Hepatologie und Infektiologie, Otto-von-Guericke Universität, Magdeburg, Germany
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De Bortoli N, Ripellino C, Cataldo N, Marchi S. Unspecified intestinal malabsorption in patients treated with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers: a retrospective analysis in primary care settings. Expert Opin Drug Saf 2017; 16:1221-1225. [PMID: 28871813 DOI: 10.1080/14740338.2017.1376647] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To investigate the possible relationship between the use of Angiotensin II Receptor Blockers (ARBs) or Angiotensin-Converting-Enzyme Inhibitors (ACE-i) and unspecified intestinal malabsorption (IM) within the Italian and German real-life context. RESEARCH DESIGN AND METHODS a retrospective cohort of patients with a new unspecified IM diagnosis during the period 1 January 2010-31 December 2013 was extracted from Italian IMS Health Longitudinal Patient Database and German IMS Disease Analyzer. Only patients with at least one prescription of ARB or ACE-i medication during the 6 months preceding the IM diagnosis were included and then followed up for 12 months to assess treatment exposure. RESULTS After stratification by year and molecule, the proportion of patients experiencing an unspecified IM diagnosis on total patients receiving ARBs or ACE-i ranged from 0% to 0.14%, showing no relevant differences between molecules and no time trends. CONCLUSIONS this study indicates that ACE-i or ARBs were rarely associated to an unspecified IM diagnosis. No relevant difference between each specific ACE-i and ARB was highlighted.
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Affiliation(s)
- Nicola De Bortoli
- a Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery , University of Pisa , Pisa , Italy
| | - Claudio Ripellino
- b Department of Real World Evidence , HEOR Consultant Freelance , Milan , Italy
| | - Nazarena Cataldo
- c Department of Real World Evidence , QuintilesIMS , Milan , Italy
| | - Santino Marchi
- a Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery , University of Pisa , Pisa , Italy
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Gizzo S, Garcia-Velasco JA, Heiman F, Ripellino C, Bühler K. A cost-effectiveness evaluation comparing originator follitropin alfa to the biosimilar for the treatment of infertility. Int J Womens Health 2016; 8:683-689. [PMID: 27994486 PMCID: PMC5153281 DOI: 10.2147/ijwh.s118687] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To perform a cost-effectiveness evaluation comparing the originator follitropin alfa (Gonal-f®) to the biosimilar (Bemfola®) in the Italian and Spanish contexts, with an assessment of the German and UK backgrounds. METHODS Starting from the study by Rettenbacher et al, a cost-effectiveness model was developed in the Italian and Spanish contexts. Clinical data on subjects, doses of gonadotropin, pregnancies, live-born children, and ovarian hyperstimulation syndrome were used to feed the model. Costs related to drugs, hospitalizations, specialist visits, and examinations were retrieved from Italian and Spanish tariffs. Gonadotropin acquisition costs for Germany and the UK were also taken into account to expand the economical assessment to the other countries. The evaluation was done based on the National Health Service perspective. Sensitivity analyses, both univariate and probabilistic, as long as scenario analyses, tested the robustness of the model. RESULTS Originator follicle-stimulating hormone (FSH) costs were €3,663 and €6,387 in Italy and Spain, respectively, whereas biosimilar FSH costs were €3,483 and €6,342. The efficacy was found to be 0.52 for the originator and 0.47 for the biosimilar. The average cost per live birth was estimated to be €7,044 and €12,283 for the originator FSH and €7,411 and €13,494 for the biosimilar for Italy and Spain, respectively. Furthermore, the originator FSH generated an incremental cost-effectiveness ratio of €3,600 for Italy and €900 for Spain compared to the biosimilar. Sensitivity analyses confirmed the results of the base case model. CONCLUSION This analysis indicated that the originator FSH is a cost-efficient treatment strategy for Italian and Spanish health services compared to the biosimilar and it would be worthwhile extending this evaluation to other countries.
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Affiliation(s)
- Salvatore Gizzo
- Department of Woman and Child Health, University of Padua, Padua, Italy
| | - Juan A Garcia-Velasco
- Department of Obstetrics and Gynecology, Rey Juan Carlos University Madrid, Madrid, Spain
| | - Franca Heiman
- IMS Health Information Solutions Italy Srl, Milan, Italy
| | | | - Klaus Bühler
- Centre for Gynaecology, Endocrinology, and Reproductive Medicine, Ulm and Stuttgart, Germany
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Colivicchi F, Gulizia MM, Franzini L, Imperoli G, Castello L, Aiello A, Ripellino C, Cataldo N. Clinical Implications of Switching Lipid Lowering Treatment from Rosuvastatin to Other Agents in Primary Care. Adv Ther 2016; 33:2049-2058. [PMID: 27671328 PMCID: PMC5083763 DOI: 10.1007/s12325-016-0412-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Indexed: 12/22/2022]
Abstract
Introduction Switching from any statin to another non-equipotent lipid lowering treatment (LLT) may cause a low-density lipoprotein cholesterol increase and has been associated with a higher probability of negative cardiovascular outcomes. The aim of the study was to assess the impact of switching from rosuvastatin to any other LLT on clinical outcomes in primary care. Methods This was a retrospective analysis based on data from IMS Health Longitudinal Patient Database, which is a general practice database including information of more than 1.0 million patients representative of the Italian population by age, and medical conditions. Patients that started on rosuvastatin (10–40 mg/day) between January 2011 and December 2013 were considered. The date of the first prescription was defined as the index date (ID). The observation period lasted from the ID to September 2015 or until LLT discontinuation, or the occurrence of an acute myocardial infarction (AMI), or death. Results The primary end point of the study was the occurrence of an AMI during the observation period. The final study population included 10,368 patients. During the observation period, 2452 (23.6%) patients were switched from rosuvastatin to another LLT. The majority of patients (55.6%) were switched to atorvastatin, followed by simvastatin (24.9%), simvastatin/ezetimibe combination (10.0%) and other statins (9.5%). Female gender (HR, hazard ratio, 1.10, 95% CI, confidence interval, 1.02–1.19, p = 0.04) and the presence of chronic kidney disease (HR 1.47, 95% CI 1.16–1.86, p = 0.05) were associated with a higher probability of switch. During the observation period, 113 patients experienced an AMI (incidence of 6.7 AMI/1000 patient-years). Multivariate analysis with Cox proportional hazards method, including switching as a time-dependent covariate, demonstrated that changing from rosuvastatin to another LLT was an independent predictor of AMI (HR 2.2, 95% CI 1.4–3.5, p = 0.001). Conclusion We conclude that switching from rosuvastatin to another non-equipotent LLT may impart an increased risk of AMI and should be avoided. Funding AstraZeneca SpA.
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Affiliation(s)
- Furio Colivicchi
- Cardiology Division, S. Filippo Neri Hospital, ASL Roma 1, Rome, Italy
| | | | | | - Giuseppe Imperoli
- Internal Medicine Division, S. Filippo Neri Hospital, ASL Roma 1, Rome, Italy
| | - Lorenzo Castello
- Cardiology Division, S. Filippo Neri Hospital, ASL Roma 1, Rome, Italy
| | - Alessandro Aiello
- Cardiology Division, S. Filippo Neri Hospital, ASL Roma 1, Rome, Italy
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Turini M, Piovesana V, Ruffo P, Ripellino C, Cataldo N. An assessment of chemotherapy-induced nausea and vomiting direct costs in three EU countries. Drugs Context 2015; 4:212285. [PMID: 26322114 PMCID: PMC4544273 DOI: 10.7573/dic.212285] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND chemotherapy-induced nausea and vomiting (CINV) has been commonly reported as one of the most distressing adverse effects among treated patients with cancer. Inadequately treated, CINV can lead to increased resource utilization and severely impair patients' daily functioning and quality of life. Direct costs include acquisition cost of antiemetic drugs and rescue medication, administration devices, add-on treatments, such as hydration, and additional patient care, that is, nursing and physician time, unscheduled office visits, emergency room admissions, and, in some cases, extended hospitalization or readmission. There are many reports on the cost-effectiveness of antiemetic drugs, but information on the total cost per patient associated with CINV is limited. The costs associated with severe CINV episodes are considered responsible for the most significant part of the expenditures. SCOPE The aim of this study was to investigate the management of CINV episodes in three European health-care environments and to estimate direct costs associated with severe CINV episodes. METHODS An online survey addressed to Italian, German, and French oncologists and oncology nurses was performed. The survey included 41 questions about the management and the resource utilization for patients experiencing any CINV episode during the 6-month period preceding the survey. Furthermore, the cost associated with severe CINV episode management was estimated by adopting the National Health Service's perspective. FINDINGS A large proportion of patients receiving chemotherapy experienced a CINV episode (34.4% in Italy, 50.2% in France, and 40.4% in Germany); among those, 8.8% in Italy, 11.6% in France, and 19.2% in Germany experienced a severe CINV episode. Compared with Italy, Germany and France presented a greater hospitalization rate following an unplanned visit to the oncology ward or an emergency room access due to CINV. In Italy, the mean cost per patient with a severe CINV episode resulted in approximately €389, about half of the mean cost in France (€750) and a third of the mean cost in Germany (€1,017). CONCLUSIONS Severe CINV episodes requiring hospitalization, day hospital, or hospitalization extension involve a significant cost for the National Health Services; additional studies should be conducted in order to evaluate potential ways to offset these expenses.
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Affiliation(s)
- Marco Turini
- Helsinn Healthcare SA, Lugano/Pazzallo, Switzerland
| | | | | | | | - Nazarena Cataldo
- IMS Health Information Solutions Medical Research srl, Milan, Italy
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Levi Setti PE, Alviggi C, Colombo GL, Pisanelli C, Ripellino C, Longobardi S, Canonico PL, De Placido G. Human recombinant follicle stimulating hormone (rFSH) compared to urinary human menopausal gonadotropin (HMG) for ovarian stimulation in assisted reproduction: a literature review and cost evaluation. J Endocrinol Invest 2015; 38:497-503. [PMID: 25480425 PMCID: PMC4555088 DOI: 10.1007/s40618-014-0204-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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] [Received: 07/21/2014] [Accepted: 10/21/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Gonadotropins are protein hormones which are central to the complex endocrine system that regulates normal growth, sexual development, and reproductive function. There is still a lively debate on which type of gonadotropin medication should be used, either human menopausal gonadotropin or recombinant follicle-stimulating hormone. The objective of the study was to perform a systematic review of the recent literature to compare recombinant follicle-stimulating hormone to human menopausal gonadotropin with the aim to assess any differences in terms of efficacy and to provide a cost evaluation based on findings of this systematic review. METHODS The review was conducted selecting prospective, randomized, controlled trials comparing the two gonadotropin medications from a literature search of several databases. The outcome measure used to evaluate efficacy was the number of oocytes retrieved per cycle. In addition, a cost evaluation was performed based on retrieved efficacy data. RESULTS The number of oocytes retrieved appeared to be higher for human menopausal gonadotropin in only 2 studies while 10 out of 13 studies showed a higher mean number of oocytes retrieved per cycle for recombinant follicle-stimulating hormone. The results of the cost evaluation provided a similar cost per oocyte for both hormones. CONCLUSIONS Recombinant follicle-stimulating hormone treatment resulted in a higher oocytes yield per cycle than human menopausal gonadotropin at similar cost per oocyte.
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Affiliation(s)
- P E Levi Setti
- Humanitas Fertility Center, Division of Gynaecology and Reproductive Medicine, Department of Gynaecology, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - C Alviggi
- Dipartimento Universitario di Neuroscienze, Scienze Riproduttive ed Odontostomatologiche, Università degli Studi di Napoli, "Federico II", Naples, Italy
| | - G L Colombo
- Department of Drug Sciences, University of Pavia, Pavia, Italy
- S.A.V.E. Studi Analisi Valutazioni Economiche, Milan, Italy
| | - C Pisanelli
- Hospital Pharmacist, ACO San Filippo Neri, Rome, Italy
- Società Italiana Di Farmacia Ospedaliera, Milan, Italy
| | - C Ripellino
- CSD Medical Research Srl, Viale Jenner n 53, 20159, Milan, Italy.
| | - S Longobardi
- Medical Department, MerckSerono S.p.A, Rome, Italy
| | - P L Canonico
- Dipartimento di Scienze del Farmaco, Università del Piemonte Orientale, Largo Donegani 2, Novara, Italy
| | - G De Placido
- University Department of Obstetrics, Gynaecology, Urology and Reproductive Medicine, University of Naples Federico II, Naples, Italy
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Heiman F, Ripellino C, Visentin E. Real World Data in Oncology: Third- and Fourth-Line Treatments Administered in Metastatic Colon-Rectal Cancer (MCRC). Value Health 2014; 17:A644. [PMID: 27202311 DOI: 10.1016/j.jval.2014.08.2330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- F Heiman
- CSD Medical Research S. r. l., Milan, Italy
| | | | - E Visentin
- CSD Medical Research S. r. l., Milan, Italy
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Maina G, Ripellino C, Pegoraro V, Caresano C. The Risk of Metabolic Disorders in Patients Treated with Asenapine or Olanzapine: A Real World Data Study Conducted in Italy and Spain. Value Health 2014; 17:A453. [PMID: 27201251 DOI: 10.1016/j.jval.2014.08.1234] [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: 06/05/2023]
Affiliation(s)
- G Maina
- University of Turin, Turin, Italy
| | | | - V Pegoraro
- CSD Medical Research S. r. l., Milan, Italy
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Caresano C, Di Sciascio G, Fagiolini A, Maina G, Perugi G, Ripellino C, Vampini C. Cost-effectiveness of asenapine in the treatment of patients with bipolar I disorder with mixed episodes in an Italian context. Adv Ther 2014; 31:873-90. [PMID: 25055791 PMCID: PMC4147242 DOI: 10.1007/s12325-014-0139-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Bipolar disorder is a chronic disease characterized by periods of mania or hypomania, depression, or a combination of both (mixed state). Because bipolar disorder is one of the leading causes of disability, it represents an important economic burden on society. Asenapine (ASE) is a new second-generation antipsychotic developed and approved for the treatment of manic or mixed episodes associated with bipolar disorder. The objective of the present study was to assess the cost-effectiveness of ASE compared to olanzapine (OLA) in the treatment of patients experiencing mixed episodes associated with bipolar I disorder in the context of the Italian National Health Service (NHS). METHODS A pharmacoeconomic model was developed to simulate the management of Italian bipolar I patients with mixed episodes over a 5-year time horizon by combining clinical parameters with resource utilization. An expert panel of Italian psychiatrists and health economists was responsible for adapting a UK model to the Italian context. The primary outcome measure of the economic evaluation was the incremental cost effectiveness ratio, where effectiveness is measured in terms of quality adjusted life-years gained. Scenario analyses, sensitivity analyses, and a probabilistic sensitivity analysis were performed to test the robustness of the model. RESULTS This pharmacoeconomic model showed that ASE resulted to be dominant over OLA; in fact, ASE was associated with lower direct costs (derived largely by the savings from hospitalizations avoided) and also generated a better quality of life. Results were robust to changes in key parameters; both scenario analyses and sensitivity analyses demonstrated model reliability. CONCLUSIONS Results from this study suggest that the management of bipolar I patients with mixed episodes using ASE as alternative to OLA can lead to cost saving for the Italian NHS and improve patients quality of life.
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Affiliation(s)
- Chiara Caresano
- Department of Psychiatry, Lundbeck Italia S.p.A, Milan, Italy
| | | | - Andrea Fagiolini
- Department of Molecular Medicine, University of Siena, Siena, Italy
| | - Giuseppe Maina
- Department of Neurosciences, University of Torino, Turin, Italy
| | - Giulio Perugi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Institute of Behavioural Sciences “G. De Lisio”, Pisa, Italy
| | | | - Claudio Vampini
- Department of Mental Health, Ospedale Civile Maggiore, Verona, Italy
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Maina G, Ripellino C. The risk of metabolic disorders in patients treated with asenapine or olanzapine: a study conducted on real-world data in Italy and Spain. Expert Opin Drug Saf 2014; 13:1149-54. [DOI: 10.1517/14740338.2014.943732] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Papaleo E, Alviggi C, Colombo GL, Pisanelli C, Ripellino C, Longobardi S, Canonico PL. Cost-effectiveness analysis on the use of rFSH + rLH for the treatment of anovulation in hypogonadotropic hypogonadal women. Ther Clin Risk Manag 2014; 10:479-84. [PMID: 25028553 PMCID: PMC4077876 DOI: 10.2147/tcrm.s62351] [Citation(s) in RCA: 7] [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] [Indexed: 12/03/2022] Open
Abstract
Background Hypogonadotropic hypogonadal women are characterized by ovarian functionality deficiency, caused by low concentrations of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). To recover reproduction functionality, recommended therapies for ovarian induction involve injections of FSH and LH medications. Objective Since important differences exist between recombinant and urinary gonadotropin therapies in terms of efficacy and cost, the objective of this study was to develop a cost-effectiveness model to compare recombinant FSH (rFSH) + recombinant LH (rLH) and highly purified human menopausal gonadotropin (HP-HMG). Methods A Markov model was developed, considering three cycles of therapy; probability of pregnancy and miscarriage were considered, and the efficacy was evaluated in terms of pregnancy occurrence. The perspective of the model was that of the Italian Health Service, so only direct cost (drugs, specialist visits, patient examinations, and hospitalizations) were included. Results rFSH + rLH is associated with a higher total cost (€3,453.50) and higher efficacy (0.87) compared with HP-HMG (€2,719.70 and 0.50). rFSH + rLH generated an incremental cost effectiveness ratio equal to €2,007.30 compared to HP-HMG; the average cost per pregnancy is estimated to be €3,990.00 for recombinant strategy and €5,439.80 for urinary strategy. Results of probabilistic sensitivity analysis were consistent with the abovementioned findings. Conclusion Despite the higher acquisition cost in comparison to HP-HMG, rFSH + rLH resulted in a higher pregnancy rate, which makes it the recommended choice when considering cost-effectiveness of LH in supporting FSH-induced follicular gonadotropins in hypogonadotropic hypogonadal women.
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Affiliation(s)
- Enrico Papaleo
- Centro Scienze della Natalità, Gynecological-Obstetrics Department, San Raffaele Hospital, Vita-Salute San Raffaele, Milan, Italy
| | - Carlo Alviggi
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University "Federico II" of Naples, Naples, Italy
| | - Giorgio Lorenzo Colombo
- Department of Drug Sciences, University of Pavia, Pavia, Italy ; SAVE Studi Analisi Valutazioni Economiche, Milan, Italy
| | - Claudio Pisanelli
- ACO San Filippo Neri, Rome, Italy ; Società Italiana Di Farmacia Ospedaliera, Milan, Italy
| | | | | | - Pier Luigi Canonico
- Department of Pharmaceutical Sciences, University of Piemonte Orientale, Novara, Italy
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Abstract
OBJECTIVE: Aim of this study was the evaluation of the adherence level to GOLD guidelines for the COPD patients’ treatment in the Italian GPs setting, observing the time trend on ICS therapies’ pharmacoutilization, specifically in mild and moderate COPD patients, which is considered inappropriate by GOLD guidelines. Moreover, a pharmacoeconomic analysis has been implemented in order to evaluate the economical burden of the improper management of COPD.METHODS: The retrospective GPs database study has analyzed patients with at least one diagnosis of COPD during the periods January 2005 – December 2008 (Cohort 1) and January 2009 – December 2011 (Cohort 2), who had a reported value of VEMS, at least one prescription of a drug from ATC R03 class within two months from the date of spirometric exam and aged 40 or more. Disease severity has been defined according to 2008 GOLD guidelines. Comparison between the cohorts has been implemented to verify possible variations in guideline adherence. Furthermore, an economical analysis has been developed in order to highlight saves obtained by following GOLD guidelines and the total inappropriate therapies’ costs.RESULTS: The first cohort involved 2,103 COPD patients, while the second cohort included 1,647 subjects. Reduction of ICS therapies has been shown between the two cohorts, with a decrease of 8.4% for mild patient and 1.6% for moderate patients; considering all the disease severities, the reduction was about 4%. Pharmacoeconomic analysis on mild and moderate patients has pointed out that about 50% of the total ICS treatments (814,692 € on 1,658,164 €) is related to the ICS element, and so considered inappropriate costs.CONCLUSION: Economic differences between the two periods have highlighted a minor mean costs for Cohort 2, underlining an improvement in the adherence to the GOLD guidelines in the last period.
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Mencacci C, Aguglia E, Biggio G, Cappellari L, Di Sciascio G, Fagiolini A, Maina G, Tortorella A, Katz P, Ripellino C. C-QUALITY: cost and quality-of-life pharmacoeconomic analysis of antidepressants used in major depressive disorder in the regional Italian settings of Veneto and Sardinia. Clinicoecon Outcomes Res 2013; 5:611-21. [PMID: 24348057 PMCID: PMC3857011 DOI: 10.2147/ceor.s52063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Major depression is a commonly occurring, seriously impairing, and often recurrent mental disorder. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are the treatments most commonly used for major depressive disorder. The objective of this study was to assess the cost-effectiveness of SSRIs and SNRIs in the treatment of major depressive disorder in two Italian regional settings, ie, Veneto and Sardinia. Methods A decision analytic model was adapted from the Swedish Dental and Pharmaceutical Benefits Agency to reflect current clinical practice in the treatment of major depressive disorder in the most significant Italian regions. This adaptation was possible as a result of collaboration with an expert panel of Italian psychiatrists and health economists. The population comprised patients with a first diagnosis of major depressive disorder and initiating one SSRI or SNRI drug for the first time. The time frame used was 12 months. Efficacy and utility data for the model were retrieved from the literature and validated by the expert panel. Local data were used for resource utilization and for treatment costs based on the perspective of each regional health service. Scenario analyses and probabilistic sensitivity analyses were performed to test the robustness of the model. Results Base case analysis showed that escitalopram is associated with the largest health gain (in quality-adjusted life years) and a lower total cost at one year for Sardinia (except for sertraline, against which it was cost-effective) and for Veneto, and therefore dominates the other treatment strategies, given that more quality-adjusted life years are achieved at a lower total cost. Scenario analyses and probabilistic sensitivity analyses support the robustness of the model. Conclusion The results indicate that escitalopram is the most cost-effective pharmacologic treatment strategy for both regional health services compared with all SSRIs and all SNRIs used in the first-line treatment of major depressive disorder.
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Affiliation(s)
- Claudio Mencacci
- Department of Mental Health, Fatebenefratelli Hospital, Milan, Italy
| | - Eugenio Aguglia
- Department of Clinical and Molecular Biomedicine, University of Catania, Catania, Italy
| | - Giovanni Biggio
- Department of Experimental Biology and Center of Excellence for the Neurobiology of Drug Dependence, University of Cagliari, Calgiari, Italy
| | | | | | - Andrea Fagiolini
- Department of Molecular Medicine, University of Siena and Department of Mental Health, University of Siena Medical Center, Siena, Italy
| | - Giuseppe Maina
- Department of Neurosciences, University of Torino, Torino, Italy
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Abstract
Background Depression has a lifetime prevalence of 10%–25% among women and 5%–12% among men. Selective serotonin reuptake inhibitors (SSRIs) are the most used and the most cost-effective treatment for long-term major depressive disorder. Since the introduction of generic SSRIs, the costs of branded drugs have been questioned. The objective of this study was to assess the cost-effectiveness (€ per quality-adjusted life year [QALY]) of escitalopram (which is still covered by a patent) compared with paroxetine, sertraline, and citalopram, the patents for which have expired. Methods A decision analytic model was adapted from the Swedish Dental and Pharmaceutical benefits agency model to reflect current clinical practice in the treatment of depression in Italy in collaboration with an expert panel of Italian psychiatrists and health economists. The population comprised patients with a first diagnosis of major depressive disorder and receiving for the first time one of the following SSRIs: escitalopram, sertraline, paroxetine, and citalopram. The time frame used was 12 months. Efficacy and utility data for the original model were validated by our expert panel. Local data were considered for resource utilization and for treatment costs based on the Lombardy region health service perspective. Several scenario simulations, oneway sensitivity analyses, and Monte Carlo simulations were performed to test the robustness of the model. Results The base case scenario showed that escitalopram had an incremental cost-effectiveness ratio (ICER) of €4395 and €1080 per QALY compared with sertraline and paroxetine, respectively. Escitalopram was dominant over citalopram, which was confirmed by most one-way sensitivity analyses. The escitalopram strategy gained 0.011 QALYs more than citalopram, 0.008 more than paroxetine, and around 0.007 more than sertraline. Monte Carlo simulations indicated that ICER values for escitalopram were centered around €1100 and €4400 per QALY compared with paroxetine and sertraline, respectively. Although there is no official cost-effectiveness threshold in Italy, the value of €25,000 per QALY could be acceptable. All ICER values retrieved in all analyses were lower than this threshold. Conclusion The findings from this cost-effectiveness analysis indicate that escitalopram could be accepted as a cost-effective strategy for the Lombardy region health service compared with the other SSRIs studied. The present assessment is based on ICER values resulting from this analysis, which are lower than the thresholds proposed by health care authorities in other European Union countries. These benefits are driven by the effectiveness of escitalopram, which result in an improved health-related quality of life, a higher probability of sustained remission, and better utilization of health care resources. The study results are robust and in line with other pharmacoeconomic analyses comparing escitalopram with other SSRIs.
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