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Di Matteo S, Freilone R, Bruno GM, Notaro R, Moumene S, Martone N, Teruzzi C, Ciccarone A, Colombo GL. Cost-Utility Analysis Comparing Pegcetacoplan to Anti-C5 Monoclonal Antibodies in the Treatment of Paroxysmal Nocturnal Hemoglobinuria. Clinicoecon Outcomes Res 2024; 16:225-232. [PMID: 38623087 PMCID: PMC11018133 DOI: 10.2147/ceor.s442906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 03/26/2024] [Indexed: 04/17/2024] Open
Abstract
Background Paroxysmal nocturnal hemoglobinuria is a rare, acquired disease characterized by hemolytic episodes and associated with significant clinical burden. The introduction of C5 inhibitory monoclonal antibodies (C5i) represented a major breakthrough in PNH treatment, effectively reducing intravascular hemolysis (IVH) but showing limited impact on extravascular hemolysis (EVH). In 2021, the C3 inhibitor pegcetacoplan was approved by EMA and recently reimbursed in Italy, which also has the advantages in the reduction of both IVH and EVH, increasing hemoglobin values and simultaneously improving the quality of life and fatigue of patients. A cost-utility analysis was developed to compare pegcetacoplan to C5i (eculizumab and ravulizumab) in the PNH population who remain anemic after treatment with C5i for at least 3 months. Materials and Methods The analysis employed a Markov model with a 5-year time horizon whereby patients can transition among 3 PNH health states, adopting the perspective of the Italian NHS. Efficacy data were sourced from the PEGASUS study, with drug prices reflecting ex-factory costs. Additionally, costs associated with resource utilization, adverse events, and complications were estimated based on outpatient and hospital care rates, excluding indirect expenses. Utility and disutility values related to transfusions were also considered, with pegcetacoplan allowing for dose escalation. Results The cumulative cost of treatment per individual patient at 5 years was estimated to be €1,483,454 for pegcetacoplan, €1,585,763 for eculizumab, and €1,574,826 for ravulizumab. Pegcetacoplan demonstrated a superior increase in quality-adjusted life years (QALYs) compared to both eculizumab (0.51 increase) and ravulizumab (0.27 increase). Furthermore, pegcetacoplan showed a reduction in complication management costs (€22,891 less compared to eculizumab and €22,611 less compared to ravulizumab) and lower transfusion-related expenses (€14,147 less than both C5i treatments). Conclusion Pegcetacoplan emerged as the dominant strategy in this analysis, being more effective, less expensive and improves quality of life in the analyzed population affected by PNH.
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Affiliation(s)
- Sergio Di Matteo
- Center of Research, SAVE Studi - Health Economics and Outcomes Research, Milan, Italy
| | - Roberto Freilone
- Dipartimento di Oncologia - Direttore SC Ematologia, Azienda Ospedaliera Universitaria Città della Salute e della Scienza, Torino e componente Tumor Molecular Board (TMB) Regione Piemonte, Torino, Italy
| | - Giacomo Matteo Bruno
- Center of Research, SAVE Studi - Health Economics and Outcomes Research, Milan, Italy
- Department of Drug Sciences, University of Pavia, Pavia, Italy
| | - Rosario Notaro
- Direttore S.C. Core Research Laboratory in ISPRO, Firenze, Italy
| | - Sabrin Moumene
- Center of Research, SAVE Studi - Health Economics and Outcomes Research, Milan, Italy
| | | | | | - Antonio Ciccarone
- Center of Research, SAVE Studi - Health Economics and Outcomes Research, Milan, Italy
| | - Giorgio Lorenzo Colombo
- Center of Research, SAVE Studi - Health Economics and Outcomes Research, Milan, Italy
- Department of Drug Sciences, University of Pavia, Pavia, Italy
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Lorenzo Colombo G. [The economic assessment of the drug and the budget impact analysis in the context of Health Technology Assessment]. G Ital Cardiol (Rome) 2024; 25:e1-e3. [PMID: 38230539 DOI: 10.1714/4182.41698] [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] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Affiliation(s)
- Giorgio Lorenzo Colombo
- CEFAT - Centro di Economia del Farmaco e delle Tecnologie Sanitarie, Dipartimento di Scienze del Farmaco, Università degli Studi, Pavia
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Di Matteo S, Moumene S, Lorenzo Colombo G, De Luca L. [Economic evaluation of a fixed-dose combination (acetylsalicylic acid and rosuvastatin) in the cardiovascular context]. G Ital Cardiol (Rome) 2024; 25:e4-e8. [PMID: 38230540 DOI: 10.1714/4182.41699] [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: 01/18/2024]
Abstract
BACKGROUND Cardiovascular diseases pose a significant challenge to the society and healthcare systems, with serious implications in terms of mortality and healthcare expenditure. The treatment of cardiovascular diseases, based on acetylsalicylic acid combined with statins in multi-pill regimens, is characterized by a lower adherence rate among patients compared to the single-pill combination. A potential solution lies in single-pill formulations, drugs that combine two or more active ingredients at a fixed dosage within the same dosage unit. METHODS In order to assess the potential pharmacoeconomic impact of single-pill treatment, a budget impact model (BIM) was developed, considering the combination of 100 mg acetylsalicylic acid and 5 mg, 10 mg, or 20 mg rosuvastatin. RESULTS The use of the single pill, according to the selected scenario, could result in savings in Italy compared to the use of multi-pill at 100%, ranging from € 951 201 in the case of using both single and multi-pill at 50%, to € 1 902 402 in the case of using the single pill exclusively. Sensitivity analysis confirmed the robustness of the results. CONCLUSIONS The developed BIM allows observing the potential savings that single-pill treatment could generate, linked both to an increase in adherence rates and the consequent improvement in clinical outcomes for patients, as well as the lower cost of medications. The use of single pills represents a promising solution to enhance patient adherence and reduce costs in the management of cardiovascular diseases in Italy.
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Affiliation(s)
- Sergio Di Matteo
- Centro di Ricerca S.A.V.E. Studi Analisi Valutazioni Economiche, Milano
| | - Sabrin Moumene
- Centro di Ricerca S.A.V.E. Studi Analisi Valutazioni Economiche, Milano
| | - Giorgio Lorenzo Colombo
- Centro di Ricerca S.A.V.E. Studi Analisi Valutazioni Economiche, Milano - Dipartimento di Scienze del Farmaco, Università degli Studi, Pavia
| | - Leonardo De Luca
- U.O.C. Cardiologia, Dipartimento di Scienze Cardio-Toraco-Vascolari, A.O. San Camillo Forlanini, Roma
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Abraham I, Hiligsmann M, Lee KKC, Citrome L, Colombo GL, Gregg M. What to Expect in 2024: Important Health Economics and Outcomes Research (HEOR) Trends. Clinicoecon Outcomes Res 2023; 15:799-809. [PMID: 38274129 PMCID: PMC10810314 DOI: 10.2147/ceor.s453171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/08/2023] [Indexed: 01/27/2024] Open
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Bracarda S, Iacovelli R, Baldazzi V, Zucali PA, Gernone A, Conti GN, Pappagallo G, Brunelli M, Bruzzi P, Fiorini E, Magenta L, Diomede F, Mereta F, D’Aria I, Magliano D, Liberatori M, Cantù D, Croce D, Eandi S, Colombo GL, Ferrante F, Salè EO, Marinozzi A, Lenzi D, Remiddi F, Remiddi S. U-CHANGE Project: a multidimensional consensus on how clinicians, patients and caregivers may approach together the new urothelial cancer scenario. Front Oncol 2023; 13:1186103. [PMID: 37576880 PMCID: PMC10422043 DOI: 10.3389/fonc.2023.1186103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/29/2023] [Indexed: 08/15/2023] Open
Abstract
Introduction Advanced urothelial carcinoma remains aggressive and very hard to cure, while new treatments will pose a challenge for clinicians and healthcare funding policymakers alike. The U-CHANGE Project aimed to redesign the current model of care for advanced urothelial carcinoma patients to identify limitations ("as is" scenario) and recommend future actions ("to be" scenario). Methods Twenty-three subject-matter experts, divided into three groups, analyzed the two scenarios as part of a multidimensional consensus process, developing statements for specific domains of the disease, and a simplified Delphi methodology was used to establish consensus among the experts. Results Recommended actions included increasing awareness of the disease, increased training of healthcare professionals, improvement of screening strategies and care pathways, increased support for patients and caregivers and relevant recommendations from molecular tumor boards when comprehensive genomic profiling has to be provided for appropriate patient selection to ad hoc targeted therapies. Discussion While the innovative new targeted agents have the potential to significantly alter the clinical approach to this highly aggressive disease, the U-CHANGE Project experience shows that the use of these new agents will require a radical shift in the entire model of care, implementing sustainable changes which anticipate the benefits of future treatments, capable of targeting the right patient with the right agent at different stages of the disease.
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Affiliation(s)
- Sergio Bracarda
- President of Italian Society of Uro-Oncology, Department of Medical Oncology, Santa Maria Hospital, Terni, Italy
| | - Roberto Iacovelli
- Department of Medical Oncology, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Valentina Baldazzi
- Department of Medical Oncology, Santa Maria Annunziata Hospital, Florence, Italy
| | - Paolo Andrea Zucali
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Angela Gernone
- Department of Medical Oncology, Policlinico Universitario Azienda Ospedaliera (A.O), Bari, Italy
| | | | | | - Matteo Brunelli
- Pathology Unit, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Paolo Bruzzi
- Department of Clinical Epidemiology, National Institute for Cancer Research, Istituto Scientifico Tumori (IST), Genoa, Italy
| | | | | | - Francesco Diomede
- Federazione Associazioni Volontariato in Oncologia (F.A.V.O) Federation, Rome, Italy
| | | | | | | | - Monica Liberatori
- Department of Medical Oncology, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Daniela Cantù
- Italian Association of Physiotherapists, Milan, Italy
| | - Davide Croce
- Centro di Ricerca sull’Economia e il Management in Sanità e nel Sociale, Libero Istituto Universitario Cattaneo (LIUC) Business School, Castellanza (VA), Turin, Italy
| | - Simone Eandi
- Social Innovation EcosystEm Development (SEEd) Medica Publishers, Turin, Italy
| | | | - Fulvio Ferrante
- Department of Diagnostic and Pharmaceutical Assistance, Unità Operativa Complessa (UOC) Pharmacy, Local Health Unit Azienda Sanitaria Locale (ASL) Frosinone, Frosinone, Italy
| | - Emanuela Omodeo Salè
- Department Hospital Pharmacy, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Andrea Marinozzi
- Clinical Pharmacy, Azienda Ospedaliera Universitaria (AOU) Ospedali Riuniti, Ancona, Italy
| | - Daniele Lenzi
- Medical Department, Azienda Ospedaliera Università, Siena, Italy
| | | | - Stefano Remiddi
- Medical Writing & Statistics Department, NUME PLUS, Florence, Italy
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Nyholm N, Danø A, Schnack H, Colombo GL. The Cost-Effectiveness of Anti-IL17 Biologic Therapies for Moderate-to-Severe Plaque Psoriasis Treatment in Italy and Germany: A Sequential Treatment Analysis. Clinicoecon Outcomes Res 2023; 15:607-619. [PMID: 37533798 PMCID: PMC10392902 DOI: 10.2147/ceor.s417922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/15/2023] [Indexed: 08/04/2023] Open
Abstract
Objective The objective of this study was to optimise the cost-effectiveness of different anti-IL17 treatment sequences used in the treatment of moderate-to-severe plaque psoriasis in Italy and Germany over a five-year time horizon. Methods We adjusted a previously published treatment sequence model for biologic drugs used in psoriasis treatment to an Italian and German setting, respectively. The model included all anti-IL17 biologics currently available in the treatment of moderate-to-severe plaque psoriasis in the markets of scope (secukinumab, ixekizumab, brodalumab and bimekizumab). Real-world discontinuation rates were used to model switches between the four anti-IL17 biologics included in the study. The treatment costs were based on label dosing recommendations for each drug, including induction and maintenance therapy, and the manufacturer prices of each drug in Italy and Germany, respectively. We used long-term Psoriasis Area and Severity Index 100 (PASI100) measures to inform the model on the efficacy for each treatment. The cost-effectiveness in the analysis was evaluated based on the cost per PASI100-responder. Results We found that the most cost-effective treatment sequence was achieved by using brodalumab as first-line treatment, bimekizumab as second-line treatment, ixekizumab as third-line treatment and secukinumab as fourth-line treatment in both Italy and Germany, which resulted in a total cost per responder of €128,200 and €138,212, respectively, over a five-year period. Several scenario analyses were also conducted and ensured that the results were robust to changes in key input parameters. Conclusion Our study showed that using brodalumab as a first-line therapy to treat moderate-to-severe psoriasis in both Italy and Germany leads to the most cost-effective treatment sequence, when compared to all possible combinations of anti-IL17s over a five-year time horizon. In addition, we found that treatment discontinuation and switching are important factors when assessing the cost-effectiveness of biologic therapies.
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Affiliation(s)
| | | | | | - Giorgio Lorenzo Colombo
- CEFAT Center of Pharmaceuticals Economics and Medical Technologies Evaluation, Department of Drug Sciences, University of Pavia, Pavia, Italy
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Colombo GL, Valentino MC, Fabi A, Dieci MV, Caruggi M, Bruno GM, Lombardi G, Di Matteo S. Economic Evaluation for Palbociclib Plus Fulvestrant vs Ribociclib Plus Fulvestrant and Abemaciclib Plus Fulvestrant in Endocrine-Resistant Advanced or Metastatic Breast Cancer in Italy. Ther Clin Risk Manag 2023; 19:301-312. [PMID: 37013197 PMCID: PMC10066701 DOI: 10.2147/tcrm.s391769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 03/12/2023] [Indexed: 03/30/2023] Open
Abstract
Background To date, no study evaluated the cost-effectiveness of palbociclib (PAL) plus fulvestrant (FUL) vs ribociclib (RIB) plus FUL and abemaciclib (ABM) plus FUL in Italy. Cost-effectiveness analysis comparing the three cyclin-dependent 4/6 kinase inhibitors in combination with endocrine therapies for the management of postmenopausal women with HR+, HER2- advanced or metastatic breast cancer in Italy was developed. Material and Methods To assess the cost-effectiveness of PAL plus FUL vs RIB plus FUL and ABM plus FUL, a cost-minimization has been carried out with a conservative scenario considering three CDK4/6 inhibitors with equal effectiveness in terms of overall survival (OS) (MAIC, Rugo et al 2021). Adverse events (AEs) associated with all therapies were obtained from clinical trials. Ad-hoc analysis was performed to estimate the cost-effectiveness considering the quality-of-life (QoL) data (Lloyd et al 2006). Results Cost-minimization inputs were drugs, visits and exams, AE monitoring and best supportive care (BSC) before the progression state, active and BSC in the progression and terminal phase of the last two weeks of life. Given the comparability of PAL, RIB and ABM in terms of efficacy, this analysis demonstrated slight economic savings over a lifetime for PAL. Results showed saving per patient of €305 (lifetime) when PAL is compared with RIB; for PAL vs ABM a saving of €243 (lifetime) in a conservative scenario. Results of a budget impact analysis showed a potential savings of €319,563 for PAL vs RIB and €297,544 for PAL vs ABM. When QoL data were considered, results may favor PAL due to the lower impact of AE with savings and improvement in the QoL related to fewer AE. Conclusion From the Italian perspective, a cost-saving profile associated with the use of PAL+FUL for the management of advanced/metastatic HR+/HER2- breast cancer compared to RIB+FUL and ABM+FUL emerged.
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Affiliation(s)
- Giorgio Lorenzo Colombo
- Department of Drug Sciences, University of Pavia, Pavia, Italy
- Correspondence: Giorgio Lorenzo Colombo, Email
| | - Maria Chiara Valentino
- S.A.V.E. Studi Analisi Valutazioni Economiche S.r.l., Health Economics & Outcomes Research, Milan, Italy
| | - Alessandra Fabi
- Precision Medicine Breast Unit, Scientific Directorate, Department of Women, Children and Public Health Sciences, “A. Gemelli” IRCCS, Roma, Italy
| | - Maria Vittoria Dieci
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
- Oncology 2, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Mauro Caruggi
- S.A.V.E. Studi Analisi Valutazioni Economiche S.r.l., Health Economics & Outcomes Research, Milan, Italy
| | - Giacomo Matteo Bruno
- S.A.V.E. Studi Analisi Valutazioni Economiche S.r.l., Health Economics & Outcomes Research, Milan, Italy
| | - Gloria Lombardi
- Real World Solutions, IQVIA Solutions Italy S.r.l, Milan, Italy
| | - Sergio Di Matteo
- S.A.V.E. Studi Analisi Valutazioni Economiche S.r.l., Health Economics & Outcomes Research, Milan, Italy
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Torre E, Di Matteo S, Bruno GM, Martinotti C, Valentino MC, Testino G, Rebora A, Bottaro LC, Colombo GL. Economic Burden of Non-Alcoholic Steatohepatitis (NASH) Among Diabetic Population in Italy: Analysis and Perspectives. Clinicoecon Outcomes Res 2022; 14:607-618. [PMID: 36127889 PMCID: PMC9482784 DOI: 10.2147/ceor.s371778] [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: 05/06/2022] [Accepted: 08/10/2022] [Indexed: 11/29/2022] Open
Abstract
Background Aim of our study is to evaluate the economic impact of NASH among diabetic population in Italy and potential benefits of treatments that can slow the disease progression. Methods A Markov model was conducted from the Italian National Healthcare System perspective reporting results at 3, 5, 10 and 15 years. The model included NASH and T2DM patients with all stages of fibrosis (F0-F3), compensated cirrhosis (CC), decompensated cirrhosis (DCC), hepatocellular carcinoma (HCC), liver transplant (LT), post-LT and death. A 1-year model cycle length was considered, with each patient passing through the stages and exiting the model when reached one of mortality states. Transition probabilities and annual cost related to health states were derived from published literature. Moreover, the model made it possible to develop a scenario analysis to simulate the impact of treatments capable of slowing the disease progression in phases F0-F4 (CC). Results The results highlighted an economic burden of NASH in T2DM patients of approximately € 1.4 billion, € 3.1 billion, and € 9.4 billion, respectively, after 3, 5 and 10 years, reaching about € 17.3 billion after 15 years. The slowing down of the progression in the early stages of the disease (fibrosis F0-CC) has led to significant savings corresponding to € 2.3 billion at 15 years. These savings were generated by the reduction of the patients in the advanced stages of the disease, which is linked to a reduction in deaths, equal to 92,208 deaths avoided over a 15-year time horizon. Conclusion Patients with NASH and T2DM reported an important burden in Italy. It is important to investigate the potential clinical and economic benefits of antidiabetic drugs that have been shown to be effective in preventing the transition to advanced disease, simultaneously acting on the therapeutic goals of diabetic disease.
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Affiliation(s)
- Enrico Torre
- Diabetology and Metabolic Diseases Unit - ASL3, Genoa, Italy
| | - Sergio Di Matteo
- S.A.V.E. Studi Analisi Valutazioni Economiche S.r.l., Health Economics & Outcomes Research, Milan, Italy
| | | | - Chiara Martinotti
- S.A.V.E. Studi Analisi Valutazioni Economiche S.r.l., Health Economics & Outcomes Research, Milan, Italy
| | - Maria Chiara Valentino
- S.A.V.E. Studi Analisi Valutazioni Economiche S.r.l., Health Economics & Outcomes Research, Milan, Italy
| | | | - Alberto Rebora
- Diabetology and Metabolic Diseases Unit - ASL3, Genoa, Italy
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Pellacani G, Farnetani F, Ciardo S, Chester J, Kaleci S, Mazzoni L, Bassoli S, Casari A, Pampena R, Mirra M, Lai M, Magi S, Mandel VD, Di Matteo S, Colombo GL, Stanganelli I, Longo C. Effect of Reflectance Confocal Microscopy for Suspect Lesions on Diagnostic Accuracy in Melanoma: A Randomized Clinical Trial. JAMA Dermatol 2022; 158:754-761. [PMID: 35648432 PMCID: PMC9161119 DOI: 10.1001/jamadermatol.2022.1570] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Importance Previous systematic reviews and meta-analyses have concluded that given data paucity, a comparison of reflectance confocal microscopy (RCM) with dermoscopy is complex. They recommend comparative prospective studies in a real-world setting of suspect lesions. Objective To test the hypothesis that RCM reduces unnecessary lesion excision by more than 30% and identifies all melanoma lesions thicker than 0.5 mm at baseline. Design, Setting, and Participants This randomized clinical trial included 3165 patients enrolled from 3 dermatology referral centers in Italy between January 2017 and December 2019, with a mean (SD) follow-up of 9.6 (6.9) months (range, 1.9-37.0 months). The consecutive sample of 3165 suspect lesions determined through dermoscopy were eligible for inclusion (10 patients refused). Diagnostic analysis included 3078 patients (48 lost, 39 refused excision). Data were analyzed between April and September 2021. Interventions Patients were randomly assigned 1:1 to standard therapeutic care (clinical and dermoscopy evaluation) with or without adjunctive RCM. Information available guided prospective clinical decision-making (excision or follow-up). Main Outcomes and Measures Hypotheses were defined prior to study initiation. All lesions excised (baseline and follow-up) were registered, including histopathological diagnoses/no change at dermoscopy follow-up (with or without adjunctive RCM). Number needed to excise (total number of excised lesions/number of melanomas) and Breslow thickness of delayed diagnosed melanomas were calculated based on real-life, prospective, clinical decision-making. Results Among the 3165 participants, 1608 (50.8%) were male, and mean (SD) age was 49.3 (14.9) years. When compared with standard therapeutic care only, adjunctive RCM was associated with a higher positive predictive value (18.9 vs 33.3), lower benign to malignant ratio (3.7:1.0 vs 1.8:1.0), and a number needed to excise reduction of 43.4% (5.3 vs 3.0). All lesions (n = 15) with delayed melanoma diagnoses were thinner than 0.5 mm. Conclusions and Relevance This randomized clinical trial shows that adjunctive use of RCM for suspect lesions reduces unnecessary excisions and assures the removal of aggressive melanomas at baseline in a real-life, clinical decision-making application for referral centers with RCM. Trial Registration ClinicalTrials.gov Identifier: NCT04789421.
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Affiliation(s)
- Giovanni Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy.,Dermatology Clinic, Sapienza University of Rome, Rome, Italy
| | - Francesca Farnetani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Silvana Ciardo
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Johanna Chester
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy.,Department of Surgery, Medicine, Dental Medicine and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Shaniko Kaleci
- Department of Surgery, Medicine, Dental Medicine and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Laura Mazzoni
- Skin Cancer Unit, Istituto Scientifico Romagnolo per lo Studio dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Sara Bassoli
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Alice Casari
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Riccardo Pampena
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy.,Skin Cancer Unit, Istituto Scientifico Romagnolo per lo Studio dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Marica Mirra
- Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Michela Lai
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy.,Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Serena Magi
- Skin Cancer Unit, Istituto Scientifico Romagnolo per lo Studio dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Victor D Mandel
- Skin Cancer Unit, Istituto Scientifico Romagnolo per lo Studio dei Tumori (IRST) IRCCS, Meldola, Italy
| | | | - Giorgio Lorenzo Colombo
- CEFAT Center of Pharmaceuticals Economics and Medical Technologies Evaluation, University of Pavia, Italy
| | - Ignazio Stanganelli
- Skin Cancer Unit, Istituto Scientifico Romagnolo per lo Studio dei Tumori (IRST) IRCCS, Meldola, Italy.,Dermatology Unit, University of Parma, Parma, Italy
| | - Caterina Longo
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy.,Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Torre E, Colombo GL, Di Matteo S, Martinotti C, Valentino MC, Rebora A, Cecoli F, Monti E, Galimberti M, Di Bartolo P, Gaggioli G, Bruno GM. Economic Impact of COVID-19 Lockdown on Italian NHS: Focus on Diabetes Mellitus. Clinicoecon Outcomes Res 2021; 13:503-518. [PMID: 34163191 PMCID: PMC8213950 DOI: 10.2147/ceor.s313577] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/19/2021] [Indexed: 01/14/2023] Open
Abstract
Background In Italy, the adoption of a total lockdown has generated almost total suspension of outpatient visits except for emergencies. Even after lockdown, the pandemic fear created additional barriers to access the health services. The aim of our study is to evaluate the economic impact of the lockdown for COVID-19 on public health in Italy, focusing on its effects on diabetic population. Materials and Methods We analyzed the impact of the lockdown on excess mortality and morbidity in the Italian diabetic population during 2020. The analysis was divided into several steps: a quantification of specialist visit reduction, the calculation of excess mortality in the diabetic population, the economic evaluation of the slowdown in the use of innovative diabetic therapies. Furthermore, the impact of the lockdown on the reduction of procedures and follow-up visits in diabetic population was evaluated. The overall impact of the pandemic and lockdown effects on costs and quality of life was then calculated. Results During 2020, a drop of 28% in patient access has been observed. Diabetic patients recorded a twice higher mortality value compared to general population (20.4% vs 10.2%). The analysis of market data revealed a slowdown in consumption of new antidiabetic therapies (−14%, 27% vs 41%). We estimated an expense of €26.6 million for NHS and a loss of 257 utilities in diabetic population due to the missed benefits related to slowdown in innovative antidiabetic drugs use and non-optimal follow-up and control of diabetes complications. In simulation scenarios, we also estimated an overall expenditure ranging from €38.7 to 94.0 million and a loss of 294–836 utilities. Conclusion Diabetic population paid a high tribute to pandemic and lockdown, both in terms of number of deaths and burden of diabetic complications, together with an overall deterioration of quality of life.
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Affiliation(s)
- Enrico Torre
- Endocrinology Diabetology and Metabolic Diseases Unit - ASL3, Genoa, Italy
| | | | - Sergio Di Matteo
- S.A.V.E. Studi Analisi Valutazioni Economiche S.r.l., Health Economics & Outcomes Research, Milan, Italy
| | - Chiara Martinotti
- S.A.V.E. Studi Analisi Valutazioni Economiche S.r.l., Health Economics & Outcomes Research, Milan, Italy
| | - Maria Chiara Valentino
- S.A.V.E. Studi Analisi Valutazioni Economiche S.r.l., Health Economics & Outcomes Research, Milan, Italy
| | - Alberto Rebora
- Endocrinology Diabetology and Metabolic Diseases Unit - ASL3, Genoa, Italy
| | - Francesca Cecoli
- Endocrinology Diabetology and Metabolic Diseases Unit - ASL3, Genoa, Italy
| | - Eleonora Monti
- Endocrinology Diabetology and Metabolic Diseases Unit - ASL3, Genoa, Italy
| | | | - Paolo Di Bartolo
- Diabetes Center of Ravenna, Romagna Diabetes Clinical Network, Romagna Local Health Authority, Ravenna, Italy
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Colombo GL, Heiman F, Peduto I. Utilization of Healthcare Resources in Osteoarthritis: A Cost of Illness Analysis Based on Real-World Data in Italy. Ther Clin Risk Manag 2021; 17:345-356. [PMID: 33911870 PMCID: PMC8072261 DOI: 10.2147/tcrm.s301005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 01/12/2021] [Accepted: 03/15/2021] [Indexed: 01/01/2023] Open
Abstract
Purpose Understand the demographics and clinical features of patients with osteoarthritis (OA), quantify healthcare resource utilization by OA patients, and estimate the annual direct medical costs per OA patient from a National Health Service (NHS) perspective in Italy. Patients and Methods Retrospective observational cohort analysis using data from electronic medical records captured by the Italian IQVIA Longitudinal Patient Database (LPD). Only direct medical costs reimbursed by the NHS were considered. Patients were included if they received at least one diagnosis of OA during the period from January 1 to December 31, 2018. Each patient was observed for 3 years: a 24-month baseline period preceding the index date, and a 12-month follow-up period starting at the index date. Results A total of 71,467 patients met inclusion criteria: 43.98% had not been prescribed NSAIDs/opioids, 40.76% had been prescribed NSAIDs, and 15.26% an opioid. Mean age was 71.36 years, and 68.2% of the patients were women. At least one comorbidity was present in 91.34% of the patients; 38.05% were newly diagnosed with OA. During 1-year of follow-up, 173,884 prescriptions with an associated diagnosis of OA were found: 47.36% had been prescribed an NSAID, 9.11% diclofenac, 8.30% codeine+paracetamol, and 7.32% ketoprofen. Nearly 15% of the patients had at least 1 request for a specialist visit and 23.82% had at least 1 request for exams. Orthopedic visits accounted for 60% of all specialist visits. Yearly mean costs per patient were €622, for approximately €2.5 billion per year in direct costs, considering 3.9 million patients with OA in Italy. Protheses were a major driver in annual costs: €143.45 in patients without a prosthesis and €10,090.91 in those with a joint prosthesis. Conclusion This real-world analysis of direct costs of care of patients with OA in Italy confirms the substantial economic burden. Direct costs dramatically increased when joint replacement was needed.
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Affiliation(s)
| | - Franca Heiman
- Real World Solutions, IQVIA Solutions Italy S.r.l., Milan, Italy
| | - Ilaria Peduto
- Real World Solutions, IQVIA Solutions Italy S.r.l., Milan, Italy
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Torre E, Bruno GM, Di Matteo S, Martinotti C, Valentino MC, Bottaro LC, Colombo GL. Cost-Utility Analysis of Saxagliptin/Dapagliflozin Versus Gliclazide and Insulin Glargine: Economic Implications of the Outcomes of the CVD-Real Studies I and II. Health Serv Insights 2020; 13:1178632920929982. [PMID: 32595277 PMCID: PMC7298424 DOI: 10.1177/1178632920929982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 05/04/2020] [Indexed: 12/20/2022] Open
Abstract
Diabetes treatment cost represents an ever-growing problem. The adoption of new
drugs in therapy, although they can guarantee an improvement in patient’s
quality of life, can meet obstacles when it involves an increase in costs. We
decided to compare the costs and benefits of the new saxagliptin and
dapagliflozin combination versus traditional therapies. Bodyweight loss and the
sharp reduction in hypoglycemic episodes were the 2 main clinical outcomes that
emerged from registered studies of saxagliptin and dapagliflozin compared with
the sulfonylureas. These results, combined with the good cardiovascular risk
profile, led to develop a cost-utility analysis. We aimed to show the economic
value of this new association therapy. We carried out a cost-utility analysis
from the Italian National Healthcare System (NHS) perspective, focused on direct
costs related to the treatment and management of main diabetes complications.
Utility scores adopted have been measured based on the patient’s perception of
weight changes. In light of the better durability profile of
saxagliptin/dapagliflozin compared with gliclazide, we also considered a
simulation scenario to assess the impact on costs of switching to basal insulin,
starting from gliclazide and the fixed combination, respectively, and based on
the related probabilities to switch. To assess the robustness of the results, a
1-way sensitivity analysis was performed by changing the main parameters by
±20%. Furthermore, the sensitivity of the results was tested considering the
addition of a percent discount, because the purchase costs of drugs are usually
subject to hidden discounts. We calculated the total direct annual cost per
patient of saxagliptin/dapagliflozin versus gliclazide and insulin glargine for
patients with type 2 diabetes mellitus not achieving glycemic control on
metformin plus saxagliptin alone, dapagliflozin alone, or gliclazide at a lower
dosage. Total treatment costs have been obtained adding the direct cost of the
drug, needles, glycemic self-monitoring, hypoglycemic events, cardiovascular
complications, and effect on consumption of other drugs. The total direct cost
of saxagliptin/dapagliflozin fixed dose combination was €414.62 higher than
gliclazide (€1.067.72 vs €653.10), and greater than basal insulin, with a
difference of €166.99 (€1067.72 vs €900.72). Despite the higher annual direct
total cost, the additional cost per quality-adjusted life year (QALY) gained,
compared with gliclazide, has been €11 517, and €4639, when compared with
insulin glargine in the base-case scenario, and the robustness of the results
has been shown in the sensitivity analysis. The results of our cost-utility
analysis, expressed as incremental cost-effectiveness ratios, were fully
compliant with the threshold adopted for Italy. Then, saxagliptin/dapagliflozin
can be considered a cost-effective oral hypoglycemic agent. The positive effect
of this drug on the quality of life, induced by the bodyweight loss, has allowed
this outcome, despite the higher annual cost per patient, mainly determined by
the drug purchase cost.
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Affiliation(s)
- Enrico Torre
- Endocrinology Diabetology and Metabolic Diseases Unit-ASL3, Genoa, Italy
| | - Giacomo Matteo Bruno
- S.A.V.E. Studi Analisi Valutazioni Economiche S.r.l., Health Economics & Outcomes Research, Milan, Italy
| | - Sergio Di Matteo
- S.A.V.E. Studi Analisi Valutazioni Economiche S.r.l., Health Economics & Outcomes Research, Milan, Italy
| | - Chiara Martinotti
- S.A.V.E. Studi Analisi Valutazioni Economiche S.r.l., Health Economics & Outcomes Research, Milan, Italy
| | - Maria Chiara Valentino
- S.A.V.E. Studi Analisi Valutazioni Economiche S.r.l., Health Economics & Outcomes Research, Milan, Italy
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Canonica GW, Colombo GL, Rogliani P, Santus P, Pitotti C, Di Matteo S, Martinotti C, Bruno GM. Omalizumab for Severe Allergic Asthma Treatment in Italy: A Cost-Effectiveness Analysis from PROXIMA Study. Risk Manag Healthc Policy 2020; 13:43-53. [PMID: 32158289 PMCID: PMC6986414 DOI: 10.2147/rmhp.s211321] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 11/28/2019] [Indexed: 01/16/2023] Open
Abstract
Introduction Inadequately controlled severe asthma patients require additional therapy accounting for significant clinical and economic burden. Our analysis aims to determine the cost-effectiveness of omalizumab in the management of severe allergic asthma in Italy based on observational data from the PROXIMA study. Methods Observational data on efficacy, healthcare resource utilization and changes in quality of life at 12 months after the initiation of omalizumab were examined to estimate the cost-effectiveness compared to pre-omalizumab period and results were expressed with Incremental Cost-Effectiveness Ratio (ICER). The cost–utility analysis estimated the cost per quality-adjusted life-year (QALY) gained. Direct health costs were assessed from the perspective of the Italian National Health Service (NHS). Results Omalizumab reduced the incidence of exacerbations, number of hospitalizations, physician visits, and improved quality of life after 12 months of treatment. Omalizumab had a greater effectiveness than pre-omalizumab treatment involving 0.132 QALYs gained and led to a €3729 per patient reduction in direct healthcare costs, excluding the add-on treatment cost. Nevertheless, the addition of omalizumab cost led to €7478 increase in total direct costs with respect to pre-omalizumab period. Based on difference in total direct cost and difference in QALY between post and pre-omalizumab period, the ICER was €56,847. According to sensitivity analysis, omalizumab provided a cost-effective use of NHS resources, already at 20% discounted price. Conclusion This study offers a real-world evidence of omalizumab effectiveness in Italy. Despite the high acquisition cost of the innovative drug, omalizumab is a sustainable treatment option for patients with uncontrolled severe allergic asthma.
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Affiliation(s)
| | - Giorgio Lorenzo Colombo
- S.A.V.E. S.r.l. Studi Analisi Valutazioni Economiche Health Economics & Outcomes Research - Research Center, Milan, Italy.,Drug Science Department, Pavia University, Pavia, Italy
| | - Paola Rogliani
- Respiratory Unit, Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Pierachille Santus
- Department of Biomedical and Clinical Sciences (DIBIC), University of Milan, Division of Pulmonary Diseases, Ospedale L. Sacco, ASST Fatebenefratelli-Sacco, Milan, Italy
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Colombo GL, Di Matteo S, Martinotti C, Oselin M, Valentino MC, Bruno GM, Pitotti C, Menzella F. Omalizumab and long-term quality of life outcomes in patients with moderate-to-severe allergic asthma: a systematic review. Ther Adv Respir Dis 2019; 13:1753466619841350. [PMID: 31035904 PMCID: PMC6492364 DOI: 10.1177/1753466619841350] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background: Asthma is a highly prevalent chronic inflammatory airways disease, with a
considerable impact on quality of life (QoL). To express the effects of
asthma on patients’ subjective experience, patient-reported outcomes (PROs)
represent an important instrument. The asthma QoL questionnaire (AQLQ) is
one of the main PROs among these. Materials and methods: To identify long-term asthma-related QoL outcomes associated with omalizumab
therapy in patients with moderate-to-severe asthma, we developed a
systematic review according to the PRISMA guidelines. Published real-world
effectiveness studies of adults or adolescents (12 years or older) with
moderate-to-severe allergic asthma treated with omalizumab for at least 48
weeks were reviewed. Sources used were Medline
(PubMed), the Cochrane Library and
Google Scholar up to February 2018. In addition, a
cross-referencing search was conducted to complete the revision. Results: A total of 255 potential papers were identified in the first search through
the database. After full-text viewing, eight articles were finally included
in the review. We summarized the results according to the study design,
patient baseline characteristics and effectiveness outcomes assessed by AQLQ
score results: variation from baseline to the end of study. Results
confirmed the long-term benefits of omalizumab as an add-on therapy in
patients with uncontrolled moderate-to-severe allergic asthma. Since there
is a lot of evidence on omalizumab effectiveness, we aimed to focus on how a
therapy can change patient’s QoL in a long time period. Data showed
long-term effects of omalizumab treatment on subjective (PROs) and objective
(lung function, corticosteroid use, hospitalizations, asthma exacerbation)
effectiveness measures. Conclusion: Studies included in our review were observational trials that, due to their
design, present a potential risk of selection bias in the patients included.
Beyond this limit, the evaluation of QoL using the AQLQ showed a clear
increase over time, following both 48 weeks and 9 years of observation,
where QoL improvements still were significant over baseline values.
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Affiliation(s)
- Giorgio Lorenzo Colombo
- Department of Drug Sciences, University of Pavia, Via G. Previati 74 20149 Milano c/o S.A.V.E., Pavia, Italy
| | - Sergio Di Matteo
- S.A.V.E. Studi Analisi Valutazioni Economiche S.r.l., Health Economics & Outcomes Research, Milan, Italy
| | - Chiara Martinotti
- S.A.V.E. Studi Analisi Valutazioni Economiche S.r.l., Health Economics & Outcomes Research, Milan, Italy
| | - Martina Oselin
- S.A.V.E. Studi Analisi Valutazioni Economiche S.r.l., Health Economics & Outcomes Research, Milan, Italy
| | - Maria Chiara Valentino
- S.A.V.E. Studi Analisi Valutazioni Economiche S.r.l., Health Economics & Outcomes Research, Milan, Italy
| | - Giacomo Matteo Bruno
- S.A.V.E. Studi Analisi Valutazioni Economiche S.r.l., Health Economics & Outcomes Research, Milan, Italy
| | | | - Francesco Menzella
- Department of Medical Specialties, Pneumology Unit, Arcispedale Santa Maria Nuova- IRCCS, Azienda USL di Reggio Emilia, Reggio Emilia, Italy
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15
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Canonica GW, Colombo GL, Bruno GM, Di Matteo S, Martinotti C, Blasi F, Bucca C, Crimi N, Paggiaro P, Pelaia G, Passalaqua G, Senna G, Heffler E. Shadow cost of oral corticosteroids-related adverse events: A pharmacoeconomic evaluation applied to real-life data from the Severe Asthma Network in Italy (SANI) registry. World Allergy Organ J 2019; 12:100007. [PMID: 30937132 PMCID: PMC6439414 DOI: 10.1016/j.waojou.2018.12.001] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [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: 08/08/2018] [Revised: 11/12/2018] [Accepted: 12/09/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Asthma is one of the most common non-communicable respiratory diseases, affecting about 6% of the general population. Severe asthma, even if afflicts a minority of asthmatics, drives the majority of costs of the disease. The aim of this study is to create a pharmacoeconomic model to predict the costs of corticosteroid-related adverse events in severe asthmatics and applying it to the first published epidemiologic data from the Severe Asthma Network in Italy (SANI) registry. METHODS The analysis was conducted from the perspective of the Italian National Healthcare System (INHS). Model inputs, derived from literature, included: asthma epidemiology data, frequency of adverse events, percentage of severe asthma treated with OCS and adverse event cost (Diagnosis-Related Group (DRG) national tariffs). We estimated costs per different patient groups: non-asthma controls, mild/moderate and severe asthmatics. Final results report estimated direct cost per patient and total direct cost for overall target population, showing economic impact related to corticosteroid complication. RESULTS Based on epidemiological data input, in Italy, asthmatic subjects resulted about 3,999,600, of which 199,980 with severe asthma. The number of patients with severe asthma OCS-treated was estimated at 123,988. Compared to the non-asthma control cohort and to that with moderate asthma annual cost per severe asthmatic patient resulted respectively about €892 and €606 higher, showing a corticosteroids shadow cost ranging from 45% to 30%.Applying the cost per patient to the target population identified for Italy, the budget impact model estimated a total annual cost related to OCS-related adverse events of €242.7 million for severe asthmatics. In respect with non-asthmatic and moderate population, an incremental expenditure of about € 110.6 million and €75.2, respectively, were shown. CONCLUSIONS Our study provides the first estimates of additional healthcare costs related to corticosteroid induced adverse events in severe asthma patient. Budget impact model results highlighted the relevant economic impact of OCS-related adverse events in severe asthma patients. The future extrapolation of additional data from SANI registry will support the development of a model to investigate the role of corticosteroids sparing drugs.
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Affiliation(s)
- Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, Humanitas Research Hospital, Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Giorgio Lorenzo Colombo
- Drug Science Department, Pavia University, Italy
- Studi Analisi Valutazioni Economiche (S.A.V.E.) S.r.l., Health Economics & Outcomes Research Center, Milan, Italy
| | - Giacomo Matteo Bruno
- Studi Analisi Valutazioni Economiche (S.A.V.E.) S.r.l., Health Economics & Outcomes Research Center, Milan, Italy
| | - Sergio Di Matteo
- Studi Analisi Valutazioni Economiche (S.A.V.E.) S.r.l., Health Economics & Outcomes Research Center, Milan, Italy
| | - Chiara Martinotti
- Studi Analisi Valutazioni Economiche (S.A.V.E.) S.r.l., Health Economics & Outcomes Research Center, Milan, Italy
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, University of Milan, Italy
- Internal Medicine Department, Respiratory Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS “Cà Granda – Ospedale Maggiore Policlinico”, Milan, Italy
| | - Caterina Bucca
- Pneumology Unit, Cardiovascular and Thoracic Department, AOU Molinette “Città della Salute e della Scienza”, Department of Medical Sciences, University of Torino, Italy
| | - Nunzio Crimi
- Allergy and Respiratory Medicine, Department of Clinical and Experimental Medicine, University of Catania, Italy
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Italy
| | - Girolamo Pelaia
- Department of Medical and Surgical Sciences, Respiratory Unit – University Magna Graecia of Catanzaro, Italy
| | - Giovanni Passalaqua
- Allergy and Respiratory Diseases, Department of Internal Medicine (DIMI) – University of Genoa, Italy
| | - Gianenrico Senna
- Asthma Center and Allergy Unit, University of Verona and General Hospital, Verona, Italy
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, Humanitas Research Hospital, Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
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Poscia R, Vizza CD, Di Matteo S, Oselin M, Bruno GM, D'Alto M, Ghio S, Colombo GL. Budget Impact Model of riociguat (Adempas®) in Pulmonary Arterial Hypertension (PAH) in Italy. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky218.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- R Poscia
- AOU Policlinico Umberto I, Roma, Italy
| | - CD Vizza
- AOU Policlinico Umberto I, Roma, Italy
| | - S Di Matteo
- S.A.V.E. Studi Analisi Valutazioni Economiche S.r.l., Health Economics & Outcomes Research, Milano, Italy
| | - M Oselin
- S.A.V.E. Studi Analisi Valutazioni Economiche S.r.l., Health Economics & Outcomes Research, Milano, Italy
| | - GM Bruno
- S.A.V.E. Studi Analisi Valutazioni Economiche S.r.l., Health Economics & Outcomes Research, Milano, Italy
| | - M D'Alto
- Ospedale Monaldi di Napoli, Napoli, Italy
| | - S Ghio
- Policlinico San Matteo Pavia Fondazione IRCCS, Pavia, Italy
| | - GL Colombo
- Department of Drug Sciences, University of Pavia, S.A.V.E. Studi Analisi Valutazioni Economiche S.r.l., Health Economics & Outcomes Research, Milano, Italy
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Torre E, Bruno GM, Di Matteo S, Martinotti C, Oselin M, Valentino MC, Parodi A, Bottaro LC, Colombo GL. Cost-minimization analysis of degludec/liraglutide versus glargine/aspart: economic implications of the DUAL VII study outcomes. Clinicoecon Outcomes Res 2018; 10:413-421. [PMID: 30100746 PMCID: PMC6067612 DOI: 10.2147/ceor.s169045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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] [Indexed: 01/30/2023] Open
Abstract
Background Diabetes represents a relevant public health problem worldwide due to its increasing prevalence and socioeconomic burden. There is no doubt that tight glycemic control reduces the development of diabetic complications such as the long-term costs related to the disease. The aim of our model was to calculate total direct costs associated with the two treatments considered in DUAL VII study, and hence evaluate the potential economic benefits for the National Health System (NHS) deriving from the use of insulin degludec plus liraglutide (IDegLira) in a once-daily fixed combination. Materials and methods We applied the cost-minimization technique adopting the NHS point of view to the DUAL VII trial outcomes. In the model, developed in Microsoft Excel®, we calculated and compared annual costs per patient of the two therapeutic options for type 2 diabetes (T2D) patients not achieving glycemic control on basal insulin and metformin described in the trial, including costs of therapy management and side effects, both negative and positive. Annual treatment costs were calculated based on IDegLira and basal bolus end-of-trial doses resulting in a 1:2 ratio (40.4 U vs 84.1 U). Therefore, maintaining the IDegLira/basal bolus at 1:2 dose ratio, we calculated the correlation between the dose reduction and costs compared to DUAL VII doses base case scenario. Results Total treatment costs were obtained by adding annual cost of drug, needles, glycemic self-monitoring, hypoglycemic events, and effect on consumption of other drugs. Total annual costs of IDegLira combination resulted in €434 higher than basal bolus in DUAL VII base case (40.4 U); the two treatments reported equal costs at 34% dose reduction (26.7 U), while below this value IDegLira treatment became less expensive, with about €215 gain at 50% dose reduction (20.2 U). It is also important to notice that above the break-even point, until an IDegLira dose of 30 U, the cost difference is negligible in view of the clinical benefit provided by the fixed combination highlighted in DUAL VII trial. Conclusion Adding the significant clinical findings derived from DUAL VII trial to our economic evaluation, IDegLira seems to offer an important alternative to basal-bolus therapy.
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Affiliation(s)
- Enrico Torre
- Endocrinology, Diabetology and Metabolic Diseases Unit, ASL3, Genoa, Italy
| | - Giacomo Matteo Bruno
- S.A.V.E. Studi Analisi Valutazioni Economiche S.r.l., Health Economics & Outcomes Research, Milan, Italy
| | - Sergio Di Matteo
- S.A.V.E. Studi Analisi Valutazioni Economiche S.r.l., Health Economics & Outcomes Research, Milan, Italy
| | - Chiara Martinotti
- S.A.V.E. Studi Analisi Valutazioni Economiche S.r.l., Health Economics & Outcomes Research, Milan, Italy
| | - Martina Oselin
- S.A.V.E. Studi Analisi Valutazioni Economiche S.r.l., Health Economics & Outcomes Research, Milan, Italy
| | - Maria Chiara Valentino
- S.A.V.E. Studi Analisi Valutazioni Economiche S.r.l., Health Economics & Outcomes Research, Milan, Italy
| | - Alessio Parodi
- General Direction International Evangelic Hospital, Genoa, Italy
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Colombo GL, Cammà C, Attili AF, Ganga R, Gaeta GB, Brancaccio G, Franzini JM, Volpe M, Turchetti G. Patterns of treatment and costs of intermediate and advanced hepatocellular carcinoma management in four Italian centers. Ther Clin Risk Manag 2015; 11:1603-12. [PMID: 26527877 PMCID: PMC4621183 DOI: 10.2147/tcrm.s88208] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is a severe health condition associated with high hospitalizations and mortality rates, which also imposes a relevant economic burden. PURPOSE The aim of the present survey is to investigate treatment strategies and related costs for HCC in the intermediate and advanced stages of the disease. PATIENTS AND METHODS The survey was conducted in four Italian centers through structured interviews with physicians. Information regarding the stage of disease, treatments performed, and related health care resource consumption was included in the questionnaire. Direct health care cost per patient associated with the most relevant treatments such as sorafenib, transarterial chemoembolization (TACE), and transarterial radioembolization (TARE) was evaluated. RESULTS Between 2013 and 2014, 285 patients with HCC were treated in the four participating centers; of these, 80 were in intermediate stage HCC (Barcelona Clinic Liver Cancer Classification [BCLC] B), and 57 were in the advanced stage of the disease (BCLC C). In intermediate stage HCC, the most frequent first-line treatment was TACE (63%) followed by sorafenib (15%), radiofrequency ablation (14%), and TARE (1.3%). In the advanced stage of HCC, the most frequently used first-line therapy was sorafenib (56%), followed by best supportive care (21%), TACE (18%), and TARE (3.5%). The total costs of treatment per patient amounted to €12,214.54 with sorafenib, €13,418.49 with TACE, and €26,106.08 with TARE. Both in the intermediate and in the advanced stage of the disease, variability in treatment patterns among centers was observed. CONCLUSION The present analysis raises for the first time the awareness of the overall costs incurred by the Italian National Healthcare System for different treatments used in intermediate and advanced HCC. Further investigations would be important to better understand the effective health care resource usage.
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Affiliation(s)
| | - Calogero Cammà
- Section of Gastroenterology, Di.Bi.M.I.S., University of Palermo, Palermo, Italy
| | | | - Roberto Ganga
- Clinical Medicine Division, Ospedale Brotzu, Cagliari, Italy
| | | | | | | | - Marco Volpe
- Business Integration Partners S.p.A., Milan, Italy
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Pellacani G, Witkowski A, Cesinaro AM, Losi A, Colombo GL, Campagna A, Longo C, Piana S, De Carvalho N, Giusti F, Farnetani F. Cost-benefit of reflectance confocal microscopy in the diagnostic performance of melanoma. J Eur Acad Dermatol Venereol 2015; 30:413-9. [PMID: 26446299 DOI: 10.1111/jdv.13408] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 07/29/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND The sub-optimal diagnostic accuracy for melanoma leads to excise a high number of benign lesions, with consequent costs. Reflectance confocal microscopy (RCM) improves diagnostic specificity, thus possibly inducing a reduction in unnecessary excisions and related costs. OBJECTIVE To estimate the influence of RCM on number of benign lesions needed to excise (NNE) a melanoma, in term of clinical outcomes and costs per patient. PATIENTS AND METHODS Skin neoplasms excised by the dermatology public service in the Province of Modena were retrieved form centralized pathology database. Differences in NNE between the territorial service (using dermoscopy only) and the University Hospital (adding also RCM to the patients' workflow) were calculated and cost analysis was performed through a micro-costing approach. RESULTS A large reduction in benign lesions excised at University Hospital was evident, leading to NNE of 6.25 for University Hospital, compared to 19.41 for Territorial Dermatology. Since 4320 unnecessary excisions can be saved every million inhabitants, an overall yearly saving of over 280,000 Eur can be expected from the use of RCM. CONCLUSIONS The systematic use of RCM was dramatically affecting the number of benign lesions excised, and this can be translated in a significant cost-benefit advantage.
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Affiliation(s)
- G Pellacani
- Department of Dermatology, University of Modena, Reggio Emilia, Italy
| | - A Witkowski
- Department of Dermatology, University of Modena, Reggio Emilia, Italy
| | - A M Cesinaro
- Department of Pathology, University of Modena, Reggio Emilia, Italy
| | - A Losi
- Department of Dermatology, University of Modena, Reggio Emilia, Italy
| | - G L Colombo
- Department of Drug Sciences, University of Pavia, Pavia, Italy
| | - A Campagna
- General Direction, Policlinico Hospital, Modena, Italy
| | - C Longo
- Dermatology and Skin Cancer Unit, IRCCS - Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - S Piana
- Department of Pathology, IRCCS - Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - N De Carvalho
- Department of Dermatology, University of Modena, Reggio Emilia, Italy
| | - F Giusti
- Department of Dermatology, University of Modena, Reggio Emilia, Italy
| | - F Farnetani
- Department of Dermatology, University of Modena, Reggio Emilia, Italy
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20
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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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21
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Di Matteo S, Bruno GM, Astuti N, Di Filippo E, Valenti D, Colombo GL, Maggiolo F. Switching from an EFV-Based STR to a RPV-Based STR is Effective, Safe and Improves HIV Patients Health Status. Value Health 2014; 17:A677-A678. [PMID: 27202494 DOI: 10.1016/j.jval.2014.08.2520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- S Di Matteo
- S. A. V. E. Studi Analisi e Valutazioni economiche, Milan, Italy
| | - G M Bruno
- S. A. V. E. Studi Analisi e Valutazioni economiche, Milan, Italy
| | - N Astuti
- Az. Osp. Papa Giovanni XXII, Bergamo, Italy
| | | | - D Valenti
- Az. Osp. Papa Giovanni XXII, Bergamo, Italy
| | | | - F Maggiolo
- Az. Osp. Papa Giovanni XXII, Bergamo, Italy
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Di Matteo S, Colombo GL, Malnis D, Bruno GM. Clinical Pathway And Health Care Resources Utilization Of A Patients Cohort At High Risk Of Cardiovascular Disease Of Local Health Care Unit (Asln°1) Of Milan: A Results Of Intervention On Secondary Prevention. Value Health 2014; 17:A492. [PMID: 27201466 DOI: 10.1016/j.jval.2014.08.1457] [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)
- S Di Matteo
- S. A. V. E. Studi Analisi e Valutazioni economiche, Milan, Italy
| | | | - D Malnis
- Dipartimento Governance asl Milano1, Rho, Italy
| | - G M Bruno
- S. A. V. E. Studi Analisi e Valutazioni economiche, Milan, Italy
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23
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Di Matteo S, Colombo GL, Pellacani G, Bruno GM. Cost-Effectiveness Analysis of Ingenolo Mebutato Verse Imiquimod in the Treatment of Actinic Keratoses in the Perspective of the Italian Health System. Value Health 2014; 17:A608. [PMID: 27202117 DOI: 10.1016/j.jval.2014.08.2126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- S Di Matteo
- S. A. V. E. Studi Analisi e Valutazioni economiche, Milan, Italy
| | | | - G Pellacani
- Università degli Studi di Modena e Reggio Emilia, Modena, Italy
| | - G M Bruno
- S. A. V. E. Studi Analisi e Valutazioni economiche, Milan, Italy
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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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25
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Simoens S, Dunselman G, Dirksen C, Hummelshoj L, Bokor A, Brandes I, Brodszky V, Canis M, Colombo GL, DeLeire T, Falcone T, Graham B, Halis G, Horne A, Kanj O, Kjer JJ, Kristensen J, Lebovic D, Mueller M, Vigano P, Wullschleger M, D'Hooghe T. The burden of endometriosis: costs and quality of life of women with endometriosis and treated in referral centres. Hum Reprod 2012; 27:1292-9. [PMID: 22422778 DOI: 10.1093/humrep/des073] [Citation(s) in RCA: 601] [Impact Index Per Article: 50.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND This study aimed to calculate costs and health-related quality of life of women with endometriosis-associated symptoms treated in referral centres. METHODS A prospective, multi-centre, questionnaire-based survey measured costs and quality of life in ambulatory care and in 12 tertiary care centres in 10 countries. The study enrolled women with a diagnosis of endometriosis and with at least one centre-specific contact related to endometriosis-associated symptoms in 2008. The main outcome measures were health care costs, costs of productivity loss, total costs and quality-adjusted life years. Predictors of costs were identified using regression analysis. RESULTS Data analysis of 909 women demonstrated that the average annual total cost per woman was €9579 (95% confidence interval €8559-€10 599). Costs of productivity loss of €6298 per woman were double the health care costs of €3113 per woman. Health care costs were mainly due to surgery (29%), monitoring tests (19%) and hospitalization (18%) and physician visits (16%). Endometriosis-associated symptoms generated 0.809 quality-adjusted life years per woman. Decreased quality of life was the most important predictor of direct health care and total costs. Costs were greater with increasing severity of endometriosis, presence of pelvic pain, presence of infertility and a higher number of years since diagnosis. CONCLUSIONS Our study invited women to report resource use based on endometriosis-associated symptoms only, rather than drawing on a control population of women without endometriosis. Our study showed that the economic burden associated with endometriosis treated in referral centres is high and is similar to other chronic diseases (diabetes, Crohn's disease, rheumatoid arthritis). It arises predominantly from productivity loss, and is predicted by decreased quality of life.
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Colombo GL, Chimenti S, Di Matteo S, Fargnoli MC, Frascione P, Silipo V, Peris K. Cost-effectiveness analysis of topical treatments for actinic keratosis in the perspective of the Italian health care system. GIORN ITAL DERMAT V 2010; 145:573-581. [PMID: 20930692] [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] [Indexed: 05/30/2023]
Abstract
Actinic keratosis (AK) is the most common cutaneous malignant neoplasm and its prevalence continues to increase. According to the most recent findings, AK is currently considered the initial stage, in situ, of squamous cell carcinoma. Field-directed therapies for AKs are the preferred treatment since they have the advantage to clear the clinically visible lesions and also subclinical lesions within the cancerous field. We assessed the cost-effectiveness of topical treatments for AKs including 3% diclofenac in 2.5% hyaluronic acid (HA) gel, imiquimod 5% cream and photodynamic therapy with methyl aminolevulinate (MAL-PDT) in the perspective of the Italian Health Care System (SSN). We used a decision tree analytical approach and efficacy data were drawn from published clinical trials. Cost was evaluated from the SSN perspective during a time horizon of 3 months. A responder was defined as a patient with all lesions clinically cleared and showing an excellent cosmetic result. Based on the applied model, the cost per complete responder was calculated. Diclofenac 3% in HA was less expensive (Euro 256) than MAL-PDT (Euro 320) and imiquimod (Euro 342). Effectiveness was similar and better for diclofenac 3% in HA and MAL-PDT (0.813%) in comparison to 0.734% of imiquimod, respectively. The one-way and probabilistic sensitivity analyses confirmed the results of base case scenario. Based on this cost-effectiveness model, diclofenac 3% in HA can be considered the treatment of choice for AK lesions and surrounding field under a pharmacoeconomic point of view.
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Affiliation(s)
- G L Colombo
- University of Pavia, Faculty of Pharmacy, Pavia, Italy
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27
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Affiliation(s)
- G L Colombo
- Parma Aiuto E Lib. Docente in the Royal University Ophthalmic Clinic, Parma, Dir. Prof. C. Gallenga
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Favalli EG, Marchesoni A, Colombo GL, Sinigaglia L. Pattern of use, economic burden and vial optimization of infliximab for rheumatoid arthritis in Italy. Clin Exp Rheumatol 2008; 26:45-51. [PMID: 18328146] [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] [Indexed: 05/26/2023]
Abstract
OBJECTIVE The aim of this study was to retrospectively examine the pattern of utilization in clinical practice and the costs of therapy of infliximab in the treatment of refractory rheumatoid arthritis (RA). METHODS Ninety-five RA patients (22 newly treated and 73 maintenance patients) who received at least one infliximab infusion during a selected observation period of one year were studied. After induction phase, infliximab was given at initial dose of 3 mg/kg every 8 weeks. Based on clinical efficacy measured by Disease Activity Score 28 (DAS 28) index, dose adjustments were performed by increasing pro kg dose and/or reducing infusion interval. Overall one-year's treatment costs were also examined. RESULTS Sixteen (17%) out of 95 patients discontinued treatment before the end of the study owing to lack of efficacy (15) or adverse events (1). Thirteen (59%) out of 22 newly treated patients experienced treatment escalation in the first year of therapy by increasing dose (13.6%), reducing interval (9%), or both (36.3%). The mean infliximab dose administered to all the patients was 3.57 mg/kg and the mean infusion interval was 50 days. Considering all expenditure items, the mean year treatment cost per patient was euro 8454,65. Infliximab vial optimization allows us to reduce this amount to euro 7505,85, with a significant saving of euro 948,80 per patient/year. CONCLUSIONS In this observational study, adjustments in infliximab treatment in the first year of therapy were common. Despite dose escalation, the mean dosing schedule does not significantly differ from those recommended in the product label. The cost of treatment could be reduced by using infliximab vial optimization.
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Affiliation(s)
- E G Favalli
- Department and Chair of Rheumatology, Gaetano Pini Institute, Milan, Italy.
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29
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Evers SMAA, Ament AJHA, Colombo GL, Konradsen HB, Reinert RR, Sauerland D, Wittrup-Jensen K, Loiseau C, Fedson DS. Cost-effectiveness of pneumococcal vaccination for prevention of invasive pneumococcal disease in the elderly: an update for 10 Western European countries. Eur J Clin Microbiol Infect Dis 2007; 26:531-40. [PMID: 17570001 DOI: 10.1007/s10096-007-0327-z] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Pneumococcal vaccine is effective in preventing invasive pneumococcal disease in adults >or=65 years of age, but it is not widely used in Western Europe. In this study, data from an earlier (1995) cost-effectiveness study on Belgium, France, Scotland, Spain, and Sweden are updated, and data on five new countries--Denmark, the UK (specifically, England and Wales), Germany, Italy and The Netherlands--are added. Epidemiological and economic variables specific for each country were used, and it was assumed that pneumococcal and influenza vaccines would both be administered during the same physician visit. In the base-case analyses, the cost-effectiveness ratios ranged from euro 9239 to euro 23,657 per quality-adjusted life-year. Because the incidence and mortality of invasive pneumococcal disease were underestimated in most countries, a country-by-country analysis was performed, assuming an incidence of 50 cases per 100,000 population and mortality rates of 20, 30 and 40%. For a mortality of 20%, the cost-effectiveness ratios ranged from euro 4,778 to euro 17,093, and for a mortality of 30%, they ranged from euro 3,186 to euro 11,395. Pneumococcal vaccination to prevent invasive pneumococcal disease in elderly adults was very cost-effective in all 10 countries. This evidence justifies the wider use of the vaccine in Western Europe.
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Affiliation(s)
- S M A A Evers
- Department of Health, Organization, Policy and Economics, Maastricht University, PO Box 616, Maastricht, 6200, MD, The Netherlands.
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Colombo GL, Serra G, Morlotti L, Fara GM. [The role of economic evaluation for the implementation of vaccination strategies]. Ann Ig 2005; 17:479-90. [PMID: 16523707] [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: 05/07/2023]
Abstract
The analysis described below tries to underline the major economic aspects of vaccination strategies both in childhood (polio, diphtheria, tetanus, H influenzae, measles, rubella, mumps, et) and in the elderly (limited to influenza control). As a result we could demonstrate that, in spite of the formal recognition of the paramount importance of prevention in general, and of vaccinal prevention in particular; vaccinations are at present very poorly considered by policymakers and politicians. This in contrast with the fact that the studies so far examined show that vaccinations are among the most productive interventions (lowest cost per year of life-year spared, very good cost-benefit ratio, thanks to the cases of diseases avoided). Such a convenience is highest when, in front of a given disease, the vaccinal strategy has been duly selected. Therefore, it is suggested that additional resources should be provided in the future to complete the framework and to increase the coverage of vaccinations, including the new offers against Varicella, N meningitidis and Str pneumoniae: and, in the future, against Rotavirus and HPV.
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Affiliation(s)
- G L Colombo
- S.A.V.E. Studi Analisi Valutazioni Economiche, Milano.
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Marchetti M, Colombo GL. Cost-effectiveness of universal pneumococcal vaccination for infants in Italy. Vaccine 2005; 23:4565-76. [PMID: 15992969 DOI: 10.1016/j.vaccine.2005.04.033] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [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: 10/22/2004] [Revised: 04/20/2005] [Accepted: 04/26/2005] [Indexed: 11/18/2022]
Abstract
This study aimed at estimating the health and economic outcomes of universal infant vaccination with seven-valent pneumococcal conjugate vaccine (PCV-7) in Italy. A Markov model simulated lifetime evolution of a birth cohort (538,138 children): universal vaccination would avert 769 invasive infections, 18 deaths and 1323 life years. At base-case analysis, universal three-dose vaccination would cost euro 26,449 (95% CI: 1975-62,075) and euro 38,286 (95% CI: 22,164-70,801) per life year-saved in the societal and the NHS perspective, respectively. In the hypothesis of a 5-year long protection period, vaccination would cost euro 32,694 and euro 43,115 per life-year saved. Considering yearly incidence of invasive pneumococcal disease reported for Veneto and Sardinia regions, PCV-7 vaccination would result highly cost-effective determining a cost of euro 10,479 and euro 16,890 per life year-save in the NHS and the societal perspective, respectively.
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Affiliation(s)
- M Marchetti
- Laboratory of Medical Epidemiology, IRCCS Policlinico San Matteo, viale Golgi 19, 27100 Pavia, Italy.
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Colombo GL, Caruggi M, Serra G, Vinci M. [Management of acute pain in Italy. Economic aspects and quality of life]. Recenti Prog Med 2005; 96:7-15. [PMID: 15789632] [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: 05/02/2023]
Abstract
OBJECTIVES This study aims to measure quality of life and treatment costs of patients with acute pain due to osteoarticular diseases;2 to asses associations between pain, quality of life and treatment costs from NHS' perspective. PATIENTS AND METHODS Observational, multicentric study; patients of both gender were enrolled sequentially from March to July 2002 and observed for 30 days. Type of pain was assessed by a McGill Pain Questionnaire, while degree of severity was measured by VAS (Visual Analogue Scale) ranging from 0 (no pain) to 10 (very severe pain). Quality of life was assessed by EQ-5D (EuroQol/Quality of Life in Europe-5 Dimensions). RESULTS 188 patients matched by gender and age in to four group: male < or =65 years (51), female < or =65 years (59), male > 65 years (42), female > 65 years (36). Male's age ranged from 36 to 88 years, while female's ranged from 31 to 87 years. Groups differ for type of pain. Cost after enrollment (48.99 Euro) is due for about 60% to diagnostic examinations, while pharmacological therapies account for only 17.64 Euro. Mean score of EQ-5D shows a low level of utility (0.265) that reflects a rather law quality of life. Patient older than 65 years had lower score than patient of the same gender but younger. Differences are significant in the dimension anxiety/depression that afflicts women and older patients. CONCLUSIONS This study valued utility of patients with non oncological acute pain in Italy and health cost of diagnostic and therapeutic path faced by patients.
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Colombo GL, Caruggi M, Vinci M. [Quality of life and treatment costs in patients with non-cancer chronic pain]. Recenti Prog Med 2004; 95:512-20. [PMID: 15598088] [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: 05/01/2023]
Abstract
BACKGROUND there is still little information about the use of generic questionnaires [e.g. the 36-item Short Form health survey (SF-36)] and utility questionnaires [e.g. the EuroQOL instrument (EQ-5D) and visual analogue scale (VAS)] in patients with non-cancer chronic pain. OBJECTIVES (i) to measure quality of life and utility in patients with non-cancer chronic pain using the SF-36 and the EuroQOL questionnaires; (ii) to assess direct costs and to evaluate the impact of some clinical variables on diagnostic or treatment costs. PARTICIPANTS 153 patients from 9 Italian Center for treatment non-cancer chronic pain (54% male, mean age 57 years) completed both quality of life questionnaires and diagnostic and treatment prescription questionnaire. RESULTS the mean scores for the 8 domains of the SF-36 ranged from 23.7 (physical role) to 53.7 (mental health). The EuroQOL mean score was 0.28 in the self-classifier (EQ-5D) version and 6.4 in the visual analogue scale (VAS) version. The direct costs was assessed in 173 Euro, in two months observation period (the analysis was conducted from the National Health System perspectives); we found some differences between pathologies observed: about 180 Euro for back pain or arthrosis, about 155 Euro for periarthritis of the shoulder. CONCLUSIONS our study, quantified the quality of life in patients with non-cancer chronic pain, showed that the presence of pain had an important role. The EuroQOL measurements obtained from these patients will aid evaluation of the cost-utility ratio for pain therapies.
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Colombo GL. [Cost-of-illness study of pneumococcal disease in Italian children]. Ann Ig 2002; 14:373-88. [PMID: 12508446] [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: 02/28/2023]
Abstract
Streptococcus pneumoniae (S pneumoniae, or pneumococcus) is a leading cause of illness in children, and causes illness and death among the elderly and persons with certain underlying conditions. A Cost-of-Illness (COI) estimate for each pneumococcal disease (meningitis, bacteremia, pneumonia, and otitis media) was determined using decision tree analysis that considered both direct and indirect costs. Information on the burden of pneumococcal disease in Italy, in terms of data on the incidence and seroprevalence of disease was collected from published and unpublished records, supplemented, and verified by Italian pediatric and infectious disease experts. The annual cost to society of caring for children with pneumococcal disease is estimated to be around 59,604,477 euro including both direct costs and indirect costs (productivity changes). Direct costs accounted for 39.9% of the total costs. The value of resources used to treat otitis media was 60.6% of the total direct costs; 31.9% was the value of resources for treating pneumonia; 6.5% for treating bacteremia; 1.0% for treating meningitis. A sensitivity analysis confirmed the robustness of the results.
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