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Cortesi PA, Maloberti A, Micale M, Pagliarin F, Antonazzo IC, Mazzaglia G, Giannattasio C, Mantovani LG. Costs and effects of cardiovascular risk reclassification using the ankle-brachial index (ABI) in addition to the Framingham risk scoring in women. Atherosclerosis 2020; 317:59-66. [PMID: 33213858 DOI: 10.1016/j.atherosclerosis.2020.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 06/19/2020] [Revised: 10/01/2020] [Accepted: 11/05/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIMS Ankle brachial index (ABI) is a simple and cheap parameter to assess the presence of atherosclerosis. It could also help correctly reclassify the cardiovascular risk when added to the Framingham risk score (FRS). Recent evidence has demonstrated improvement in prediction performance of ABI when added to FRS, particularly in women. However, no studies have been published yet evaluating the cost-effectiveness of this approach. This study attempts to fill in this gap by assessing the cost-effectiveness of ABI measurements in primary prevention in women. METHODS We developed a Markov model to compare two different strategies for assessing the cardiovascular risk (low, intermediate and high) among women in the general population: 1) FRS strategy, and 2) FRS + ABI strategy; and the relative impact associated with interventions for preventing CV events in intermediate and high-risk categories. RESULTS In the base-case analysis, FRS + ABI reported an additional cost of € 110 and a gain of 0.0039 QALYs per patient, resulting in an ICER of € 27.986/QALY, when compared to FRS alone. The ICER improved to €1.641/QALY when using a lifetime horizon. The effectiveness of preventive CV disease interventions reported also a significant impact. A 32% reduction of CV events was the minimum value estimated to maintain FRS + ABI as a cost-effective strategy. CONCLUSIONS The addition of ABI to FRS is a cost-effective approach in women classified at low and intermediate risk with FRS only. This new approach gives the possibility to reclassify and allocate them into the appropriate risk group and treatment.
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Affiliation(s)
- Paolo Angelo Cortesi
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | - Alessandro Maloberti
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy; Cardiology 4, "A. De Gasperis" Department, Niguarda Ca Granda Hospital, Milan, Italy.
| | - Mariangela Micale
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | - Federica Pagliarin
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | | | - Giampiero Mazzaglia
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | - Cristina Giannattasio
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy; Cardiology 4, "A. De Gasperis" Department, Niguarda Ca Granda Hospital, Milan, Italy
| | - Lorenzo Giovanni Mantovani
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy; IRCCS Multimedica, Sesto San Giovanni, Italy
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Cortesi PA, Tamburino D, Facchetti R, Micale M, Mantovani LG, Crippa S, Capurso G. Benefit and costs of surveillance on cancer risk patients: the example of pancreatic cystic tumors. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Increasing number of expert recommendations and guidelines of cancer surveillance have become available in the last decade. This complex scenario have increased the uncertainty on the most valuable approach to adopt. This study aim to evaluate the case of premalignant pancreatic primarily cystic tumors surveillance, assessing the differences of programmes proposed and applied.
Methods
A review of American, European and International guidelines for surveillance of asymptomatic neoplastic pancreatic cysts was performed to assess the difference of programmes proposed. An amibispective observational study, form 1995 to 2019, was conducted on patients with premalignant pancreatic primarily cystic tumors monitored in 10 centers from 4 European countries. We estimated incidence of pancreatic cancer and surgery intervention for high grade dysplasia (HGD)/Pancreatic cancer. We also assessed the follow-up visits and exams frequency during the surveillance period and the relative mean cost per patient-year.
Results
The guidelines reported significant differences in patient’s stratification, surveillance intensity (frequency of visits-exams), and surveillance duration. In the study conducted, 961 patients were enrolled with a median (IQR) follow-up of 4.47(2.8-7.0) years. HGD or Pancreatic carcinoma was reported by 43(4.4%) patients and 67(7.0%) undergone pancreatic surgery. Within the pancreatic surgery performed, 60.6% was rated as over-treated (None/low-moderate grade dysplsya). A big variability was reported in the surveillance with a median (IQR) visit per patient-year of 0.77(0.49-1.03) and with a mean cost per-patient year of €163.3.
Conclusions
Significant heterogeneity between surveillance approaches was reported in guidelines and clinical practice. Reliable and specific data on efficacy and costs associated to surveillances programmes proposed are needed in order to perform robust assessment and help decision makers in implementing the most valuable one.
Key messages
Significant variability of surveillance programmes proposed and applied for pancreatic cystic are reported in the guidelines and clinical practice. We need more robust efficacy and costs data in order to identify the most valuable surveillances approach to implement in clinical practice and recommend in the national and international guidelines.
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Affiliation(s)
- P A Cortesi
- Research Centre on Public Health, University of Milan Bicocca, Monza, Italy
| | - D Tamburino
- Division of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Milan, Italy
| | - R Facchetti
- Research Centre on Public Health, University of Milan Bicocca, Monza, Italy
| | - M Micale
- Research Centre on Public Health, University of Milan Bicocca, Monza, Italy
| | - L G Mantovani
- Research Centre on Public Health, University of Milan Bicocca, Monza, Italy
- IRCCS Multimedica, Sesto San Giovanni, Italy
| | - S Crippa
- Division of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - G Capurso
- Vita-Salute San Raffaele University, Milan, Italy
- Clinical Research, Pancreato-Biliary Endoscopy and EUS Divis, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Cortesi PA, Barca R, Giudicatti G, Mossini S, Ciaccio A, Iannazzo S, Micale M, Cesana G, Mantovani LG. Systematic review: economic evaluations of HCV screening in the direct-acting antivirals era. Aliment Pharmacol Ther 2019; 49:1126-1133. [PMID: 30843268 DOI: 10.1111/apt.15201] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 11/26/2018] [Accepted: 02/01/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND The World Health Organization estimated that 90% of the infected people need to be diagnosed and 80% need to be treated to reach the aim of hepatitis C virus (HCV) elimination by 2030. For this reason, all possible strategies to detect and treat HCV-infected people need to be carefully evaluated to implement the best one. AIM To review and synthesise the economic evaluations of HCV screening programs conducted in the era of direct-acting antiviral agents regimens. METHODS A systematic literature review was conducted until April 2018 to provide information on the costs and effectiveness of HCV screenings in direct-acting antiviral agents era. A critical assessment of the quality of economic evaluations retrieved was conducted. RESULTS The literature search identified 716 references; 17 of them assessed cost and effectiveness of screening programs and antiviral treatments in different populations: general population (n = 7), drug users (n = 5), high-risk populations (n = 4) and other populations (n = 3). The HCV screening and direct-acting antiviral agents treatment appear to be good value for money, both in general and high-risk populations, if a cost per quality adjusted life years of $50 000 is set as willingness to pay threshold. Some studies showed the value of including lower stage of fibrosis in the treatment selection criteria. CONCLUSIONS Several HCV screening strategies plus direct-acting antiviral agents treatments resulted cost-effectiveness in different populations. However, there is still need of country and population-specific evaluations within the different HCV screening and treatment strategies available, in order to assess their cost-effectiveness and sustainability and fully support an evidence-informed policy for HCV elimination.
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Affiliation(s)
- Paolo Angelo Cortesi
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | - Roberta Barca
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | - Giulia Giudicatti
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | - Sergio Mossini
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | - Antonio Ciaccio
- Unit of Gastroenterology, Department of Medicine, Hospital San Gerardo, Monza, Italy.,International Center for Digestive Health, University of Milan-Bicocca, Monza, Italy
| | - Sergio Iannazzo
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy.,SIHS Health Economics Consulting, Turin, Italy
| | - Mariangela Micale
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | - Giancarlo Cesana
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
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D'Angiolella LS, Cortesi PA, Rocino A, Coppola A, Hassan HJ, Giampaolo A, Solimeno LP, Lafranconi A, Micale M, Mangano S, Crotti G, Pagliarin F, Cesana G, Mantovani LG. The socioeconomic burden of patients affected by hemophilia with inhibitors. Eur J Haematol 2018; 101:435-456. [DOI: 10.1111/ejh.13108] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2018] [Indexed: 01/19/2023]
Affiliation(s)
| | - Paolo A. Cortesi
- Research Centre on Public Health (CESP); University of Milano Bicocca; Monza Italy
| | - Angiola Rocino
- Hemophilia & Thrombosis Centre; San Giovanni Bosco Hospital; Naples Italy
| | - Antonio Coppola
- Regional Reference Center for Inherited Bleeding Disorders; University Hospital of Parma; Parma Italy
| | - Hamisa J. Hassan
- Department of Oncology and Molecular Medicine; Istituto Superiore di Sanità; Rome Italy
| | - Adele Giampaolo
- Department of Oncology and Molecular Medicine; Istituto Superiore di Sanità; Rome Italy
| | - Luigi P. Solimeno
- Division of Orthopaedic Surgery and Traumatology; Fondazione IRCCS Ca’ Granda; Ospedale Maggiore Policlinico; Milan Italy
| | | | - Mariangela Micale
- Research Centre on Public Health (CESP); University of Milano Bicocca; Monza Italy
| | - Sveva Mangano
- Research Centre on Public Health (CESP); University of Milano Bicocca; Monza Italy
| | - Giacomo Crotti
- Research Centre on Public Health (CESP); University of Milano Bicocca; Monza Italy
| | - Federica Pagliarin
- Research Centre on Public Health (CESP); University of Milano Bicocca; Monza Italy
| | - Giancarlo Cesana
- Research Centre on Public Health (CESP); University of Milano Bicocca; Monza Italy
| | - Lorenzo G. Mantovani
- Research Centre on Public Health (CESP); University of Milano Bicocca; Monza Italy
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D'Angiolella LS, Cortesi PA, Lafranconi A, Micale M, Mangano S, Cesana G, Mantovani LG. Cost and Cost Effectiveness of Treatments for Psoriatic Arthritis: A Systematic Literature Review. Pharmacoeconomics 2018; 36:567-589. [PMID: 29441473 DOI: 10.1007/s40273-018-0618-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Psoriatic arthritis is a long-term inflammatory arthropathy occurring in a subgroup of patients with psoriasis. In addition to irreversible bone erosions, joint destruction, and skin manifestations, psoriatic arthritis is associated with numerous comorbid conditions. Over the last 5 years, new treatments emerged; the analysis and comparisons of their additional costs and the added benefits have become increasingly important to optimize the limited resources available. METHODS A systematic literature review covering PubMed, EMBASE, and the Cochrane Library was performed from May 2012 to October 2017 focusing on the most recent evidence of costs, benefits, and burden of psoriatic arthritis and its treatments. All economic evaluations assessing the burden of patients with psoriatic arthritis and written in English were eligible for inclusion. We also performed an assessment of the quality of the studies. RESULTS Of the 1652 references found in the literature search, nine cost-effectiveness analyses and 12 cost-of-illness studies were included in the current review. Patients with psoriatic arthritis incur substantially higher direct and indirect costs, as compared with patients with psoriasis without arthritis or patients with other inflammatory diseases. The cost of treatment with biologic therapies is the major predictor of the total cost. However, individuals with psoriatic arthritis are also affected by substantial productivity losses and indirect costs. Biologic therapies are generally cost effective vs. conventional therapies (e.g., synthetic drugs) for treating psoriatic arthritis. CONCLUSIONS Psoriatic arthritis is associated with a significant economic burden and biologic therapies contribute significantly to these costs. Biologic therapies are more effective than disease-modifying anti-rheumatic drugs for the symptoms and signs of psoriatic arthritis and for improving quality of life and inhibiting structural radiological damage. Therefore, biologic therapies are cost effective compared with conventional therapies: the increased direct cost associated with biologic drugs is offset by the significant improvement in the efficacy of treatments and in patient management of psoriatic arthritis.
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Affiliation(s)
- Lucia Sara D'Angiolella
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Via G. Pergolesi 33, 20900, Monza, Italy
| | - Paolo Angelo Cortesi
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Via G. Pergolesi 33, 20900, Monza, Italy
| | - Alessandra Lafranconi
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Via G. Pergolesi 33, 20900, Monza, Italy
| | - Mariangela Micale
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Via G. Pergolesi 33, 20900, Monza, Italy
| | - Sveva Mangano
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Via G. Pergolesi 33, 20900, Monza, Italy
| | - Giancarlo Cesana
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Via G. Pergolesi 33, 20900, Monza, Italy
| | - Lorenzo Giovanni Mantovani
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Via G. Pergolesi 33, 20900, Monza, Italy.
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Cortesi PA, D'Angiolella LS, Lafranconi A, Micale M, Cesana G, Mantovani LG. Modern Treatments of Haemophilia: Review of Cost-Effectiveness Analyses and Future Directions. Pharmacoeconomics 2018; 36:263-284. [PMID: 29170896 DOI: 10.1007/s40273-017-0588-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Cost is currently one of the most important aspects in haemophilia care. Factor concentrates absorb more than 90% of healthcare direct costs of haemophilia care, and the debate regarding the high cost of haemophilia treatments and their different use across different countries is increasing. OBJECTIVE The objective of this study was to review cost-effectiveness analyses conducted on treatment options in haemophilia, focusing on their results and their strengths and limitations; to highlight the possible issues associated with economic evaluations of new treatment options. METHODS Electronic searches in PubMed and EMBASE were performed to retrieve papers published between November 2015 and September 2017 to update the previous review of economic evaluations of haemophilia treatments by Drummond et al. Reference lists of included articles and reviews were examined for relevant studies, which were assessed for their quality and their empirical results. RESULTS Twenty-six relevant economic analyses were identified; 15 (57.7%) were conducted in patients with haemophilia with inhibitors while 11 (42.3%) involved patients without inhibitors. There were methodological variations among the included studies, and differences in the treatment schemes make a comparative assessment of interventions for patients with haemophilia difficult. Only immune tolerance induction showed consistent results in its cost-saving profile compared with the treatment with bypassing agents. CONCLUSIONS Economic evaluations of haemophilia treatments are increasing, but the identification of general cost-effectiveness trends is still difficult in these studies. We are now facing a new era in haemophilia management with a soaring need for high-quality economic evaluations, performed through proactive collaboration between clinical experts, budget holders and health economists.
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Affiliation(s)
- Paolo A Cortesi
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Via G. Pergolesi 33, Monza, 20900, Italy
| | - Lucia S D'Angiolella
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Via G. Pergolesi 33, Monza, 20900, Italy
| | - Alessandra Lafranconi
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Via G. Pergolesi 33, Monza, 20900, Italy
| | - Mariangela Micale
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Via G. Pergolesi 33, Monza, 20900, Italy
| | - Giancarlo Cesana
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Via G. Pergolesi 33, Monza, 20900, Italy
| | - Lorenzo G Mantovani
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Via G. Pergolesi 33, Monza, 20900, Italy.
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Capetti AF, Micale M, Carenzi L, Niero F, Landonio S, Vimercati S, Dedivitiis G, Rizzardini G. Strategic use of dual regimens of boosted protease inhibitors plus maraviroc in poorly adherent subjects in view of long-acting drugs: A retrospective study. Medicine (Baltimore) 2017; 96:e5728. [PMID: 28207500 PMCID: PMC5319489 DOI: 10.1097/md.0000000000005728] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In view of the forthcoming long-acting antiretrovirals, measures should be taken to prevent the selection of HIV drug resistance mutations. All subjects who had been switched to boosted protease inhibitors plus maraviroc (bPIs/MVC) with baseline HIV-1 RNA >50 copies/mL between June, 2014, and April, 2015, were retrospectively evaluated. HIV-1 RNA, CD4+ T-cells, serum glucose, creatinine, ALT, and adverse events were controlled every 3 to 4 months. We retrospectively analyzed 44 patients: 18 were taking darunavir/ritonavir (DRV/r) and 26 atazanavir/ritonavir (ATV/r) once daily, plus MVC 300 mg once daily. Seven subjects were in CDC stage C. All had a follow-up of at least 24 weeks, 28 exceeded 48 weeks, and 21 exceeded 72 weeks. All had experienced at least 1 viral failure and had selected at least 1 resistance-associated mutation (RAM). At baseline, 38 had plasma HIV-1 RNA 50-499 copies/mL and 6 had ≥500. At week 24, none had viremia >500 and 30 (68.2%) had suppressed HIV-1 RNA below 50 copies/mL. Of the subgroup with 48 weeks' follow-up, 23 had HIV-1 RNA 50-499 copies/mL, 5 had ≥500, and 20/28 suppressed to <50 copies/mL. Of the longest observed subgroup (72 weeks), 17 had HIV-1 RNA 50-499 copies/mL, and 4 had ≥500 copies/mL and 15/21 (71.4%) suppressed to <50 copies/mL. This combination allowed fair suppression of viral replication, with minor genotypic evolution in 6 subjects, and seems to be a feasible strategy to prevent damaging future options.
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Affiliation(s)
| | | | | | | | | | | | | | - Giuliano Rizzardini
- 1st Division of Infectious Diseases
- Whitwaterstrand University, Johannesburg, South Africa
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Micale M. Charcot and Les Névroses Traumatiques: historical and scientific reflections. Rev Neurol (Paris) 1994; 150:498-505. [PMID: 7754283] [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: 01/27/2023]
Abstract
Between 1878 and 1893, Jean-Martin Charcot published over twenty detailed case histories dealing with what he termed "traumatic hysteria" and what today would be labelled the psychoneurology of trauma. Charcot's cases record a highly diverse clinique tableau of symptoms. Etiologically, Charcot posited a dual model of a hereditary diathèse, or constitutional predilection to nervous degeneration, and an environment agent provocateur. Increasingly during the 1880s, he emphasized the role of "psychical shock". These writings of Charcot also exhibit many of the same, superb clinical qualities that distinguish his work on other medical topics. Charcot isolated several hystero-traumatic formations and provided outstanding clinical depictions of subgenres of the disorder, most notably brachial monoplegias. His clinical demonstrations of the differential diagnosis of organic and functional post-traumatic pathologies represent Charcot the virtuoso neurologist at his finest. Taken together, these writings offer a penetrating exploration of the complex and elaborate functional sequelae of minor bodily injury and the phenomenon of traumatic psychogenic somatic symptom-formation. The revival today of medical interest in psycho-traumatic pathology, particularly in the traumatic origins of dissociative states and post-traumatic stress disorders, provide an important context for the renewed appreciation of Charcot's work in this area.
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Affiliation(s)
- M Micale
- Department of History Yale University New Haven, Connecticut 06520, USA
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