The objective of this study was to estimate the indirect and direct non-health costs associated with spinal muscular atrophy (SMA), a disease that burdens the daily life of adults, children and their families in Italy. In order to develop the economic model, a multidisciplinary group of researchers was created to prepare and computerize a questionnaire, which was promoted by SMA families in collaboration with the Economic Evaluation and Heath Technology Assessment center at the University of Rome Tor Vergata. The analysis envisaged a first phase for implementing and validating the questionnaire by the multidisciplinary group. Subsequently, the questionnaire was computerized and sent out to be completed through all the association's distribution channels. The social channels and specific mailing lists were limited exclusively to SMA families. To achieve the sample number required by the research protocol, data collection began on January 8, 2018, and closed on April 15, 2018. Finally, all the data were analyzed using the economic model in order to estimate the average costs per patient.The questionnaire was able to identify a sample of 118 families (22.88% SMA I, 48.31% SMA II, 28.81% SMA III). The average age of the patients was 18.49 years (average age at diagnosis 2.88 years) with more females (55,08%) in the total respondents, taking into account a 4.24% rate of non-respondents. The economic model estimated an average annual cost per patient with SMA of €15.371,41 (€17.683,85 for SMA I, €15.974,78 for SMA II and €12.523,52 for SMA III). Of these costs, about 52% were attributable to indirect costs associated with caregivers, 15% for indirect costs associated with the patient and 4% for social security costs. A total of 17% was attributable to the direct costs incurred by the patient and 12% was attributable to the direct costs incurred by the Italian National Health Service (SSN).To our knowledge, this survey represents the first nationwide analysis estimating the costs incurred by families for the management of SMA. This study highlights the need for specific policies to support families who must live with the disease, not only from the standpoint of their compromised quality of life but also due to the significant economic burden imposed by the disease.
Seasonal influenza is caused by two subtypes of influenza A and two lineages of influenza B. Although trivalent influenza vaccines (TIVs) contain both circulating A strains, they contain only a single B-lineage strain. This can lead to mismatches between the vaccine and predominant circulating B lineages, a concern especially for at-risk populations. Quadrivalent influenza vaccines (QIVs) containing a strain from both B lineages have been developed to improve protection against influenza. Here, we used a cost-utility model to examine whether switching from TIV to QIV would be cost-effective for the at-risk population in Italy. Costs were estimated from the payer and societal perspectives. The discount rate for outcomes was 3.0%. Univariate and probabilistic sensitivity analyses were performed to examine the effects of variations in parameters. Switching from TIV to QIV in Italy was estimated to increase quality-adjusted life-years (QALYs) and produce cost savings, including €1.6 million for hospitalization and approximately €2 million in productivity. The incremental cost-effectiveness ratio was €23,426 per QALY from a payer perspective and €21,096 per QALY from a societal perspective. Switching to QIV was most cost-effective for individuals ≥ 65 years of age (€19,170 per QALY). Probabilistic sensitivity analysis showed that the switching from TIV to QIV would be cost-effective for > 91% of simulation at a maximum willingness-to-pay threshold of €40,000 per QALY gained. Although the model did not take herd protection into account, it predicted that the switch from TIV to QIV would be cost-effective for the at-risk population in Italy.
Background and Objective: Acute bacterial skin and skin structure infections have been defined by Food and Drug Administration (FDA) in 2013 to define a subset of complicated skin and skin structure infections commonly treated with parenteral antibiotic therapy. Inpatient treatment of ABSSSIs involves a significant economic burden on the health-care system. This study aimed to evaluate the economic impact on National Health System associated with the management of non-severe ABSSSIs treated in hospitals with innovative long-acting dalbavancin compared to standard antibiotic therapy in Italy, Spain and Austria.Methods: A Budget Impact Analysis was developed to evaluate the direct costs associated with the management of ABSSSI from the national public health system perspective. The model considered the possibility to early discharge patients directly from the Emergency Department (ED), after one night in the hospital or after 2 or 3 night in the hospital. A scenario with Standard of Care was compared with dalbavancin scenario, where patients had the possibility of being early discharged. The epidemiological and cost parameters were extrapolated from national administrative databases and from a systematic literature review for each Country. The analysis was conducted in a 3-year time horizon. A one-way deterministic sensitivity analysis was conducted to examine the robustness of the results. Results:The model estimated an average annual number of patients with non-severe ABSSSI in Italy, Spain and Austria equal to 5,396, 7,884 and 1,788 respectively. A total annual expenditure of about € 9.9 million, € 13.5 million and € 3.4 million was estimated for treating the full set of ABSSSI patients in Italy, Spain and Austria respectively. Dalbavancin reduced the in-hospital length of stay in each Country. In the first year of its introduction, Dalbavancin significantly reduced the total economic burden in Italy and Spain (-€ 352,252 and -€ 233,991) while it increased the total economic burden in Austria (€ 80,769, 0.7% of the total expenditure for these patients); in the third year of its introduction, Dalbavancin reduced the total economic burden in each Country (-€ 1,1 million, -€ 810,650, -€ 70,269 respectively). Conclusions:The introduction of dalbavancin in a new patients pathway to treat non-severe aBSSSI, could generate a significant reduction of hospitalized patients and the overall patient's length of stay in hospital Key Points:-Dalbavancin reduces the in-hospital length of stay in each Country.-The introduction of dalbavancin in a new patients pathway to treat non-severe aBSSSI could reduce the total economic burden in each Country.
BackgroundThe association of recombinant FSH plus recombinant LH in 2:1 ratio may be used not only to induce ovulation in anovulatory women with hypogonadotropic hypogonadism but also to achieve multiple follicular developments in human IVF. The aim of this analysis was to estimate the cost-effectiveness of Controlled Ovarian Stimulation (COS) with recombinant FSH (rFSH) plus recombinant LH (rLH) in comparison with highly purified human menopausal gonadotropin (HP-hMG) in the woman undergoing in vitro fertilization (IVF) in Italy.MethodsA probabilistic decision tree was developed to simulate patients undergoing IVF, either using r-FSH + r-LH or HP-hMG to obtain COS. The model considers the National Health System (NHS) perspective and a time horizon equal to two years. Simulations were reported considering the number of retrieved oocytes (5–9, 10–15 and > 15) and transition probabilities were estimated through specific analyses carried out on the population of 848 women enrolled in the real-life.ResultsThe model estimated that patients undertaking therapeutic protocol with r-FSH + r-LH increase the general success rate (+ 6.6% for pregnancy). The incremental cost-effectiveness ratio (ICER) per quality-adjusted life year (QALY) of r-FSH + r-LH was below the willingness to pay set at €20,000 for all the considered scenarios.ConclusionsThe cost-utility analysis demonstrated that the r-FSH + r-LH is a cost-effective option for the Italian National Health System (NHS).
This study may represent a useful tool to understand the economic burden associated with the management of irAEs associated with patients affected by metastatic melanoma.
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