Background: Tyrosinemia type I is a rare but severe genetic metabolic disorder. Nitisinone combined with a diet low in tyrosine and phenylalanine became first-line therapy in 1994.Objectives: To estimate the direct medical costs of health care services related to the treatment of tyrosinemia type I, taking into consideration the real-life efficacy of nitisinone.Methods: A cost-consequence analysis was performed for all children with a confirmed diagnosis of tyrosinemia type I who were treated in
Over the past 15 years, the number of studies investigating the potential teratogenic effects of antidepressants has drastically increased. Prescribing antidepressants during pregnancy is becoming a challenge for health care providers because of conflicting data on their teratogenic potential. A critical systematic review of studies describing the relationship between antidepressant use during pregnancy and its impact on congenital malformations, prematurity, low birth weight (LBW), and child development was undertaken to summarize the current evidence-based findings. Most antidepressants do not pose a major teratogenic risk, although the data supporting this conclusion vary from one type to another. While SSRIs and tricyclics have been examined in a considerable number of studies, only scarce data is available on new antidepressants. The use of paroxetine during organogenesis has been linked to an increase in the risk of cardiovascular malformations. The impact of prenatal exposure to antidepressants on prematurity and LBW remains controversial, and most studies evaluating these outcomes are limited by their small sample size and lack of adequate reference group. Finally, information on the long-term effects of gestational antidepressant use on child development is only starting to emerge, and existing information is too limited to determine the risk.
Le norme nazionali sulla lungodegenza post-acuzieLa normativa nazionaleLe indicazioni dell’AgenasPresenza e attività della lungodegenza post-acuzieI posti letto e l’attività svoltaI ricoveri di lungodegenza post-acuzieL’organizzazione della lungodegenza nelle regioni italiane Le previsioni dei posti letto Le tipologie di lungodegenza L’utenza e il mandato La durata della degenza La collocazione e le dimensioni I collegamenti funzionali Modalità assistenziali ed organizzative Il personale I requisiti strutturali e tecnologici Indicatori di efficacia ed efficienza Le tariffe ospedaliereConclusioniBibliografiaNorme nazionali di riferimentoNormativa regionale
INTRODUCTION:Decision makers worldwide face the challenge of offering the best health care within a context of scarce resources. Technological developments have multiplied in the past decades, with the lifecycle of technologies becoming shorter. As a result, the traditional Health Technology Assessment (HTA) model is often caught in a too early, too late syndrome. In the province of Québec (Canada), there is no standardized process for assessing non-pharmaceutical technologies for reimbursement purposes, and technologies are therefore introduced via multiple sources. There are concerns that the introduction of some of the most promising technologies is delayed, and on the contrary, that others are introduced without providing a real added value to patients and the health system.METHODS:INESSS (Institut national d'excellence en santé et services sociaux), collectively with stakeholders of the Québec innovation field, has developed a dynamic process for assessing the added value of innovative technologies. POETIS (Processus optimisé d'évaluation des technologies innovantes en santé) aims to identify the technologies with the highest potential for positive impact on patients and the health system, in order to accelerate their implementation and promote their optimal use.RESULTS:POETIS comprises four phases aligned with the lifecycle of technologies: research and development, pre-implementation, limited implementation, and diffusion. It allows a continuum of assessment, from the promise of a technology to its real-world benefit. It differs from other approaches because of the sustained involvement of key stakeholders, including patients, and because it assesses technologies iteratively, therefore fostering their adaptation to better suit patients needs. It is hoped for the first technologies to be assessed in 2017.CONCLUSIONS:HTA has to adapt to the challenges of innovation, and this could be done with a lifecycle approach and an enhanced collaboration with end-users. Developed in Canada, the goals behind POETIS are common to many countries and the process could be adapted by other HTA agencies.
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