This study provides an updated epidemiological scenario of CHF in a primary care setting in Italy. These data may be useful to weight the social and economic impact of CHF and to plan strategies for improving the clinical care of CHF in general practice.

Background Multiple sclerosis (MS) is a chronic neuroinflammatory and neurodegenerative disease negatively impacting patients’ physical, psychological and social well-being with a significant economic burden. Objectives The study estimates MS burden and cost of illness in Italy from a societal perspective in 2019. Methods Information on the impact of the disease on daily activities, symptoms, employment, resource utilization and the role of caregivers was collected through questionnaires completed by 944 patients and caregivers. Results were stratified according to both disease severity and payer. Mean costs and overall costs were extrapolated from the sample to the Italian MS population considering published distribution of severity. Results The study showed a great impact of the disease on daily and work activities increasing with the disability. The overwhelming burden of fatigue emerged. Mean annual costs were estimated at €39,307/patient (€29,676, €43,464 and €53,454 in mild, moderate and severe cases, respectively). Direct healthcare costs were the major component (€21,069), followed by indirect costs (€15,004). The overall cost of the disease in Italy was €4.8 billion. The National Healthcare System (NHS) sustained most of the costs (80%), most notably direct healthcare costs, while patients paid almost all non-healthcare expenses. Conclusions This study confirmed that MS carries a substantial burden to patients and society, highlighting the need for awareness of this disease.

This analysis suggested no substantial gender differences. Further studies such as randomized population studies or meta-analysis of ACE inhibitors and ARBs randomized studies are needed to clarify whether gender differences exist in the safety profile of these drugs.

Background: Literature data indicate that migraine has a stronger impact on both healthcare consumption and quality of life (QoL) in women. Objectives: The objective of this article is to evaluate out-of-pocket (OoP) costs, productivity losses and cost of informal care of migraine in Italy, with a special focus on the detection of potential differences between male and female subjects. Methods: A cross-sectional study was conducted. Data were collected via a web-based survey platform, which included a socioeconomic questionnaire (five sections: clinical history; occupational status; informal assistance; visits, exams and treatments; and loss of productivity) and two questionnaires on QoL (EuroQol 5D 5L and Migraine-Specific Questionnaire, MSQ). Results: Six hundred and seven participants took part in the survey (average age of 42 years; female 70%). The duration of the attack (4-72 hours) was significantly much longer in women than in men (71% vs. 49%; p < 0.001). Seventy per cent of the sample reported to be employed. Lower income was associated with women (p < 0.001). Men received more informal assistance days than women (5.2 vs. 3.9 days; p = 0.007). The quarterly cost including OoP costs, informal assistance and lost productivity averaged €1,088 and was higher for men compared to women (€1,515 vs. €908; p < 0.001). The MSQ reported a significantly worse QoL for women. Conclusion: The results seemed to prove that migraine is a gender disease. Moreover, a potentially unequal access to informal assistance and healthcare resources not covered by the Italian National Health Service is highlighted for women because of their lower average income and purchasing power compared to men.

Background Fingolimod is the first oral agent approved for treatment of relapsing-remitting multiple sclerosis (RRMS). We aimed to evaluate fingolimod effectiveness in a real-world sample of RRMS patients. Methods A retrospective, multicentre study in patients treated with fingolimod, whom clinical and radiological data were collected in the 2 years preceding and following the initiation of fingolimod. Results Out of 414 patients, 56.8% received prior first-line injectable disease-modifying therapies, 25.4% were previously treated with natalizumab, 1.2% with immunosuppressant agents, and 16.7% were treatment naive. The annualized relapse rate decreased by 65% in the first year and by 70% after two years of treatment. Age ≤ 40 years, ≥ 1 relapse in the 24 months before fingolimod initiation and previous treatment with natalizumab were risk factors for relapses. Overall, 67.9% patients had no evidence of disease activity (NEDA-3) after 1 year and 54.6% after 2 years of treatment. A higher proportion of naïve (81.2% in 1 year and 66.7% after 2 years) or first-line injected patients (70.2% and 56.6%) achieved NEDA-3 than those previously treated with natalizumab (54.3% and 42.9%). Conclusions Fingolimod appeared to be effective in naive patients and after first-line treatment failure in reducing risk of relapse and disease activity throughout the 2-year follow-up.