Budget impact analysis of the use of daclatasvir in Italy for the treatment of Hepatitis C Virus (HCV) genotype 3 patients

BACKGROUND: Hepatitis C Virus (HCV) infection represents a global health problem, leading to chronic cirrhosis, hepatocellular carcinoma (HCC), hepatic decompensation and liver transplant. The aim of the study was the evaluation of the impact on the budget of the Italian National Health Service (INHS) of the use of Daclatasvir (DCV) for the treatment of HCV genotype 3 in patients with advanced fibrosis.METHODS: An analytical decision model with a five year time horizon was implemented. Two scenarios were considered: a. 100% of market share for Interferon (INF-α)+Ribavirin (RBV)+Sofosbuvir (SOF) for 12 weeks; b. SOF+DCV+RBV for 24 weeks with annual market shares of 50% in 2015 and 2016, 55% in 2017 and 2018, 60% in 2019, and INF-α+RBV+SOF for 12 weeks with the remaining market shares. Every annual cycle a percentage of patients equal to the effectiveness of the antiviral treatment reach a sustained virologic response and during the first year of treatment patients may experience treatment related adverse events. The costs considered (2015) are those of the antiviral therapy, and direct medical costs for health state and adverse events management. Univariate and multivariate sensitivity analyses were performed.RESULTS: DCV would lead to an increase of the costs for the INHS (year 1 +21.31 millions, year 2 +21.35 millions, year 3 + 23.37 millions, year 4 + 23.26 millions and year 5 +16.37 millions). The sensitivity analysis confirmed the robustness of the results.CONCLUSIONS: The use of DCV is likely to have a short term impact on the INHS budget increasing resources use compared to the sole use of INF-α+RBV+SOF. However, a trend of reduction of the costs increase is observed due to the management of health states and adverse events which may lead to the possibility to reduce costs in the long term

Budget impact analysis of antiretroviral less drug regimen simplification in HIV-positive patients on the Italian National Health Service

Background: Deintensification and less drug regimen (LDR) antiretroviral therapy (ART) strategies have proved to be effective in terms of maintaining viral suppression in human immunodeficiency virus (HIV)-positive patients, increasing tolerability, and reducing toxicity of antiretroviral drugs administered to patients. However, the economic impact of these strategies have not been widely investigated. The aim of the study is to evaluate the economic impact that ART LDR could have on the Italian National Health Service (INHS) budget.Methods: A budget impact model was structured to assess the potential savings for the INHS by the use of ART LDR for HIV-positive patients with a 3 year perspective. Data concerning ART cost, patient distribution within different ARTs, and probabilities for patients to change ART on a yearly basis were collected within four Italian infectious diseases departments, providing ART to 13.7% of the total number of patients receiving ART in Italy.Conclusion: ART LDR simplification would have a significant impact in the reduction of ART-related costs within the hospitals involved in the study. These strategies could therefore be addressed as a sustainable answer to the public financing reduction observed within the INHS in the last year, allowing therapies to be dispensed without affecting the quality of the services provided.Results: The LDR investigated (protease inhibitor-based dual and monotherapies) led to savings for the hospitals involved when compared to the \u201cdo nothing\u201d scenario on a 3 year basis, between 6.7% (23.11 million \u20ac) and 12.8% (44.32 million \u20ac) of the total ART expenditures. The mean yearly cost per patient is reduced from 9,875 \u20ac in the do nothing scenario to a range between 9,218 \u20ac and 8,615 \u20ac. The use of these strategies within the four departments involved would have led to a reduction of ART expenditures for the INHS of between 1.1% and 2.1% in 3 years

Il processo di valutazione delle tecnologie sanitarie: proposta di due strumenti hospital-based per il monitoraggio e la valutazione dell'innovazione tecnologica

Gestione integrata d'aziend

Spunti di riflessione sul modello organizzativo per intensità di cura

This article aims to present and explore some of the subjects presented in the first issue of the journal MAPS - Review of Economics and Management for Health Professions, focused on the intensity of care. In particular, we wanted to analyze the trends and the reasons that lead to this organizational change, and to clarify the dichotomy between the medical point of view and that of nurses; last but not least, the article presents a statement of future prospects, which seem to lead from a patient-centered care to a person-focused care.Il presente articolo intende proporre e approfondire alcuni dei temi presentati all'interno del primo numero del quadrimestrale di prossima pubblicazione dal titolo "MaPS - Rivista di economia e management per le professioni sanitarie", incentrata sul tema dell'intensità di cura. In particolare si vogliono scandagliare i trend e le motivazioni alla base del cambiamento organizzativo che conduce sempre più spesso in tale direzione, nonchè chiarire la dicotomia tra intensità di cura e complessità assistenziale, e da ultimo offrire uno spunto sulle prospettive future, che sembrano condurre verso un'organizzazione ospedaliera incentrata non tanto sul paziente, quanto sulla persona