Una misura di Performance dei SSR. 3. edizione

Il progetto “Una misura di Performance dei SSR”, giunto alla sua terza annualità, ha come obiettivo quello di contribuire alla valutazione della Performance dei servizi sanitari e, parallelamente, allo sviluppo di metodologie di valutazione innovative; focalizzandosi su due aspetti specifi ci: la multidimensionalità della Performance e la composizione delle diverse prospettive di cui sono portatori gli stakeholder del sistema. Il team di ricerca di C.R.E.A. Sanità (Consorzio per la Ricerca Economica Applicata in Sanità) – dell’Università di Roma Tor Vergata ha proposto e sviluppato un metodo originale basato sulla elicitazione delle Utilità attribuite alle varie dimensioni di Performance. Il Progetto è stato reso possibile grazie al contributo di un qualifi cato panel di Esperti, nonché al contributo incondizionato offerto da un gruppo di aziende del settore medicale. Per memoria (si vedano i report conclusivi delle precedenti edizioni del progetto Performance) sin dalla prima annualità (2013), prevalentemente dedicata allo sviluppo e alla implementazione della metodologia, si è confermata la dipendenza della misura di Performance dalle prospettive adottate dai diversi stakeholder. Tale evidenza si è poi confermata nella seconda edizione, in cui il metodo è stato nuovamente applicato aumentando i componenti del panel e il set di indicatori: dalla seconda edizione una particolare attenzione è stata posta alla analisi delle differenze di risultati rispetto a quanto emerso nella prima edizione, anche al fi ne di valutare la coerenza del metodo e la riproducibilità dei risultati. In questa terza edizione, oltre ad un ulteriore aumento sia del numero di componenti del panel, che ha raggiunto le 73 presenze, sia del numero di indicatori (tra i quali il panel ne ha poi selezionati dodici ritenuti maggiormente rappresentativi a fi ni della misura della Performance dei SSR), si è ulteriormente lavorato per migliorare il processo di elicitazione delle preferenze, e anche il relativo software utilizzato per la conduzione dell’esperimento. Osserviamo come, in tutte e tre le edizioni, si sia confermata la effettiva dipendenza del ranking dalla prospettiva adottata, oltre che, ovviamente, dal set di indicatori scelto, e anche dal “valore” attribuito ai loro livelli; gli esperimenti condotti hanno anche permesso di apprezzare, e in quest’ultima edizione si è nuovamente confermato, come il contributo delle diverse dimensioni alla Performance si modifi chi nel tempo, in modo peraltro sostanzialmente coerente con l’evoluzione del quadro di politica sanitaria.Grazie al fatto che in quest’ultima edizione sono stati confermati cinque indicatori già prescelti nella precedente, è stato inoltre possibile analizzare la “stabilità” del “valore” attribuito ai livelli degli indicatori: in effetti questo sembra dipendere dalla categoria di stakeholder (ovvero dalla prospettiva), ma che rimanga sostanzialmente stabile nel tempo. Di seguito si fornisce una descrizione analitica della metodologia, i risultati ottenuti dall’esercizio di elicitazione delle preferenze ed un confronto dei ranking ottenuti con gli esiti di altri sistemi di valutazione dei SSR oggi in uso

Cost-Effectiveness of Vaccination with the 20-Valent Pneumococcal Conjugate Vaccine in the Italian Adult Population

The availability of a new 20-valent pneumococcal conjugate vaccine (PCV) makes it appropriate to assess its cost-effectiveness. This was evaluated by adopting the Italian National Health Service perspective, using a cost consequences Markovian model. The expected effects of vaccination with 20-valent PCV were compared with the administration of 13-valent PCV and 15-valent PCV. Assuming a 100% vaccination of cohorts aged 65–74 years, in the (lifetime) comparison between 20-valent PCV and 13-valent PCV, the former is dominant (lower cost for a better health outcome). A reduction in disease events was estimated: −1208 deaths; −1171 cases of bacteraemia; −227 of meningitis; −9845 hospitalised all-cause nonbacteremic pneumonia cases (NBP) and −21,058 non-hospitalised. Overall, in the Italian population, a total gain of 6581.6 life years and of 4734.0 QALY was estimated. On the cost side, against an increase in vaccinations costs (EUR +40.568 million), other direct health costs are reduced by EUR 48.032 million, with a net saving of EUR +7.464 million. The comparison between 20-valent PCV and 15-valent PCV results in an Incremental Cost-Effectiveness Ratio (ICER) of EUR 66 per life year gained and EUR 91 per QALY gained. The sensitivity analyses confirm the robustness of the results. We can conclude that the switch to 20-valent PCV is a sustainable and efficient investment

Prevalenza della fibrillazione atriale, eleggibilità al trattamento e consumo di anticoagulanti orali nelle Aziende Sanitarie italiane: impatto dei nuovi anticoagulanti

Background. Atrial fibrillation (AF) increases significantly the risk of comorbidities and premature death. This paper aims to estimate: 1) the current prevalence of AF in Italy as a whole and within individual local health authorities (LHA); 2) the proportion of strongly eligible patients receiving oral anticoagulants; 3) the impact of non-vitamin K antagonist oral anticoagulants (NOACs). Methods. The prevalence of AF and the proportion of patients strongly eligible for anticoagulant treatment (defined by a CHADS2 score ≥2) were obtained by applying the results of a systematic literature search to the Italian population stratified by gender, age and LHA. The consumption of oral anticoagulants in eligible patients within each LHA was derived from Intercontinental Marketing Services data. Results. Altogether, the detected prevalence of AF in Italy is 1.7%, i.e. 1 036 448 cases. Of these, 62.6%, i.e. 648 832 subjects, are estimated to have a CHADS2 ≥2 and therefore strongly eligible for anticoagulant treatment. The estimated percentage of eligible treated patients in 2015 was 43.7%, significantly greater compared to 2014 (31.3%), with local and regional variabilities. In 2015 the estimated use of NOACs for AF was 36.4% of all oral anticoagulants, with marked local and regional variabilities. NOAC prescription appears influenced by financial limitations and by factors related to the network of anticoagulation services. Conclusions. The present analysis shows a prevalence of AF in Italy of 1.7%. The overall rate of anticoagulant use is increasing, but is still insufficient, with marked regional and local variations. In 2015, approximately one third of oral anticoagulation in eligible patients was based on NOACs

Il dimensionamento ottimale delle Unità Farmaci Antiblastici in condizioni di efficienza gestionale

Introduction The Recommendation n. 14 of 2012 of Ministry of Health, regarding the prevention of errors in therapy, in the oncological sector, provides for the institution of a Centralized Unit for cytotoxic drug or the possibility to make covenants with others hospitals where the compounding is made in a centralized way.This study aims to define a methodology to detect reference standard about technological sizing (manual or robotic workstations) and number of professionals working in the Centralized Unit for cytotoxic drug. Materials and Methods A specific model has been made in order to simulate scenarios of sizing based on structural and organizational features, and activities defined by the users. The model allows, in particular, to determine the medium cost of a cytotoxic compound, depending on configuration of Centralized Unit for cytotoxic drug adopted, by defining a reference value or standard cost helpful to regulate the covenants between hospitals. Results Evidently, by increasing the number of compounds the needs in terms of personnel and technologies increases: the simulation model, based on hypothesis described, estimated for the minimum sizing, until 90 compounds per die, 1 pharmacist and 2 technicians/nurses. The maximum one, expected per 230-250 compounds per die was of 3 pharmacists and 7 technicians/nurses; in terms of technological sizing it moved from 1 workstation until 90 compounds per die to 3 when the number of compounds became double. Regarding the compound’s cost there were potential important economies of scale: from € 15.6 with 1 workstation and about 80 compounds per die, to € 13.8 (-11.5%) with 2 workstations and about 160 compounds per die, until € 13.2 (-15.4) with 3 workstations and 230 compounds per die. Conclusions The results obtained through the simulation model agree with the quantitative data reported in regulations, available to date, by ensuring about the correctness of scenarios. They could represent a standard to support the regional and local health planning by allowing an optimal management of centralized compounding of cytotoxic therapies, by ensuring the maximum efficiency

Comparison of three treatment protocols with intra-articular low or intermediate molecular weight hyaluronic acid in early symptomatic knee osteoarthritis

Introduction: Viscosupplementation with hyaluronic acid (HA) is indicated for non-responders to non-pharmacological therapy, to analgesics or when non-steroidal anti-inflammatory drugs (NSAIDs) are contraindicated. The aim of this study is to compare the efficacy, safety and costs of three different HA treatments (Sinovial® Forte, sinovial one and hyalgan). Patients and methods: Ninety patients with grade I/II Kellgren–Lawrence knee osteoarthritis were included in three groups, the first was treated with hyalgan (weekly for 5 weeks), the second with Sinovial® Forte (weekly for 3 weeks) and the third group with a single injection of sinovial one. Results: All three treatments were effective, with an average reduction in the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) score of 18.9 points for hyalgan, 18.04 points for Sinovial® Forte and 17.92 points for sinovial one. The comparison of the three groups did not show any statistical difference in terms of efficacy. National health system (NHS) and social costs are, respectively, €419.12 and €853.43 for hyalgan, €338.64 and €599.22 for Sinovial® Forte, €221.56 and €308.42 for sinovial one. Conclusion: All three treatments were equally effective with no statistically significant differences; thus, the treatment with sinovial one may be considered as clinically effective as the other two regimens, but with a very efficient cost profile in early symptomatic knee osteoarthritis

Pilot health technology assessment study: organizational and economic impact of remote monitoring system for home automated peritoneal dialysis

Purpose Follow-up of automated peritoneal dialysis (APD) has been improved by data transmission by cellular modem and internet cloud. With the new remote patient monitoring (RPM) technology, clinical control and prescription of dialysis are performed by software (Baxter Claria-Sharesource), which allows the center to access home operational data. The objective of this pilot study was to determine the impact of RPM compared to traditional technology, in clinical, organizational, social, and economic terms in a single center. Methods We studied 21 prevalent APD patients aged 69 ± 13 years, on dialysis for a median of 9 months, for a period of 6 months with the traditional technology and 6 months with the new technology. A relevant portion of patients lived in mountainous or hilly areas. Results Our study shows more proactive calls from the center to patients after the consultation of RPM software, reduction of calls from patients and caregivers, early detection of clinical problems, a significant reduction of unscheduled visits, and a not significant reduction of hospitalizations. The analysis also highlighted how the RPM system lead to relevant economic savings, which for the health system have been calculated € 335 (mean per patient-month). With the social costs represented by the waste of time of the patient and the caregiver, we calculated € 685 (mean per patient-month). Conclusion In our pilot report, the RPM system allowed the accurate assessment of daily APD sessions to suggest significative organizational and economic advantages, and both patients and healthcare providers reported good subjective experiences in terms of safety and quality of follow-up