Farmacoeconomia dei COXIB nella patologia osteoarticolare: revisione della letteratura

A new class of anti-inflammatory agents, the selective inhibitors of cyclooxygenase-2 (COXIBs), has been recently introduced into the market for the treatment of osteoarthritis and reumatoid arthritis. Randomized and controlled clinical trials showed a similar efficacy and a better tolerability profile of COXIBs compared with conventional non-steroidal anti-inflammatory drugs (NSAIDs). The aim of this study was to perform a scientific literature review relating to the economic impact produced by COXIBs' introduction. The research of references included the following databases: MEDLINE, EMBASE and the NHS (Economic Evaluation Database) of the York University. A total of 67 in extenso pubblications have been extracted. Of these 13 papers having the specific objective to evaluate the economic implications of COXIBs in comparison to conventional NSAIDs was analysed. In ten cases (77%), cost-effectiveness analyses were performed. The European context was considered in eight cases (62%), while that of North America and Asia were investigated in four and one case, respectively. The analysis of costs took always into account direct costs of the management of arthritis exclusively (drugs, and resources associated with the treatment of gastrointestinal side effects). Indirect and intangible costs were never considered. The results of this review highlight that the higher tollerability profile of COXIBs may generate a cost-saving. This cost-saving seems to be basically due to the reduced frequency of gastroprotective agents coprescription and also to a lesser appearance of severe gastrointestinal side effects compared with conventional NSAIDs. Besides the disease management improving, the cost-saving associated with COXIBs can completely or partially offset the net increase of expense induced by their higher price of purchase

LA SPESA FARMACEUTICA TERRITORIALE NELLE AZIENDE SANITARIE LOCALI: INDICATORI PER IL CONTROLLO E PER L'ALLOCAZIONE DELLE RISORSE

Despite the territorial pharmaceutical expenditure represents only about the 15% of the health expenditure, some features, as the high increase, the supply containment policies (even in the short period), the variability as to the volume of the services supplied, make it the cost item where the health managers focus there attention on. Such importance has gone growing during the last years due to two main groups of factors: the ones, demographic, scientific and epidemiological, which made its volume growing, the others, administrative and financial, which tried to restrain its growing due to the slowdown of the public resources. The Local Health Units (LHU) of the National Health Service, whose financial balances are under their responsibility according to the legislative decree 502/92, developed and begun to use some control indicators to guarantee a correct management of the pharmaceutical expenditure, a correct allocation of the resources available and a support for the managers decisions. Mostly, such indicators have been used for the drugs use assessment (in pieces and value), on the short period (one financial year) and threshold survey fields (pharmaceutical department). Nevertheless, do not assess the therapeutic practice (drugs use) and outcomes connected to the different therapeutic solutions (population health) caused some criticality, as the absence of a control system between applied and indicated processes (analysis of the variance as regards the therapeutic indications of efficacy and cost-efficacy of the drugs therapy) and the inducement to a change towards a control of the consumers rather than towards an increase of therapeutic appropriateness. The absence of a complete indicators system caused a situation of allocative inefficiency, as the same amount of resources available should have been used alternatively producing a better clinical and economic result, and this reduced the control of the LHU towards the several actors who wheel around the territorial pharmaceutical expenditure with different objectives. The project of this thesis was the investigation of the Ferrara LHU case which can give to this research results the generalization to an enough wide sample of health structures, as regards its demographic, social and consumer structure, as well as its business management and its control system. The project was carried out by the ratification of a “second level” control indicators package, in addition to those present, by the arrangement of information technologies and data processing methods, by the cooperation with the stakeholders charged by the LHU of the outcomes assessment. The project of this thesis, called ALARM project (Adherence to Long-term therapies: Assessment and Real practice Management), started on 2004, was renewed till 2010 with the cooperation of Centro di Ricerca in Economia e Management della Salute (CRISAL) of the Univerity of Ferrara, LHU of Ferrara, Ferrara Hospital, Azienda delle Farmacie Municipalizzate (AFM) of Ferrara, AstraZeneca Italia S.p.A. and Pfizer Italia S.p.A. The results of the study were object of presentations at several national and international congresses

The rotational spectrum of 15^{15}ND. Isotopic-independent Dunham-type analysis of the imidogen radical

The rotational spectrum of $^{15}$ND in its ground electronic $X^{3}\Sigma^{-}$ state has been observed for the first time. Forty-three hyperfine-structure components belonging to the ground and v = 1 vibrational states have been recorded with a frequency-modulation millimeter-/submillimeter-wave spectrometer. These new measurements, together with the ones available for the other isotopologues NH, ND, and $^{15}$NH, have been simultaneously analysed using the Dunham model to represent the ro-vibrational, fine, and hyperfine energy contributions. The least-squares fit of more than 1500 transitions yielded an extensive set of isotopically independent $U_{lm}$ parameters plus 13 Born--Oppenheimer Breakdown coefficients $\Delta_{lm}$. As an alternative approach, we performed a Dunham analysis in terms of the most abundant isotopologue coefficients $Y_{lm}$ and some isotopically dependent Born--Oppenheimer Breakdown constants $\delta_{lm}$ [R. J. Le Roy, J. Mol. Spectrosc. 194, 189 (1999)]. The two fits provide results of equivalent quality. The Born--Oppenheimer equilibrium bond distance for the imidogen radical has been calculated [$r_e^{BO}$ =103.606721(13) pm] and zero point energies have been derived for all the isotopologues.Comment: 11 pages, 1 figure, 8 tables. Accepted for publication in Phys. Chem. Chem. Phy

Achievement of therapeutic target in subjects on statin treatment in clinical practice. Results of the STAR (Statins Target Assessment in Real practice) study

The primary aim of the STAR Study (Statins Target Assessment in Real practice) was to determine the LDLcholesterol reduction and to analyse patient’s and therapeutic factors associated to LDL-cholesterol target attainment in newly treated subjects with statins in an unselected population in clinical practice setting. Administrative databases (including pharmaceutical prescriptions and hospital admissions) and laboratory test databases (including LDL-cholesterol values) of five Local Health Units, distributed in Emilia Romagna, Toscana and Umbria, were linked. A retrospective cohort study was conducted and all subjects aged ≥18 years with a first prescription for statins (newly treated subjects) between January 1st, 2007 and June 30th, 2008 were included. All statin prescriptions over a 12 months follow-up period were considered and used to calculate adherence to treatment. Baseline and follow-up LDL-cholesterol, respectively, were defined according to the nearest determination to the first prescription for statins and to the end of the follow-up period. A total of 3.232 subjects was included, 1.516 males (47%) and 1.716 females (53%), with an average age equal to 65,9 ± 11,3 years. Among included subjects, 22,6% had a gap to LDL-cholesterol target <10%, 30,0% between 10 and 29%, 20,7% between 30 and 49%, and 26,7% ≥50%. Among those with a gap to target ≥50%, 30-49%, and 10-29%, respectively, LDLcholesterol target was attained by 7,1%, 41,8%, and 62,3% of subjects. LDL-cholesterol target attainment was associated to gap to target, adherence with treatment, and type of statin

Pharmacoutilization of epoetins in na\uc3\uafve patients with hematological malignancies in an unselected italian population under clinical practice setting: A comparative analysis between originator and biosimilars

Aim: The purpose of this study was to assess the prescription of epoetins and consumption of health care resources (in terms of drug treatments) in na\uc3\uafve patients with hematological malignancies in a real-world setting; in particular, we compared the results between reference product and biosimilar products. Methods: An observational retrospective study based on administrative and laboratory databases of three local health units was conducted. All adults diagnosed with hematological malignancies and who had received at least one epoetin (either reference product or biosimilars) prescription for the first time between 1 January 2010 and 30 April 2012 (enrollment period) were included. The date of the first prescription of epoetin within the enrollment period was defined as index date (ID). Patients were followed up for 4 weeks after ID (follow-up period) and were investigated for the 1-year period before the ID. The difference between the last hemoglobin (Hb) measurement after ID and the one prior to ID (\uce\u94Hb) was evaluated. The drug cost analysis was conducted from the perspective of the Italian National Health System. Results: Overall, 69 patients were included in the study; 48 of them received reference epoetin product and 21 received biosimilars as first prescription. Among reference product users, the mean \uc2\ub1 standard deviation (SD) age was 62.5\uc2\ub114.7 years; this cohort of patients was slightly significantly younger than the biosimilar users (71.8\uc2\ub111.8 years). The mean \uc2\ub1SD overall Hb level prior to treatment was lower among patients who started with biosimilar products (9.6\uc2\ub11.1 g/dL) compared to those who started with a reference product (10.1\uc2\ub12.1 g/dL). No significant differences in \uce\u94Hb were observed between biosimilar and originator groups during the followup period. The mean \uef\u82\u81\uef\u81\ubd\uef\u80&nbsp;SD cost per patient was \ue2\u82\uac667.98\uc2\ub1573.93 and \ue2\u82\uac340.85\uc2\ub1235.73 for the reference product and biosimilar users, respectively (p=0.065). Conclusion: Our study showed that the use of biosimilar products might contribute to controlling health care costs (in terms of drug treatments) for patients with hematological malignancies being maintained by high-quality anemia therapy. Our findings also showed some discordances regarding the most appropriate therapeutic approach in daily clinical practice

Evaluation of the Impact of Catheter Ablation Procedure on Outcomes and Economic Burden in Patients with Atrial Fibrillation: Real-World Data from Italian Administrative Databases

A real-world analysis among the Italian population has been carried out to estimate the number of atrial fibrillation (AF) patients undergoing catheter ablation and to evaluate their clinical outcome and economic burden. A retrospective analysis on administrative Italian databases has been performed. Between January 2011 and December 2019, all patients diagnosed with AF were considered and those undergoing catheter ablation were identified. Overall, 3084 (3.54%) of AF patients with at least one catheter ablation were included (mean age 63.2, 67.3% males). A significant decrease in the use of AF-related medications and in hospitalizations, mainly related to AF and heart failure, was observed during the 3-year post-ablation period. The average total cost per patient during the 1-year before ablation period was significantly higher compared to the 1-year post-ablation cost (EUR 5248 vs. 4008, respectively; p &lt; 0.001). After propensity score matching, the overall mortality of patients who underwent ablation was significantly lower compared to that assessed in patients not treated with the procedure (9.386/1000 vs. 23.032/1000 person-year, respectively; p &lt; 0.001). Moreover, the mean total costs were significantly higher in patients who did not undergo ablation compared to those who received ablation (EUR 5516 vs. 4008, respectively; p &lt; 0.001). This real-world data analysis shows that in Italy, although catheter ablation is performed in a minority of AF patients, it is associated with significantly better post-procedure clinical outcomes and a significant reduction in healthcare-related costs

Terahertz spectroscopy and global analysis of the rotational spectrum of bis-deuterated amidogen radical ND_{2}

The deuteration mechanism of molecules in the interstellar medium (ISM) is still being debated. Observations of deuterium-bearing species in several astronomical sources represent a powerful tool to improve our understanding of the interstellar chemistry. In this scenario, the doubly-deuterated form of the amidogen radical could be a target of detection in space

Farmacoepidemiologia e farmacoeconomia della terapia anti-ipertensiva: uno studio osservazionale della popolazione della Asl di Ravenna

The aim of the paper was to perform a pharmacoepidemiological and pharmacoeconomic analysis of antihypertensive drug treatment. An administrative database kept by the Local Health Unit of Ravenna listing patient baseline characteristics, drug prescriptions and hospital admissions was used to perform a population-based cohort study. The study included all new users of antihypertensive drugs, 20 years of age or over receiving a first prescription for diuretics, beta-blockers, calcium channel-blockers, ACE inhibitors or angiotensin II antagonists (AIIAs) between January 1st, 2000 and December 31st, 2000. All prescriptions for anti-hypertensive drugs filled during the 12-months follow-up period were considered. Patients were classified as continuers, switchers and discontinuers on the basis of their prescription dynamics. A total of 14.062 patients were included in the study of whom only 39,7% resulted persistent at 12 months. Patients initially prescribed for AIIAs were more likely to continue antihypertensive treatment than those started on other drug classes as well as those with older age, concurrent drug therapies and previous hospitalisation for cardiovascular diseases. The overall cost of the study cohort for antihypertensive drugs amounted to 1.238.752,37 euros of which 80,6% was used for persistent patients. The annual average cost for antihypertensive drugs was 171,73 euro for continuers, 205,10 euros for switchers and 28,29 euros for discontinuers. Factors associated to drug cost were age, pattern of persistence, number of prescribed drug classes, and class prescribed at enrolment. Nonpersistence with antihypertensive pharmacotherapy induced a high cost for the consumption of antihypertensive drug since discontinuers are responsible for a significant percentage of drug resources allocated on subjects exposed to therapy. A correlation between drug therapy cost and persistence with treatment is needed to evaluate the appropriateness of drug utilization and to perform cost-effectiveness analyses between alternative pharmacological agents