Approaches to Estimating Indirect Costs in Healthcare: Motivations for Choice

Abstract When performing health economic evaluations all costs and expected benefits (in terms of clinical effectiveness, utility, monetary benefits) should be taken into account. Costs are direct and indirect: concerning the latter, two main methods have been developed. The Human Capital Approach (HCA) considers the gross salary in the days of absence from work due to a disease; the method based on the Friction Costs (FC), instead, considers equally the value of productivity, but the losses are limited to the period of illness when it is necessary to replace the absent worker. This paper carries out a review of the literature contributions for European countries and aims at identifying common trends within geographical areas; estimation of indirect costs in different European area may reflect the real cost of health services across countries and schematize the conditions under which a certain method should be preferred.Overall, cost analyses applying HCA are the most frequent, while studies based on FC are more common in the Netherlands, where this method has been developed: the reasons to apply HCA or FC may depend on the institutional context, for example the flexibility in the job market, and the epidemiologic environment

willingness to pay for innovation the case of the anti hcv drugs from the italian national health service perspective

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Direct and indirect costs of cluster headache : a prospective analysis in a tertiary level headache centre

Cluster headache (CH) is the most frequent trigemino-autonomic cephalgia. CH can manifest as episodic (ECH) or chronic cluster headache (CCH) causing significant burden of disease and requiring attack therapy and prophylactic treatment. The few data available on the economic burden of CH come from retrospective studies based on questionnaires, population surveys and medical insurance claims database. Although all these studies showed an important economic burden, they provided different estimates depending on variability of CH awareness and management, healthcare systems, available therapies and use of treatments according to different guidelines. This prospective study aimed to quantify the total direct and indirect cost of ECH and CCH over a cluster period, both for the patient and for the National Health System (NHS), using data from subjects who consecutively attended an Italian tertiary headache centre between January 1, 2018 and December 31, 2018. A total 108 patients (89 ECH, 19 CCH) were included. Mean attack frequency was 2.3 ± 1.4 per day. Mean total cost of a CH bout was €4398 per patient and total cost of CCH was 5.4 times higher than ECH (€13,350 vs. €2487, p <  0.001). Direct costs represented the 72.1% of total cost and were covered for the 94.8% by the NHS. The costs for any item of expense were higher for CCH than for ECH (p <  0.001). Mean indirect costs for a CH bout were €1226 per patient and were higher for CCH compared to ECH (€3.538 vs. €732), but the difference was not significant. Days with reduced productive capacity impacted for the 64.6% of the total indirect costs. The analysis of the impact CH on work showed that 27%% of patients felt that CH had limited their career, 40% had changed their work pattern, 20% had changed their place of employment and 10% had lost a job due to the disease. Our results provide a valuable estimate of the direct and indirect costs of ECH and CCH in the specific setting of a tertiary headache centre and confirm the high economic impact of CH on both the NHS and patients

Budget impact of pneumococcal vaccination in adults and elderly in Italy

BackgroundStreptococcus pneumoniae or pneumococcus, is responsible for severe invasive infections (IPD) in high risk groups and in the elderly. Moreover the pneumococcus is the most common cause of..

Estimation of the number of HCV-positive patients in Italy

Background: HCV is one of the main causes of cirrhosis, hepatocellular carcinoma (HCC) and liver transplantation. Aim: The aim of this study was to estimate the number of living individuals diagnosed with hepatitis C in Italy. This study also aimed to stratify these subjects as diagnosed and cured, diagnosed awaiting a cure, and undiagnosed (individuals who were not diagnosed, living or lived with hepatitis C). Methods: To quantify the number of ill patients in Italy, an inquiry was conducted based on questionnaires submitted to three nationally representative regions, namely, Campania, Lazio and Piemonte, as representatives of the three main areas of Italy (North, Centre and South regions). The data were collected through a questionnaire to acquire demographic and clinical information on patients in the participating hospitals. The questionnaires contained 6 questions on sex, age, region of residence, disease condition, type of exemption and category. The questionnaires were administered individually to consecutive patients through face-to-face interviews conducted by specialised personnel in each centre. Data were collected between September 2017 and January 2018. Results: In total, 2,860 questionnaires were analysed. They were completed by the patients (55% male), who had an average age of 61 years (64 years for women and 59 years for men). In total, 54% of the sample declared that they were still infected with HCV (1,548 patients out of 2,860 respondents), while the remaining subjects declared that they had been cured. The inquiry showed that 46.6% of the sample had at least a 016 exemption (chronic hepatitis), while more than 51% (1,469 interviewed patients out of 2,860 respondents) had a different type of exemption. Only 2% of the respondents declared that they had no exemption. Assuming that the analysed sample is representative of the actual HCV-positive population in Italy and considering the number of 016 exempt patients in the regional data, the model estimates that there are 443,491 cured and HCV-positive living patients and 240,043 ill patients who have yet to be treated. Conclusions: Although this study has limitations, it represents a considerable improvement over the previously available studies. This study can help decision-makers implement more effective strategic planning to eliminate hepatitis C

Economic burden of schizophrenia in Italy : a probabilistic cost of illness analysis

Schizophrenia is a chronic, debilitating psychiatric disease with highly variable treatment pathways and consequent economic impacts on resource utilisation. The aim of the study was to estimate the economic burden of schizophrenia in Italy for both the societal and Italian National Healthcare perspective

Cost-effectiveness analysis of Vaborem in Carbapenem-resistant Enterobacterales (CRE) - 'Klebsiella pneumoniae' infections in Italy

BackgroundVaborem is a fixed dose combination of vaborbactam and meropenem with potent activity against target Carbapenem-resistant Enterobacterales (CRE) pathogens, optimally developed for Klebsiella pneumoniae carbapenemase (KPC). The study aims to evaluate the cost-effectiveness of Vaborem versus best available therapy (BAT) for the treatment of patients with CRE-KPC associated infections in the Italian setting.MethodsA cost-effectiveness analysis was conducted based on a decision tree model that simulates the clinical pathway followed by physicians treating patients with a confirmed CRE-KPC infection in a 5-year time horizon. The Italian National Health System perspective was adopted with a 3% discount rate. The clinical inputs were mostly sourced from the phase 3, randomised, clinical trial (TANGO II). Unit costs were retrieved from the Italian official drug pricing list and legislation, while patient resource use was validated by a national expert. Model outcomes included life years (LYs) and quality adjusted life years (QALYs) gained, incremental costs, incremental cost-effectiveness ratio (ICER) and incremental cost-utility ratio (ICUR). Deterministic and probabilistic sensitivity analyses were also performed.ResultsVaborem is expected to decrease the burden associated with treatment failure and reduce the need for chronic renal replacement therapy while costs related to drug acquisition and long-term care (due to higher survival) may increase. Treatment with Vaborem versus BAT leads to a gain of 0.475 LYs, 0.384 QALYs, and incremental costs of €3549, resulting in an ICER and ICUR of €7473/LY and €9246/QALY, respectively. Sensitivity analyses proved the robustness of the model and also revealed that the probability of Vaborem being cost-effective reaches 90% when willingness to pay is €15,850/QALY.ConclusionsIn the Italian setting, the introduction of Vaborem will lead to a substantial increase in the quality of life together with a minimal cost impact, therefore Vaborem is expected to be a cost-effective strategy compared to BAT

Analisi di impatto di budget di pasireotide in pazienti con Acromegalia nella prospettiva del Servizio Sanitario Nazionale

Background: L’obiettivo dell’analisi è stato quello di valutare l’impatto economico dell’introduzione di pasireotide nella prospettiva del Servizio Sanitario Nazionale (SSN). Metodi: I dati epidemiologici e di costo che hanno implementato il modello di budget impact (BI) sono stati ottenuti tramite una revisione sistematica della letteratura. Il BI è stato stimato confrontando uno scenario senza l’introduzione di pasireotide rispetto ad uno scenario con nella prospettiva del SSN. Inoltre, è stata sviluppate una analisi di sensibilità deterministica (DSA) e l’applicazione del metodo payoff. Risultati: Il modello ha stimato un totale di circa 2.314 pazienti acromegalici ad oggi trattati con una seconda linea farmacologica. L’introduzione di pasireotide consente una riduzione complessiva di spesa pari a € 662.095 nei 5 anni di analisi. La DSA ed il valore atteso di pay-off confermano la robustezza dei risultati. Conclusioni: L’introduzione sul mercato di pasireotide non comporta un aggravio di spesa per il SSN, ma genera una reale riduzione dei cost

Developing a cost estimation model for work-related stress: An absence-based estimation using data from two Italian case studies

Objectives This paper discusses the development of a cost-estimation model for work-related stress based on psychosocial risk exposure and absence from work. It presents findings from its implementation and evaluation in two organizations in Italy, using national-level tools developed by the Italian Workers’ Compensation Authority (INAIL). It also provides recommendations for the development of similar cost-calculation methods in other countries.Methods The cost-estimation model was based on the human capital approach using an indirect cost indicator: loss of productivity due to days of absence attributable to work-related stress. Furthermore, the population attributable fraction (PAF) epidemiological measure was used to calculate the impact of exposure to work-related stress on the basis of data collected through validated tools developed by INAIL and salary cost data.Results The developed model was implemented and evaluated in two organizations, the first in healthcare (N=1014) and the second in public administration (N=534). In the first case, it was found that absence related to work-related stress cost the organization €445 000. In the second case, the cost was €360 000.Conclusions The proposed model provides an example of how organizations can incorporate well-established indicators associated with work-related stress (eg, various types of absence, psychosocial risk perception, loss of productivity on the basis of salary costs) in a practical way in cost estimations of work-related stress. Such cost estimation can be applied in other countries and organizations to establish the economic and business case of managing work-related stress