La sinistra:italiana una commedia in tre atti.

L’entrata nella seconda Repubblica è stata scandita dalla marcia trionfale della sinistra in predicato di vincere le elezioni politiche. I risultati elettorali più gratificanti della sinistra sono stati la traballante vittoria del 1996 e le non vittorie (sostanziali pareggi) del 2006 e del 2013, al contrario erano certe nelle previsioni e nei fatti le vittorie berlusconiane del 2001 e del 2008

Cost Effectiveness of the 13-Valent Pneumococcal Conjugate Vaccination Program in Chronic Obstructive Pulmonary Disease Patients Aged 50+ Years in Spain

Background: Patients with chronic obstructive pulmonary disease (COPD) are at elevated risk of pneumococcal infection. A 13-valent pneumococcal conjugate vaccine (PCV13) was approved for protection against invasive disease and pneumonia caused by Streptococcus pneumoniae in adults. This study estimated the incremental cost-effectiveness ratio (ICER) of vaccinating COPD patients 50 years old with PCV13 compared with current vaccination policy (CVP) with 23-valent pneumococcal polysaccharide vaccine. Methods: A Markov model accounting for the risks and costs for all-cause non-bacteremic pneumonia (NBP) and invasive pneumococcal disease (IPD) was developed. All parameters, such as disease incidence and costs (; 2015 values), were based on published data. The perspective of the analysis was that of the Spanish National Healthcare System, and the horizon of evaluation was lifetime in the base case. Vaccine effectiveness considered waning effect over time. Outcomes and costs were both discounted by 3 % annually. Results: Over a lifetime horizon and for a 629,747 COPD total population, PCV13 would prevent 2224 cases of inpatient NBP, 3134 cases of outpatient NBP, and 210 IPD extra cases in comparison with CVP. Additionally, 398 related deaths would be averted. The ICER was 1518 per quality-adjusted life-year (QALY) gained for PCV13 versus CVP. PCV13 was found to be cost effective versus CVP from a 5-year modelling horizon (1302 inpatient NBP and 1835 outpatient NBP cases together with 182 deaths would be prevented [ICER 25,573/QALY]). Univariate and probabilistic sensitivity analyses confirmed the robustness of the model. Conclusions: At the commonly accepted willingness-to-pay threshold of 30,000/QALY gained, PCV13 vaccination in COPD patients aged 50 years was a cost-effective strategy compared with CVP from 5 years to lifetime horizon in Spain. © 2015 The Author(s