Varenicline treatment for smoking cessation in high risk patients: a budget impact analysis

NTRODUCTION: The promotion of smoking cessation is a worldwide Public Health priority. OBJECTIVE: To estimate the budget impact on the Italian National Health Service (NHS) of the access to reimbursement of varenicline for the treatment of high risk patients with bronchopulmonary, diabetic and cardiovascular diseases. METHODS: A closed-group Markov model was developed in order to compare the costs incurred by the NHS to promote smoking cessation with cessation-related savings, using an alternative scenario in which aids to cessation are not reimbursed by the NHS. The analysis was conducted over a 5-year time horizon, in the perspective of the Italian NHS. Efficacy was expressed in terms of smoke abstinence for at least one year, and data was derived from clinical trials; the savings associated with smoking cessation were derived from cost-of-illness studies. RESULTS: The results show how costs would concentrate in the first year: they are estimated at € 200.6 million, of which € 162.4 million for drug therapy and € 38.2 million for counseling. Average annual savings over the first five years are estimated at € 77.7 million, with a cumulative net impact at 5 years of € -188.0 million (cost-saving). The analysis appears to be robust: sensitivity analyses show that the covering of initial costs occurs in any case between the third and fourth year, and that the treatment remains cost-saving at 5 years. CONCLUSIONS: The financial impact on the Italian NHS of the reimbursement of varenicline for the treatment of high risk smoking population would be a sustainable healthcare policy, resulting in cost savings starting from the fourth year

Evaluation of the effectiveness and efficiency of the triage emergency department nursing protocol for the management of pain

Loris Butti,1 Olga Bierti,1 Raffaela Lanfrit,1 Romina Bertolini,1 Sara Chittaro,1 Stefania Delli Compagni,1 Davide Del Russo,1 Rossella Letizia Mancusi,2 Franco Pertoldi1 1S.O.C. Emergency Medicine, AAS3 Ospedale Sant’Antonio di San Daniele del Friuli, 2C.R.E.A. Sanità, University of Tor Vergata, Rome, Italy Introduction: Pain is a common symptom presented in the emergency department (ED) although it is often underestimated, poorly evaluated and treated. The application of a protocol for timely pain management ensured by the nurse can avoid the delays in the analgesic treatment and improve the patient’s quality of waiting.Aims: To check the effectiveness and efficiency of the protocol aimed at early pain management in triage, active in our ED. In particular, the response to analgesic treatment was evaluated 60 minutes after the administration and at discharge. Patient satisfaction was also evaluated using two anonymous questionnaires both at discharge and 48 hours later via telephone.Methods: A single-center, observational study was conducted on a prospective cohort of patients (aged ≥4 years) with a pain symptom at admission in ED with no surgical picture.Results: In the observation period (June 2015–May 2016), 382 patients were enrolled, and of these, 312 (84.8%) accepted pain therapy during triage stage in the ED. In 97.4% of the cases, orosoluble paracetamol 1000 mg was administered. In the re-evaluation done 60 minutes later, 65.9% of the patients showed a reduction of at least 2 points on Numeric Rating Scale (NRS), equal to a mean reduction of 2.24 points (95% CI: 2.03–2.45). The mean time of analgesia intake was equal to 5.9 minutes (95% CI: 3.8–8.1). In the re-evaluation done at discharge, 33.2% of the patients showed a reduction of NRS score >50%, leading to a mean reduction of 39% (95% CI: 35.3%−41.9%). The level of patient satisfaction was high with a mean value >9 points (maximum satisfaction =10).Conclusion: This protocol shows that optimal pain management was achieved by patients rapidly receiving an effective painkiller therapy at triage, leading to substantial patient satisfaction. In moderate pain, orosoluble paracetamol 1000 mg provided a reduction of NRS score by 2 points in 67.6% of the patients, confirming to be the analgesic of choice in ED. Keywords: pain management, protocol, triage, analgesic, orosoluble paracetamo

Carcinoma di Merkel: Analisi epidemiologica e cost of illness

Obiettivo principale dello studio è la stima di incidenza del MCC. A tal fine è stata condotta una revisione sistematica della letteratura nazionale ed internazionale, finalizzata alla individuazione di studi specifici su popolazione. La stima epidemiologica verrà quindi utilizzata per valutare la casistica incidente sulla popolazione italiana. Altro obiettivo dello studio, alla luce del carico incidente di MCC, è l’individuazione di percorsi terapeutici ottimali, e la stima dei costi annui diretti connessi per i pazienti incidenti

Detector Simulation

This chapter provides an overview of particle and radiation transport simulation, as it is used in the simulation of detectors in High Energy and Nuclear Physics (HENP) experiments and, briefly, in other application areas. The past decade has seen significant growth in the availability of large networked computing power and particle transport tools with increasing precision available to HENP experiments, and enabled the use of detailed simulation at an unprecedented scale