COVIDIAGNOSTIX : health technology assessment of serological tests for SARS-CoV-2 infection.

Abstract Objective In vitro diagnostic tests for SARS-COV-2, also known as serological tests, have rapidly spread. However, to date, mostly single-center technical and diagnostic performance's assessments have been carried out without an intralaboratory validation process and a health technology assessment (HTA) systematic approach. Therefore, the rapid HTA for evaluating antibody tests for SARS-COV-2 was applied. Methods The use of rapid HTA is an opportunity to test innovative technology. Unlike traditional HTA (which evaluates the benefits of new technologies after being tested in clinical trials or have been applied in practice for some time), the rapid HTA is performed during the early stages of developing new technology. A multidisciplinary team conducted the rapid HTA following the HTA Core Model® (version 3.0) developed by the European Network for Health Technology Assessment. Results The three methodological and analytical steps used in the HTA applied to the evaluation of antibody tests for SARS-COV-2 are reported: the selection of the tests to be evaluated; the research and collection of information to support the adoption and appropriateness of the technology; and the preparation of the final reports and their dissemination. Finally, the rapid HTA of serological tests for SARS-CoV-2 is summarized in a report that allows its dissemination and communication. Conclusions The rapid-HTA evaluation method, in addition to highlighting the characteristics that differentiate the tests from each other, guarantees a timely and appropriate evaluation, becoming a tool to create a direct link between science and health management

The Management of Psoriatic Arthritis in Italy: Organizational Impact Analysis of Optimized Pathways

BACKGROUND: The management of psoriatic arthritis requires competencies in the fields of both rheumatology and dermatology, and a multidisciplinary approach.AIM: To propose an effective pathway for the diagnosis, monitoring and treatment of psoriatic arthritis in the Italian context, and to assess its organizational impact on the Regional Health Service of Lombardy Region.METHODS: The analysis was performed through interviews conducted with two key opinion leaders in the areas of dermatology and rheumatology. The current pathway of patients who present symptoms that might be related to psoriatic arthritis was defined and an optimized pathway was then proposed on the basis of the clinical practice, considering the implementation of a dermatology and rheumatology shared outpatient service. The organizational impact of the optimized pathway was then assessed from both the hospital and that of the Regional Health Service of Lombardy Region perspectives.RESULTS: The implementation of the service would have a positive impact on patients' experience, improving the quality of the service provided, thanks to the multidisciplinary approach adopted, limiting the patients' resources needed for the diagnosis, reducing the number of visits and time loss. The optimized pathway, therefore, would have a limited impact on the marketing mix, while potentially improving patients satisfaction, increasing the possibility of patients' retention. To successfully implement the dermatological and rheumatologic multidisciplinary service, a precise communication strategy is mandatory.CONCLUSIONS: The optimized pathway for the diagnosis and management of psoriatic arthritis proposed would have a limited organizational impact at both hospital and Regional Health Service levels, while leading to theoretical benefits in terms of a prompt diagnosis of the pathology

Budget impact analysis of the use of daclatasvir in Italy for the treatment of Hepatitis C Virus (HCV) genotype 3 patients

BACKGROUND: Hepatitis C Virus (HCV) infection represents a global health problem, leading to chronic cirrhosis, hepatocellular carcinoma (HCC), hepatic decompensation and liver transplant. The aim of the study was the evaluation of the impact on the budget of the Italian National Health Service (INHS) of the use of Daclatasvir (DCV) for the treatment of HCV genotype 3 in patients with advanced fibrosis.METHODS: An analytical decision model with a five year time horizon was implemented. Two scenarios were considered: a. 100% of market share for Interferon (INF-α)+Ribavirin (RBV)+Sofosbuvir (SOF) for 12 weeks; b. SOF+DCV+RBV for 24 weeks with annual market shares of 50% in 2015 and 2016, 55% in 2017 and 2018, 60% in 2019, and INF-α+RBV+SOF for 12 weeks with the remaining market shares. Every annual cycle a percentage of patients equal to the effectiveness of the antiviral treatment reach a sustained virologic response and during the first year of treatment patients may experience treatment related adverse events. The costs considered (2015) are those of the antiviral therapy, and direct medical costs for health state and adverse events management. Univariate and multivariate sensitivity analyses were performed.RESULTS: DCV would lead to an increase of the costs for the INHS (year 1 +21.31 millions, year 2 +21.35 millions, year 3 + 23.37 millions, year 4 + 23.26 millions and year 5 +16.37 millions). The sensitivity analysis confirmed the robustness of the results.CONCLUSIONS: The use of DCV is likely to have a short term impact on the INHS budget increasing resources use compared to the sole use of INF-α+RBV+SOF. However, a trend of reduction of the costs increase is observed due to the management of health states and adverse events which may lead to the possibility to reduce costs in the long term

Co-design as enabling factor for patient-centred healthcare : a bibliometric literature review

Service design and in particular co-design are approaches able to align with the need of healthcare contexts of value-based and patient-centered processing through a participatory design of services. The purpose of this study is to identify the characteristics of co-design and its applicability to the reengineering of healthcare services, as well as to detect the peculiarities of the application of this approach in different geographical contexts. The methodology applied for the review, Systematic Literature Network Analysis (SLNA), combines qualitative and quantitative perspectives. In detail, the analysis applied the paper citation networks and the coword network analysis to detect the main research trends over time and to identify the most relevant publications. The results of the analysis highlight the backbone of literature on the application of co-design in healthcare as well as the advantages and the critical factors of the approach. Three main literature streams emerged concerning the integration of the approach at meso and micro level, the implementation of co-design at mega and macro level, and the impacts on non-clinical related outcomes. Moreover, the findings underline differences in co-design in terms of impacts and success factors in developed countries and economies in transition or developing countries. The analysis shows the potentially added value of the application of a participatory approach to the design and redesign of healthcare services both at different levels of the healthcare organization and in the contexts of developed countries and economies in transition or developing countries. The evidence also highlights potentialities and critical success factors of the application of co-design in healthcare services redesign.https://www.dovepress.com/clinicoeconomics-and-outcomes-research-journalam2024School of Health Systems and Public Health (SHSPH)SDG-03:Good heatlh and well-bein

Benchmarking of health technologies distribution models: an investigation of Lombardy’s local health authorities

Purpose – The purpose of this paper is to develop a benchmarking framework for assessing the performance of the distribution models adopted by the local branches of National Health Services (NHSs) for delivering health technologies to patients at a local level, and to derive prescriptions for enhancing design and optimal management of the distribution models. Design/methodology/approach – The authors focussed the study on the distribution of absorbent devices for incontinence, adopting the analytic hierarchy process as a tool for developing the benchmarking framework. The authors applied the framework to the context of the Italian NHS with respect to the Lombard Local Health Authorities, assessing their performance in terms of operational efficiency and service quality. Findings – The developed framework constitutes a novel contribution, and it allows for generating prescriptions. Through its application to the context studied the authors found that a “one-size-fits-all” distribution model cannot be proposed, as regards both efficiency and effectiveness, since process standardization does not provide benefits or savings in all contexts. Rather, a total landed cost approach in the evaluation of the distribution practices must be adopted. Practical implications – This paper offers to managers and decision makers an innovative approach to the design of distribution models for health technologies. It provides policy makers with prescriptions to develop regulations fostering a comprehensive view of the factors for an optimal health technologies distribution at a local level. Originality/value – Given the dearth of scientific publications focussed on the distribution at the local level of health technologies, this paper significantly contributes to the existing body of knowledge and it offers an innovative framework which can be proficiently replicated in manifold contexts

Regulação da ativação epigenética do gene MMP2 diante da sinalização da fibronectina em linhagens tumorais de mama

Orientadora : Profª Drª Giseli KlassenCo-orientadora : Profª Drª Edneia A. S. R. CavalieriDissertação (mestrado) - Universidade Federal do Paraná, Setor de Ciências Biológicas, Programa de Pós-Graduação em Microbiologia, Parasitologia e Patologia. Defesa: Curitiba, 02/12/2014Inclui referênciasÁrea de concentraçãoResumo: O câncer de mama é o tipo de câncer mais frequente entre as mulheres em todo o mundo. A enzima MMP-2 é uma metaloprotease capaz de degradar o colágeno tipo IV, um dos principais constituintes da matriz extracelular (MEC). Sua função é amplamente descrita por atuar no mecanismo de metástases em diversos tipos de câncer. Estudos recentes demonstraram que a linhagem tumoral de mama MCF7 possui o gene MMP2 regulado por metilação do DNA. Além disso, alguns estudos têm demonstrado que a fibronectina, uma importante proteína constituinte da MEC, é capaz de promover a expressão de MMP-2 em linhagens tumorais de mama. Resultados recentes do nosso grupo mostraram que a linhagem tumoral MCF7 quando tratada com fibronectina por 5 horas sofre 30% de desmetilação da região promotora do gene MMP2. Entretanto, observou-se também que tal processo foi transitório, porque houve a remetilação parcial do promotor quando o estímulo foi retirado. Ainda, a fibronectina induziu o aumento de uma marca de histona no promotor de MMP2 que sinaliza para a ativação da transcrição gênica. Diante disso, o objetivo deste trabalho foi dar continuidade a esse estudo, avaliando a regulação epigenética do gene MMP2 em linhagens tumorais de mama após o cultivo com fibronectina em diferentes tempos. Para isso, células da linhagem MCF7 submetidas ao tratamento com fibronectina por 8, 12 e 24 horas, e da linhagem MDA-MB-436 por 24 horas, tiveram seus níveis de expressão de MMP2, metilação do DNA e modificações de histonas do promotor do gene avaliados. Na linhagem MCF7, o tratamento por 8, 12 e 24 horas foi capaz de promover o aumento da expressão de MMP2 em 7, 25 e 9 vezes, respectivamente, comparado com o controle, assim como a redução da metilação do promotor de 90% (controle) para 70%, 40% e 52%, respectivamente. O tratamento por 24h também promoveu o aumento da marca de ativação gênica H3K4me3. Ainda, após 12h de cultivo com fibronectina, a linhagem MCF7 aumentou sua capacidade migratória. A fim de verificar se o efeito observado não era exclusivo da linhagem MCF7, foi incluída no estudo a linhagem MDA-MB-436 que foi submetida ao tratamento por 24h, e apresentou aumento na expressão gênica de MMP2 (4 vezes) e redução da metilação do promotor (de 90% para 22%). Por fim, as células tratadas foram mantidas em cultivo sem a fibronectina para avaliar a estabilidade das modificações. Essas células, chamadas de recultivo, apresentaram uma redução na expressão gênica e aumento na metilação do promotor quando comparadas com as células logo após os tratamentos, confirmando o efeito transitório da fibronectina nos eventos epigenéticos, que já tinha sido observado após 5 horas de tratamento. Esses dados corroboram e complementam os mecanismos observados pelo nosso grupo de pesquisa e contribuem para a compreensão dos mecanismos epigenéticos que regulam a expressão de um importante gene associado às metástases tumorais. Palavras-chave: Câncer de mama, MMP-2, epigenética, metilação do DNA.Abstract: Breast cancer is the most common cancer worldwide among women. The MMP- 2 enzyme is a metalloprotease capable of degrading type IV collagen, a major constituent of the extracellular matrix (ECM). Its function is widely described by acting in the mechanism of metastasis in various cancers. Recent data has shown that the MCF7 breast tumor cell line has the MMP2 gene regulated by DNA methylation. In addition, some studies have shown that fibronectin, an important constituent of the extracellular matrix, is capable of promoting MMP-2 expression in breast tumor cell lines. Recent results from our group showed that fibronectin was able to induce MMP2 expression by a 30% decrease in its promoter methylation in MCF7 tumor cell line. However, it was also noted that this process was transient, because a partial promoter remethylation was observed when the stimulus was removed. Moreover, a histone marker for an open chromatin conformation was significantly increased. Therefore, the aim of this work was to continue evaluating the epigenetic regulation of the MMP2 gene after cultivation of breast tumor cell lines with fibronectin at different times. To this reason, MCF7 cells subjected to treatment with fibronectin for 8, 12 and 24 hours and MDA-MB-436 cells subjected to treatment for 24 hours, were evaluated by the levels of MMP2 expression, gene promoter DNA methylation and histone modifications. In the MCF7 cell line, treatments for 8, 12 and 24 hours were able to promote 7, 9 and 25-fold increase in MMP2 expression, respectively, compared with the mock. In addition, promoter methylation was reduced from 90% (control) to 70%, 40% and 52%, respectively. Treatment for 24h also promoted an increase of the histone open chromatin conformation marker H3K4me3. Moreover, the migratory capacity of MCF7 cells treated for 12h was increased. In order to confirm the fibronectin effect, the MDA-MB-436 cell line was subjected to 24h fibronectin treatment, which showed an increase in MMP2 gene expression (4-fold) and a reduction of promoter methylation (from 90% to 22%). Finally, the treated cells were kept in culture without fibronectin to evaluate the modifications stability. These cells (recultivation) showed a gene expression reduction and promoter methylation increased when compared to the cells after treatments, confirming the fibronectin transient effect observed after the 5h treatment. These data support and complement the mechanisms observed by our research group and contribute to understand the epigenetic mechanisms that regulate the expression of an important gene associated with tumor metastasis. Keywords: Breast cancer, MMP-2, epigenetics, DNA methylation

Monocentric Analysis of the Effectiveness and Financial Consequences of the Use of Lenograstim Versus Filgrastim for Mobilization of Peripheral Blood Progenitor Cells in Patients With Lymphoma and Myeloma Receiving Chemotherapy and Autologous Stem Cell Transplantation

Purpose: Granulocyte-colony stimulating factors (G-CSFs) are widely used to mobilize CD34+ stem cells and to support the engraftment after hematopoietic stem cell transplantation (HSCT). A budget impact analysis and an incremental cost-effectiveness study of two G-CSFs (Lenograstim and Filgrastim biosimilar), considering engraftment, number of hospitalization days and number of G-CSF vials administered were performed. Patients and methods: Between 2009 and 2016, 248 patients undergoing autologous HSCT have been evaluated and divided into three groups (100 Leno-Leno, 93 Leno-Fil, 55 Fil-Fil) according to the type of G-CSF used for hematopoietic stem cell mobilization and hematopoietic stem cell recovery after transplant. Results: The following statistically significant differences have been observed between Leno-Leno, Leno-Fil, Fil-Fil groups: a higher number of harvested CD34+ cells (10.56 vs 8.00 vs 7.20; p=0.0003) and a lower number of G-CSF vials (8 vs 8 vs 9; p=0.00020) used for full bone marrow recovery favoring Lenograstim. No statistically significant differences were found regarding the number of G-CSF vials used for mobilization, apheresis number and CD34+ cell peak. The post-transplant hematological recovery was faster in Lenograstim group than Filgrastim group: median time to neutrophil count engraftment (>500/mmc) was 12 vs 13 days; median time for platelets recovery (>20.000/mmc) was 12 vs 15 days (p=0.0001). The use of Lenograstim achieved cost savings of \u20ac566/patient over Filgrastim biosimilar, related to a decreased number of days of hospitalization (16 vs 17 days; p=0.00012), a lower overall incidence of adverse events, laboratory tests, transfusions for platelet recovery following discharge. Conclusion: In our experience, Lenograstim outperforms Filgrastim in terms of effectiveness and lower cost. This study shows a clinical superiority of Lenograstim over Filgrastim suggesting a potential cost savings favoring Lenograstim

Health technology assessment for fast-track elective knee and hip arthroplasty in a high-volume orthopaedic hospital in Italy

OBJECTIVE : The objective of the analysis presented is to assess the efficacy of a fast-track pathway for elective hip and knee arthroplasty, compared to the traditional approach, adopted within a research hospital located in Milan (Italy), in terms of length of stay reduction and related direct medical costs. METHODS : A monocentric observational retrospective study was implemented considering adult subjects who underwent elective primary total hip or knee replacement, with a diagnosis of primary or secondary osteoarthritis. Exclusion criteria were subjects admitted via emergency department, subjects undergoing knee or hip replacement because of fractures or prosthesis revision. The analysis compared the length of stay and the direct medical costs, assuming the hospital perspective, of subjects admitted in the pre-fast-track period (years 2016/2017) and during the fast-track period (years 2018/2019). RESULTS : Knee replacement mean costs are 5,599 € (± 1,158.3 €) in the pre-fast-track period and 4,487 € (± 978.4 €) in the fast-track period (− 1,112 €; − 19.9%). Hip replacement mean costs in the pre-fast-track period are 5,364 € (± 1,037.2 €) and 4,450 € (± 843.7 €) in the fast-track period (− 914 €; − 17.0%). The adoption of fast-track pathway led to a statistically significant decrease of days of hospitalization of − 2.8 (− 37.6%) in knee replacement and of − 2.9 (− 39.2%) in hip replacement. CONCLUSION : The fast-track pathway adopted proved to be effective, reducing patients’ length of stay, and sustainable and efficient, reducing direct medical costs, for both elective hip and knee replacement surgeries.The Italian Ministry of Health “Ricerca Corrente” and by a 2018 Ricerca Finalizzata grant. The APC was funded by the Italian Ministry of Health “Ricerca Corrente.https://www.dovepress.com/clinicoeconomics-and-outcomes-research-journalhj2024School of Health Systems and Public Health (SHSPH)SDG-03:Good heatlh and well-bein

Budget impact analysis of antiretroviral less drug regimen simplification in HIV-positive patients on the Italian National Health Service

Background: Deintensification and less drug regimen (LDR) antiretroviral therapy (ART) strategies have proved to be effective in terms of maintaining viral suppression in human immunodeficiency virus (HIV)-positive patients, increasing tolerability, and reducing toxicity of antiretroviral drugs administered to patients. However, the economic impact of these strategies have not been widely investigated. The aim of the study is to evaluate the economic impact that ART LDR could have on the Italian National Health Service (INHS) budget.Methods: A budget impact model was structured to assess the potential savings for the INHS by the use of ART LDR for HIV-positive patients with a 3 year perspective. Data concerning ART cost, patient distribution within different ARTs, and probabilities for patients to change ART on a yearly basis were collected within four Italian infectious diseases departments, providing ART to 13.7% of the total number of patients receiving ART in Italy.Conclusion: ART LDR simplification would have a significant impact in the reduction of ART-related costs within the hospitals involved in the study. These strategies could therefore be addressed as a sustainable answer to the public financing reduction observed within the INHS in the last year, allowing therapies to be dispensed without affecting the quality of the services provided.Results: The LDR investigated (protease inhibitor-based dual and monotherapies) led to savings for the hospitals involved when compared to the \u201cdo nothing\u201d scenario on a 3 year basis, between 6.7% (23.11 million \u20ac) and 12.8% (44.32 million \u20ac) of the total ART expenditures. The mean yearly cost per patient is reduced from 9,875 \u20ac in the do nothing scenario to a range between 9,218 \u20ac and 8,615 \u20ac. The use of these strategies within the four departments involved would have led to a reduction of ART expenditures for the INHS of between 1.1% and 2.1% in 3 years