cost per response remission in biologics available in italy for the treatment of tnf α inhibitors naive patients with ulcerative colitis

Objective: This study compares the cost of a sustained response or remission (at 52 weeks' follow-up) across biologics approved in Italy for the treatment of moderately to severely active ulcerative colitis (UC), specifically among anti-TNF-α-naïve patients. The analysis is from the perspective of the national healthcare provider (SSN) for one year of treatment. Methods: Efficacy data about the induction of response/remission probabilities at 52 weeks and the number needed to treat (NNT) were derived from a network meta-analysis of randomized controlled clinical trials of the following drugs: infliximab (originator and biosimilar), adalimumab, golimumab and vedolizumab. It included the acquisition and administration costs of biologics, based on an activity-based costing analysis performed in 3 Italian centers of excellence for UC treatment. Results: The costs per patient in sustained response at 52 weeks were, in increasing order: vedolizumab €47,772 (95% CI €29,869 - €101,055), biosimilar infliximab €48,657 (95% CI €31,488 - €95,523), golimumab (100 mg every 4 weeks at maintenance) €57,940 (95% CI €38,00 - €106,206), golimumab (50 mg every 4 weeks at maintenance) €62,504 (95% CI €39,976 - €120,477), adalimumab €101,181 (95% CI €49,635 - €422,334). The costs per patient in sustained remission at 52 weeks were: vedolizumab €86,220 (95% CI €47,015 - €206,652), biosimilar infliximab €92,562 (95% CI €52,954 - €203,619). Conclusions: In patients with moderate to severe UC not previously treated with TNF-α inhibitors, treatment needed with vedolizumab to obtain a response or remission at 52 weeks of follow-up is less costly to the SSN compared with the other UC-approved biologics available in Italy

DEVELOPMENT AND FIELD VALIDATION OF AN INNOVATIVE APPROACH TO SUSTAINABLE CULTIVATION OF DURUM WHEAT IN ITALY

Oggigiorno i dibattiti riguardanti il significato di sostenibilità, la sua misurazione attraverso indicatori e le metodologie nei quali quest’ultimi dovrebbero essere utilizzati rimangono spesso inconcludenti. Questo elaborato si propone come un prototipo per superare questi limiti. L’approccio, applicato per la coltura frumento duro, è un esempio di come è possibile consolidare i paradigmi teorici della sostenibilità e trasformarli in utili raccomandazioni per attività agricole più sostenibili. Attraverso l’implementazione di un Decision Support System (DSS) chiamato granoduro.net® e la stesura di un decalogo per una coltivazione del grano duro più competitiva (10 regole agronomiche), il divario tra i principi teorici e pratici della sostenibilità viene ridotto. Grazie alla disponibilità di Barilla S.p.A., sono stati pianificati per diversi anni, a partire dal 2011, studi di campo e il progetto è stato considerato dagli operatori del settore un esempio di come i principi teorici della sostenibilità possono essere messi in pratica con facilità. Le differenti fasi della validazione (un iniziale studio teorico, il confronto tra situazioni reali e teoriche ottimali e due anni di utilizzo sul campo di granoduro.net® e del decalogo) hanno permesso di dimostrare agli agricoltori che gli impatti antropici possono essere monitorati e ridotti e che quindi la sostenibilità è fruibile e calcolabile. Inoltre, il decalogo e granoduro.net® hanno dimostrato di essere due esempi di come è possibile migliorare la qualità delle decisioni strategiche (scelta della rotazione, lavorazione del terreno, scelta delle varietà, tecnica di fertilizzazione e uso di seme certificato) e tattiche (in risposta agli eventi generati da attacchi biotici, infestanti e necessità nutrizionali) intraprese dagli imprenditori agricoli.Current debates concerning the meaning of sustainability, its measurement by means of indicators, and the framework in which these should be applied, often remain inconclusive. This work is a prototype aimed to overcome such shortcoming. The method adopted in this work was applied to the crop of durum wheat and represents an example on how to put the theoretical paradigms of sustainability into effect by transforming them into practical recommendations for implementing more sustainable agricultural practices. The implementation of a Decision Support System (DSS) called granoduro.net® and the drafting of a handbook (ten agronomical rules for a more competitive cultivation of durum wheat) allowed to bridge the gap between the theoretical principles and the practical implementation of sustainability. Since 2011 in-field validation activity has been carried out thanks to the collaboration with Barilla S.p.A.; the project was considered by Barilla’s stakeholders as an example of how theoretical principles of sustainability can be put into practice. The several steps of the validation process (i.e., a theoretical study, a comparison between real and target values, and the in-field adoption of both the handbook and granoduro.net® for two years) demonstrated to farmers and experts that human impacts can be monitored and reduced. Therefore, it was proved that sustainability is actionable and calculable. Moreover, the handbook and granoduro.net® showed to be tools able to help farmers improving the quality of their decisions, both strategic (choice of rotation, tillage, varieties, fertilization techniques, and use of certified seeds) and tactical (in response to nutritional needs or the risk of pests, disease or weeds infestation)

Corticosteroidi per via Intravitreale per il Trattamento Dell'edema Maculare: Revisione e Valutazione Della Qualità Dell'evidenza:

Intravitreal corticosteroids for the treatment of macular edema: review and assessment of quality of the evidenceIntroductionTreatment options for macular edema include intravitreal corticosteroids. Traditionally, an injectable suspension of triamcinolone acetonide (TA) had been employed off-label; in recent years, authorities have approved sustained-release drug delivery systems (DDSs) for corticosteroids. This review aims to compare the quality of the evidence on efficacy and safety of three different formulations of intravitreal corticosteroids: the dexamethasone (DEX) implant, the fluocinolone acetonide (FA) implant, and the preservative-free injectable suspensions of TA, in the management of two retinal pathologies: diabetic macular edema (DME) and macular edema secondary to retinal vein occlusion (RVO).MethodsA search of clinical trials on MEDLINE from 01/01/2000 to 12/16/2015 was performed. Studies were included in the analysis if they met the following criteria: i) related to at least one of the preparations of interest in patients with DME or macular edema secondary to RVO; ii) included a control group treated with placebo, observation, sham procedures or conventional treatments; and iii) included visual acuity, retinal thickness and/or safety parameters as outcomes. Results were summarized in a narrative manner.ResultsTwenty-five publications from 19 RCTs were included. We observed increased attention of researchers towards TA compared to DEX and FA; however, studies for TA are less robust. Scientific publications related to DEX and FA implants are of higher quality, especially in terms of randomization and masking procedures.DiscussionAlthough trials on TA are numerous, evidence on DEX and FA implants is more robust. Since their introduction, these relatively new DDSs have been included in the main guidelines for the management of macular edema

A deployable and inflatable robotic arm concept for aerospace applications

The interest in soft systems for space missions represents a growing trend in recent years. The development of inflatable robots, combined with the improvement of deployment mechanisms, allows to build novel lightweight and deployable robotic manipulators. In several space applications, the use of soft robots could minimize bulk and mass, reducing space mission costs. The main challenges in soft robotics are the control of the system and the exertion of high forces. In this manuscript, the concept of an inflatable manipulator with two inflatable links and three degrees of freedom is proposed. After a review about the possible materials to be used for the inflatable parts, the robot mechanical structure, the deploying strategy and the pneumatic line are presented. Then, an elastostatic approach is proposed to model the robot with the aim of developing its control. The last section shows preliminary experimental tests performed on the link prototype with the purpose to evaluate a static characterization in relation to the supplied pressure. Results suggest the validity of the adopted approach to model the system and clarify the pressure influence about the system performances. The study puts the basis for the development of the first prototype of the robotic system

Epoxy resin doped with Coumarin 6: Example of accessible luminescent collectors

We report on the preparation of luminescent collectors based on epoxy resins containing Coumarin 6 as fluorescent dye. Fluorescent epoxy slabs were obtained by carefully mixing from 60 to 150 ppm of the fluorophore with bisphenol A diglycidyl ether and 4,4′-methylenebis(2-methylcyclohexylamine) as curing agent. Spectroscopic (FT-IR, solid-state NMR, Raman) investigations and calorimetric analysis evidence the success of the preparation procedure in terms of slab homogeneity, fluorophore dispersibility and its role in promoting the crosslinking extent. The concentrating ability and the derived optical efficiencies of the epoxy-based collectors are determined with a properly designed set-up and result greater (∼10%) than that of poly(methyl methacrylate) concentrators with the same fluorophore and geometry. Optical efficiencies as high as 7.4% are obtained and enable the potential use of epoxy resins as bulk thermosetting materials for solar collectors

Analysis of functional groups in atmospheric aerosols by infrared spectroscopy: ElnetPLS model for statistical selection of relevant absorption bands for OC predictions

Organic carbon (OC) is a major component of atmospheric particulate matter (PM). Typically OC concentrations are measured using thermal methods such as thermal-optical reflectance (TOR) from samples collected on quartz filters. However, TOR measurements are destructive and expensive. We estimate TOR OC concentrations using Fourier transform infrared (FT-IR) spectra of ambient samples collected on Teflon filter. We have developed a sparse statistical calibration model (ElnetPLS), which excludes unnecessary wavenumbers from infrared spectra during the model building process, permitting the identification and evaluation of the most relevant vibrational modes of molecules in complex aerosol mixtures associated with reported TOR OC concentrations. The sparsest ElnetPLS model has similar model performances of the full (2784) wavenumber models while requiring only ten wavenumbers associated with carbonyl groups

Innovative methods for Burn-In related Stress Metrics Computation

Burn-In equipment provide both external and internal stress to the device under test. External stress, such as thermal stress, is provided by a climatic chamber or by socket-level local temperature forcing tools, and aims at aging the circuit material, while internal stress, such as electrical stress, consists in driving the circuit nodes to produce a high internal activity. To support internal stress, Burn-In test equipment is usually characterized by large memory capabilities required to store precomputed patterns that are then sequenced to the circuit inputs. Because of the increasing complexity and density of the new generations of SoCs, evaluating the effectiveness of the patterns applied to a Device under Test (DUT) through a simulation phase requires long periods of time. Moreover, topology-related considerations are becoming more and more important in modern high-density designs, so a way to include this information into the evaluation has to be devised. In this paper we show a feasible solution to this problem: the idea is to load in the DUT a pattern not by shifting inside of it a bit at a time but loading the entire pattern at once inside of it; this kind of procedure allows for conservative stress measures, thus it fits for stress analysis purposes. Moreover, a method to take the topology of the DUT into account when calculating the activity metrics is proposed, so to obtain stress metrics which can better represent the activity a circuit is subject to. An automotive chip accounting for about 20 million of gates is considered as a case of study. Resorting to it we show both the feasibility and the effectiveness of the proposed methodology

Modello di stima dei costi sanitari e della capacity delle terapie intensive in Italia nel trattamento di pazienti affetti da COVID-19: valutazione dell’impatto di remdesivir

Introduction: Coronavirus disease 2019 (COVID-19) is caused by a severe acute respiratory syndrome coronavirus 2, which is a human coronavirus responsible for a pandemic. Direct interventions, i.e. physical distancing and use of protective devices, can prevent or limit contagions, however, it is also required to evaluate the optimization of limited resources, such as the Intensive Care Unit (ICU). For this purpose, it is relevant to estimate the impact of therapeutic solutions that reduce the probability that the patient transits to ICU in symptomatic subjects and in need of hospitalization. The therapeutic solutions allow a more rapid recovery of the patient and save scarce resources that can be used in the treatment of other patients. Methods: A forecasting model is designed to estimate the impact of one therapeutic solution, i.e. the antiretroviral Remdesivir, on both the capacity of intensive care and the healthcare costs for hospitals when managing the current emergency. A base case is presented as well as a best and a worst case scenario deriving from the sensitivity analyses. Results: The introduction of Remdesivir in patients receiving low-flow oxygen therapy with the purpose of reducing ICU accesses and deaths leads to 431 million euros cost savings and avoids 17,150 hospitalizations in intensive care and 6,923 deaths. In the best case, 294 million euros savings are estimated, whilst in the worst case the model estimates a saving of 512 million euros. Conclusions: Remdesivir has the potential to reduce the negative effects of the Coronavirus disease, improving patient conditions and reducing death tolls, and can also save scarce healthcare resources during this pandemic, resulting in a shorter hospital stay and fewer ICU admissions

A cost-minimization analysis of a preventive testing strategy for relatives of patients with BRCA mutated ovarian cancer

Purpose: This study aims to estimate the cost-minimization strategy of a preventive testing strategy destined to relatives of patients with BRCA mutated cancer versus a no test strategy in Italia. Methods: A BRCA testing pathway was designed by a panel of experts based on the MSTM Excel (2010) tool; the analysis was carried out considering the perspective of the Italian National Health Service. Two alternatives were considered: 1) preventive BRCA testing for relatives of patients affected by ovarian cancer carrying a BRCA1/BRCA2 mutation; 2) no test. Cost and effectiveness data, derived from literature and published sources validated by a Board of experts, were discounted using a discount factor equal to 3%. Probabilistic sensitivity analysis was performed. Results: Considering an average cost of therapy for breast and ovarian cancer major of €90,000.00 per case, the economic impact related to the preventive testing strategy are equal to –€17,814,767.25. The sensitivity analysis confirms these results in the totality of the simulations performed. Conclusions: Preventive genetic testing in relatives of patients affected by ovarian cancer is cost-effective and represents a sustainable cost for the National Healthcare System in Italia, also in the light of its reference values