A pharmacoeconomic analysis from Italian guidelines for the management of prolactinomas

Background: Prolactinoma, the most common pituitary adenoma, is usually treated with dopamine agonist (DA) therapy like cabergoline. Surgery is second-line therapy, and radiotherapy is used if surgical treatment fails or in relapsing macroprolactinoma. Objective: This study aimed to provide economic evidence for the management of prolactinoma in Italy, using a cost-of-illness and cost-utility analysis that considered various treatment options, including cabergoline, bromocriptine, temozolomide, radiation therapy, and surgical strategies. Methods: The researchers conducted a systematic literature review for each research question on scientific data- bases and surveyed a panel of experts for each therapeutic procedure's specific drivers that contributed to its total cost. Results: The average cost of the first year of treatment was euro2,558.91 and euro3,287.40 for subjects with micro- prolactinoma and macroprolactinoma, respectively. Follow-up costs from the second to the fifth year after ini- tial treatment were euro798.13 and euro1,084.59 per year in both groups. Cabergoline had an adequate cost-utility profile, with an incremental cost-effectiveness ratio (ICER) of euro3,201.15 compared to bromocriptine, based on a willingness-to-pay of euro40,000 per quality-adjusted life year (QALY) in the reference economy. Endoscopic sur- gery was more cost-effective than cabergoline, with an ICER of euro44,846.64. Considering a willingness-to-pay of euro40,000/QALY, the baseline findings show cabergoline to have high cost utility and endoscopic surgery just a tad above that. Conclusions: Due to the favorable cost-utility profile and safety of surgical treatment, pituitary surgery should be considered more frequently as the initial therapeutic approach. This management choice could lead to better outcomes and an appropriate allocation of healthcare resources

Professional exposure to urban stressors and effects on urinary metanephrines

The aim of the study is to assess whether occupational exposure to urban stressors could cause alterations in urinary metanephrines levels in traffic policemen vs administrative staff of municipal police. A total of 258 subjects were included in the study: 129 traffic policemen exposed to urban stressors (68 males and 61 females) and 129 controls (68 males and 61 females). Urinary metanephrines mean levels were significantly higher in male traffic policemen compared to controls (p<0.01). No significant differences were in female traffic policemen compared to controls. In the control group, urinary metanephrines mean levels were significantly higher in females compared to males (p<0.01). There were no significant differences in urinary metanephrines mean levels in female traffic policemen vs male traffic policemen. The increase in urinary metanephrines mean levels observed in male exposed compared to controls could be related to chronic occupational exposure to low doses of chemical, physical and psychosocial urban stressors

Spinal and temporo-mandibular disorders in male workers of the State Police

Objective. The aims of this study are to evaluate the prevalence of disorders of the lumbar region and the temporomandibular district co-morbidity in drivers and workers of the State Police employed for different office activities Materials and methods. The study population included 103 drivers as cases and 100 police officers as controls. The study was carried out through questionnaire and clinical evaluation of the spine and temporo-mandibular region. Results. At clinical examination, the drivers were found to have a higher prevalence (p < 0.05) of both symptoms and clinical signs at the spine and temporo-mandibular joint (TMJ), when compared with the controls. The results also showed a higher prevalence (p < 0.05) of co-morbidity in the two districts among the drivers, when compared with the controls. Conclusions. These results confirm that morbidity related to back and TMJ and increase in co-morbidity between the two districts are higher in professional drivers

Respiratory parameters in traffic policemen exposed to urban pollution

Studies in scientific literature have proved that urban pollution affects the respiratory system The aim of our study is to assess the effects that different time of exposure to urban pollution can cause on respiratory function in municipal traffic policemen The research was carried out on a sample of 120 traffic poll( e officers of both sexes divided into two groups, group A with work service between 1 and 10 years and group B with more than 10 years of service All subjects included in the study were tested for respiratory functions by a spirometer test Statistical analysis showed a significant difference between group A and group B (p<0 005) in some spirometric parameters, such as Forced Expiratory Volume in one second (FEV1) and Forced Vital Capacity (FVC) The study suggests that longer occupational exposure to urban pollutants increases the risk of modifications of respiratory functio

Exposure to antineoplastic drugs in health care and blood chemistry parameters

Objectives. The purpose of the research is to evaluate whether the exposure to antineoplastic drugs of health workers may cause alteration of blood chemistry parameters. Materials and Methods. Research was conducted on 5800 health workers employed in a hospital in a big Italian city. The final sample is composed of 57 people in charge of cytotoxic drugs compared with 57 subjects not exposed; each worker underwent a general clinical examination and determination of the following values: complete blood count (CBC), white blood cell count (WBC), total protein, BUN, total bilirubin, creatinine, GOT, GPT, alkaline phosphatase, gamma GT. Statistical analysis of data was based on calculation of the mean, standard deviation and the distribution into classes according to the nature of each variable. Differences were considered significant when p was <= 0.05. Results. The mean and the distribution of values of total bilirubin were significantly higher in the workers exposed to antineoplastic drugs than in workers non-exposed; the mean and the distribution of values of monocytes were significantly lower in subjects exposed compared to controls. Conclusions. According to the results antiblastic drugs, at the doses used in the departments we studied, can induce an increase in the values of total bilirubin for liver toxicity and a reduction in the monocyte line due to myelosuppression. Clin Ter 2012;163(6):e387-39