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

Spontaneous rate of sister chromatid exchanges (SCEs) in mitotic chromosomes of sheep (Ovis aries L.) and comparison with cattle (Bos taurus L.), goat (Capra hircus L.) and river buffalo (Bubalus bubalis L.).

The spontaneous level of sister chromatid exchanges (SCEs) in the sheep, estimated by exposing peripheral blood lymphocytes in 0.1 microgram/ml of 5'-bromodeoxyuridine (BrdU), was 4.08 +/- 2.47 SCE/cell, 2.04 SCE/cell cycle, 0.038 SCE/chromosome. The dose-response relationships, observed by exposing the cells to 0.1, 0.25, 0.5, 1.0, 2.5, and 5.0 micrograms/ml of BrdU, rose rapidly from 0.1 to 0.25 microgram/ml, and less rapidly at higher concentrations, thus reaching a saturation level. The analysis of variance, performed on the square root transformed data at 0.1 and 5 micrograms/ml of BrdU, indicated significant differences (P < 0.001) among the four donors tested. The distribution of the SCE/cell frequencies in the cell population of the four donors followed the Poisson 'mixture' probability function, thus confirming previous findings. The spontaneous rate of SCE/cell of sheep is compared with those previously reported for cattle, goat and river buffalo. The theoretical and practical implications of the spontaneous sister chromatid exchanges are discussed in relation to their possible use in animal production for (a) better genetic evaluation of the breeding animals under selection, (b) more precise monitoring of the genotoxic effects of environmental pollutants

Il modello di presa in carico di Regione Lombardia

Il contributo qui proposto espone i risultati di una ricerca volta a indagare l’impatto sul budget, dal punto di vista del Servizio Sanitario Regionale, dell’introduzione del nuovo modello organizzativo sviluppato da Regione Lombardia e basato sulla presa in carico di tutti gli assistiti affetti da patologie croniche.The contribution proposed here reports the results of a research aimed at investigating the impact on the budget, from the point of view of the Regional Health Service, of the introduction of the new organizational model developed by Lombardy Region and based on making itself responsible for all assisted patients affected by chronicle illnesses

Cost-effectiveness analysis of the use of letermovir for the prophylaxis of cytomegalovirus in adult cytomegalovirus seropositive recipients undergoing allogenic hematopoietic stem cell transplantation in Italy

Background: The aim of the analysis is to assess the efficiency of the allocation of economic resources related to the use of letermovir cytomegalovirus (CMV) prophylaxis in adult seropositive recipients (R+) patients receiving an allogenic hematopoietic stem cell transplantation (HSCT), compared with a no-prophylaxis strategy, assuming preemptive antiviral administration in both groups from the perspective of the Italian National Health Service (NHS), through a cost-effectiveness analysis. Methods: The model used is based on a decision tree which simulates on a lifetime horizon the progression of CMV infection, considering two alternatives: the use of letermovir CMV prophylaxis, followed by preemptive therapy in case of clinically significant CMV infection, or the avoided use of letermovir CMV prophylaxis, considering direct medical costs (referred to 2018) and quality-adjusted life years (QALYs), both discounted considering a 3% annual rate. Two scenarios were considered, representing the differences related to regional contexts and clinical practice of different typologies of hospitals (public or private accredited with Regional Health Services). Results: The use of letermovir prophylaxis compared with no prophylaxis strategy would lead to an increase of QALYs and direct medical costs in the two scenarios considered, with a mean increase of 0.45 QALYs, and an increase of direct medical costs of 10,222.4 € and of 10,809.9 € in the two scenarios. The incremental cost-effectiveness ratios are equal to 22,564 €/QALY and 23,861 €/QALY. The probabilistic sensitivity analysis conducted showed a percentage of results below the threshold of 40,000 €/QALY of 67.4% and 71.3%; and below a threshold of 25,000 €/QALY equal to 50.4% and to 53.0%. Conclusions: The use of letermovir CMV prophylaxis in adult R+ patients receiving allogenic HSCT, compared with a no-prophylaxis strategy, would be cost-effective for the Italian NHS considering the incremental cost-effectiveness thresholds of 40,000 €/QALY and of 25,000 €/QALY

Use of GnRH Treatment Based on Pregnancy-Associated Glyco-Proteins (PAGs) Levels as a Strategy for the Maintenance of Pregnancy in Buffalo Cows: A Field Study

The aim of the study was to evaluate the effects of GnRH administrated at day 35 after artificial insemination (AI) on the reproductive performance of buffalo cows. In ten buffalo farms in the period January&ndash;February, 481 buffalo cows were subjected to estrus synchronization protocol and fixed-time artificial insemination (Ovsynch&ndash;TAI program). Radioimmunoassays (RIA) for pregnancy-associated glycoproteins (PAGs) were used to detect pregnancy at day 28 after AI (cut-off value: &ge;1 ng/mL). Among pregnant subjects, those with PAG values between 1 and 2.5 ng/mL were considered at risk of embryonic mortality (EM) and were assigned into two groups: treated (T; n = 57) control (C; n = 57). Treated buffaloes received 0.01 mg of buserelin acetate intramuscularly on day 35 after AI, whereas control buffaloes received no treatment. The pregnancy diagnosis was confirmed at day 60 through PAGs level and rectal palpation. The treatment with GnRH had a significant effect (p &lt; 0.001) in reducing EM. Between days 28 and 60 after AI, the animals that experienced EM were only 2/57 in the T group, while were 13/57 in the C group. Moreover, GnRH treatment produced a significant increase (p &lt; 0.001) in the PAG concentration between day 28 and day 60. Administration of GnRH at day 35 after AI in animals considered at risk of low embryo survival based on PAG levels allowed a reduction in pregnancy losses and improved the pregnancy rate during low-breeding season in buffalo

Spontaneous rate of sister chromatid exchanges (SCEs) in mitotic chromosomes of sheep (Ovis Aries L.) and comparison with cattle (Bos Taurus L.), goat (Capra Hircus L.) and river buffalo (Bubalus bubalis L.).

The spontaneous level of sister chromatid exchanges (SCEs) in the sheep, estimated by exposing peripheral blood lymphocytes in 0.1 microgram/ml of 5'-bromodeoxyuridine (BrdU), was 4.08 +/- 2.47 SCE/cell, 2.04 SCE/cell cycle, 0.038 SCE/chromosome. The dose-response relationships, observed by exposing the cells to 0.1, 0.25, 0.5, 1.0, 2.5, and 5.0 micrograms/ml of BrdU, rose rapidly from 0.1 to 0.25 microgram/ml, and less rapidly at higher concentrations, thus reaching a saturation level. The analysis of variance, performed on the square root transformed data at 0.1 and 5 micrograms/ml of BrdU, indicated significant differences (P < 0.001) among the four donors tested. The distribution of the SCE/cell frequencies in the cell population of the four donors followed the Poisson 'mixture' probability function, thus confirming previous findings. The spontaneous rate of SCE/cell of sheep is compared with those previously reported for cattle, goat and river buffalo. The theoretical and practical implications of the spontaneous sister chromatid exchanges are discussed in relation to their possible use in animal production for (a) better genetic evaluation of the breeding animals under selection, (b) more precise monitoring of the genotoxic effects of environmental pollutants

Health service implications of the implementation of an early discharge strategy for patients admitted in infectious diseases departments in Southern Europe

4-8 November 201

The Italian answer to PrEP topic: evidence from a multi-centre HTA study

The aim of the study was the multi-dimensional evaluation (HTA) of PrEP (TDF/FTC Pre-exposure prophylaxis) Italian adoption, compared with the traditional prevention strategies for high-risk HIV-negative individuals.4-8 November 201

The impact of PrEP: results from a multicenter Health Technology Assessment into the Italian setting

IntroductionThe use of oral FTC/TDF for pre-exposure prophylaxis (PrEP) among high-risk people without HIV is emerging as an innovative strategy to decrease HIV epidemic. The study aims at evaluating the implications related to PrEP introduction, from a multidimensional point of view, with particular attention to the sustainability of its implementation.MethodsTo achieve this objective a Health Technology Assessment was conducted, within 35 Italian Infectious Disease Departments. Data were collected from literature review and using validated questionnaires and literature evidence. The introduction of PrEP (applied as “add-on” and “substitute” prevention strategy) into the clinical practice was compared with a baseline scenario (use of condoms among men who have sex with men and serodiscordant couples, and the use of Needle Syringe Programme among injection drugs users).ResultsDespite the improvement in patients’ quality of life, PrEP would generate a decrease of patient safety, and an increase in staff workflow, with investment in medical supplies and training courses.PrEP would lead to significant economic investments both for the NHS, and for citizens (40% and 2,377% respectively) if used as an add-on strategy, assuming FTC/TDF patent cost. With the off-patent drug, the NHS would benefit from an advantage (37%) and a shrink of the patients’ expenditure emerged (+682%). More economic resources are required if PrEP is applied as a substitute strategy, considering both the patent (NHS: 212%; citizens: 3,423%) and the off-patent drug (NHS: 73%; citizens: 1,077%).ConclusionsThe most cost-containing strategy would be the use of PrEP, as an add-on strategy, assuming the off-patent drugs, even if safety and organisational aspects would be deeply considered