learning effect and diffusion of innovative medical devices the case of transcatheter aortic valve implantation in italy

Aim: We investigated the diffusion of transcatheter aortic valve implantation (TAVI) since its introduction into the Italian market aimed at identifying the potential drivers of uptake and diffusion at hospital and regional levels. Materials & methods: We estimated the determinants of TAVI diffusion in Italy from 2007 to 2015 with a regression analysis based on registry data. Results: Since 2007, TAVI has shown significant diffusion rates in Italy. The diffusion is positively correlated with implanting centers' experience and with the presence of key opinion leaders. Regional recommendations on the use of TAVI negatively influence the diffusion. Reimbursement policies do not exert a relevant impact. Conclusion: Learning effect seems to be the major driver of TAVI diffusion in Italy

Abruzzo

In Abruzzo region 55,4% of women (aged 25-64) are screened regularly, meaning every 3 years. Considering regional tariffs and vaccine acquisition cost, the vaccination of 12-year-old girls with a 90% coverage could prevent 29 cases of cervicocarcinoma and 12 related deaths and thus results to be cost-effective (20.836 €/QALY). When the vaccination programme is extended to 16-year-old girls a further 28 cancer cases and 12 deaths could be prevented, with a very similar cost-effectiveness ratio. In Abruzzo region, the net cost for woman vaccinated is 199 € for the single cohort and 202 € for the multiple cohort

L'introduzione del vaccino anti-HPV bivalente adiuvato con AS04 nelle regioni italiane: impatto economico ed effetti sulla salute delle donne

Introduction: the impact of cervical cancer prevention, in particular through HPV female vaccination, has been published for many countries at the national level. However, to our knowledge no attempt has been made to address the impact at a regional level. Since the Italian health reforms of the early 1990s, introducing "managerialism", decentralization and quasi-market mechanisms, regional authorities have consequently been experimenting with different organizational and funding models to achieve an acceptable combination of equity, efficiency, freedom of choice and cost-containment. Methods: a Markov model, previously described and successfully adapted to the national scenario [La Torre, 2007], has been used to explore the impact of preventive cervical cancer vaccination with Cervarix™ at a regional level in Italy. Resource use was based on a standard therapeutic path applied to all regions. However we quantified the impact of the so-called "decentralization progress" by collecting regional data on: pap-test coverage, tariffs for treatments and cost of the vaccination course. We performed for each Italian region a cost-effectiveness analysis combined with a regional budget impact analysis. The regional analyses compared HPV vaccination, both of a single female cohort (12 years old) and a multiple female cohort (12+16 years old), plus screening to screening only. Results: 21 regional reports were produced presenting regional results on screening coverage, treatments costs, ICER and ICUR, net cost per subject vaccinated etc. Conclusions: national and regional analyses have two different aims: the former wants to address national regulatory agencies and needs to be representative of the national population whereas the latter deals with the real budget-holders, accountable in the eyes of patients. Furthermore in the Italian scenario, characterized by decentralization and local autonomy, a further level of detail is essential in order to describe the specific local settings and implications of a new health intervention

Puglia

In Apulia region 43,9% of women (aged 25-64) are screened regularly, meaning every 3 years. Considering regional tariffs and vaccine acquisition cost, the vaccination of 12-year-old girls with a 90% coverage could prevent 127 cases of cervicocarcinoma and 52 related deaths and thus results to be cost-effective (13.471€/QALY). When the vaccination programme is extended to 16-year-old girls a further 133 cancer cases and 54 deaths could be prevented, with a very similar cost-effectiveness ratio. In Apulia region, the net cost for woman vaccinated is 137€ for the single cohort and 141€ for the multiple cohort

Neurotensin is a lipid-induced gastrointestinal peptide associated with visceral adipose tissue inflammation in obesity

Neurotensin (NT) is a 13-amino acid peptide localized in the neuroendocrine cells of the small intestine, which promotes fat absorption and fatty acids translocation in response to lipid ingestion. NT-knock-out mice fed with a high-fat diet are protected from obesity, fatty liver, and the development of insulin-resistance. In humans, higher plasma levels of pro-NT, which is the stable circulating precursor of NT, predict obesity, type 2 diabetes (T2D), and cardiovascular disease. In obesity, the presence of visceral adipose tissue (VAT) inflammation leads to unfavorable metabolic outcomes and is associated with the development of T2D and non-alcoholic fatty liver disease (NAFLD). In this study, we investigated the relationship between plasma pro-NT levels and the presence of VAT inflammation in biopsies from 40 morbidly obese subjects undergoing bariatric surgery. We demonstrated that higher proNT levels are significantly associated with greater macrophages infiltration, HIF-1&alpha;, WISP-1, and UNC5B expression in VAT (all p < 0.01) due to the diagnosis of T2D and NAFLD. The overall results show that, in obesity, pro-NT is a biomarker of VAT inflammation and insulin-resistance. Additionally, NT may be involved in the development of dysmetabolic conditions likely mediated by increased gut fat absorption and the presence of a proinflammatory milieu in the adipose tissue

Veneto

In Veneto region 72,8% of women (aged 25-64) are screened regularly, meaning every 3 years. Considering regional tariffs and vaccine acquisition cost, the vaccination of 12-year-old girls with a 90% coverage could prevent 72 cases of cervicocarcinoma and 31 related deaths and thus results to be cost-effective (29.052 €/QALY). When the vaccination programme is extended to 16-year-old girls a further 67 cancer cases and 28 deaths could be prevented, with a very similar cost-effectiveness ratio. In Veneto region, the net cost for woman vaccinated is 184 € for the single cohort and 188 € for the multiple cohort

Toscana

In Tuscany region 70,2% of women (aged 25-64) are screened regularly, meaning every 3 years. Considering regional tariffs and vaccine acquisition cost, the vaccination of 12-year-old girls with a 90% coverage could prevent 51 cases of cervicocarcinoma and 21 related deaths and thus results to be cost-effective (25.732€/QALY). When the vaccination programme is extended to 16-year-old girls a further 49 cancer cases and 21 deaths could be prevented, with a very similar cost-effectiveness ratio. In Tuscany region, the net cost for woman vaccinated is 169€ for the single cohort and 172€ for the multiple cohort

Bacterial and Viral Infection and Sepsis in Kidney Transplanted Patients

Kidney transplanted patients are a unique population with intrinsic susceptibility to viral and bacterial infections, mainly (but not exclusively) due to continuous immunosuppression. In this setting, infectious episodes remain among the most important causes of death, with different risks according to the degree of immunosuppression, time after transplantation, type of infection, and patient conditions. Prevention, early diagnosis, and appropriate therapy are the goals of infective management, taking into account that some specific characteristics of transplanted patients may cause a delay (the absence of fever or inflammatory symptoms, the negativity of serological tests commonly adopted for the general population, or the atypical anatomical presentation depending on the surgical site and graft implantation). This review considers the recent available findings of the most common viral and bacterial infection in kidney transplanted patients and explores risk factors and outcomes in septic evolution

Sicilia

In Sicily region 39,6% of women (aged 25-64) are screened regularly, meaning every 3 years. Considering regional tariffs and vaccine acquisition cost, the vaccination of 12-year-old girls with a 90% coverage could prevent 169 cases of cervicocarcinoma and 68 related deaths and thus results to be cost-effective (15.534 €/QALY). When the vaccination programme is extended to 16-year-old girls a further 181 cancer cases and 75 deaths could be prevented, with a very similar cost-effectiveness ratio. In Sicily region, the net cost for woman vaccinated is 171 € for the single cohort and 176 € for the multiple cohort

Sardegna

In Sardinia region 45,5% of women (aged 25-64) are screened regularly, meaning every 3 years. Considering regional tariffs and vaccine acquisition cost, the vaccination of 12-year-old girls with a 90% coverage could prevent 38 cases of cervicocarcinoma and 15 related deaths and thus results to be cost-effective (15.347 €/QALY). When the vaccination programme is extended to 16-year-old girls a further 41 cancer cases and 18 deaths could be prevented, with a very similar cost-effectiveness ratio. In Sardinia region, the net cost for woman vaccinated is 148 € for the single cohort and 152 € for the multiple cohort