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The European Quality of Life-5 Dimensions Questionnaire (EQ-5D) is the most common instrument to value health outcomes under the patient's perspective. Several studies have investigated whether observed changes are meaningful to patients, using a variety of approaches to estimate the minimum clinically important difference (MCID). This study provides an overview of the state of art of the estimation of the MCID for the three-level EQ-5D index based on the UK scoring algorithm, critically assessing the available evidence. The interest in estimation of MCID for the EQ-5D has been increasing in recent years. However, some additional standardization in the estimation procedures may be of value, in order to enhance the ability to make comparisons across measures and disease areas. Further methodological research might also contribute to reducing gaps between theory and practice.

In 2020, the world was profoundly affected by the spread of SARS-CoV-2, a novel coronavirus first identified in December 2019, that was the causative agent of coronavirus disease 2019 (Covid-19), a severe respiratory disease classified as a pandemic by the World Health Organization (WHO) in March 2020. Covid-19 had a significant negative impact on the healthcare facilities and the economies of many countries. A need for pharmacological treatments for Covid-19 patients rapidly emerged to limit the damage caused by the disease and allow for more efficient management of hospital resources. A possible alternative treatment that has achieved encouraging results on Covid-19 is the use of monoclonal antibodies. This research aims to evaluate the cost-effectiveness of a type of monoclonal antibody, specifically the combination of casirivimab and imdevimab, and assess its impact on the Italian healthcare system. The casirivimab and imdevimab treatment efficacy on outpatients with Covid-19 was tested using a predictive Markov model. Research endpoints include hospitalizations, Intensive Care Unit (ICU) admissions, and deaths. This was translated into terms of benefits (savings) and costs for the Italian National Health Service (NHS). The model operates on a predictive time frame of 20 weeks starting from September 2021 until January 2022. The data used to populate the model comes from international academic studies and open-access resources on online databases. The model estimates the effects that can be achieved by administering casirivimab and imdevimab treatment on outpatients with Covid-19. According to the estimates, the treatment can prevent approximately 4,000 hospitalizations, 3,589 ICU admissions, and 1,500 deaths in the considered 20-week period. The potential cost savings amount to EUR 78 million, mainly attributable to the reduction in the number of hospitalizations and access to ICU. More specifically, a difference of EUR 15,4 million can be observed due to the reduction in the number of hospitalizations, a difference of EUR 59,3 million due to the reduction in the number in intensive care, and a difference of EUR 20,3 million due to the reduction in deaths as a consequence of the reduction of hospitalizations. These results are already very significant, considering that in Italy, only 4.76% of the population is eligible for monoclonal antibody treatment. The administration of casirivimab and imdevimab in outpatients with Covid-19 can accelerate recovery from the disease for patients, make hospital resource management more efficient and significantly reduce costs for healthcare facilities.

Economists consider personality as a non-cognitive asset that can have important consequences on individuals’ economic behavior. Van der Pol and Ruggeri showed, that risk attitude (RA) depends on whether individuals face choices regarding possible health gains in terms of life expectancy or quality of life. Here, we aim to explore this pattern by investigating whether individuals’ RA may change depending on the perception of the social arrangements, cultural and economic context in which they are asked to imagine going to live. Our study shows that, concerning the health domain, significant differences can be found in the RA of individuals imagining to experience a change in their set of social arrangements and standards of living. More specifically, individuals tend to be more risk averse when they are asked to move toward a country with a different religion, a lower average income, a different distribution of wealth and standard of living.

Background: In recent years, due to the epidemiological transition, the burden of very complex patients in hospital wards has increased. Telemedicine usage appears to be a potential high-impact factor in helping with patient management, allowing hospital personnel to assess conditions in out-of-hospital scenarios. Methods: To investigate the management of chronic patients during both hospitalization for disease and discharge, randomized studies (LIMS and Greenline-HT) are ongoing in the Internal Medicine Unit at ASL Roma 6 Castelli Hospital. The study endpoints are clinical outcomes (from a patient’s perspective). In this perspective paper, the main findings of these studies, from the operators’ point of view, are reported. Operator opinions were collected from structured and unstructured surveys conducted among the staff involved, and their main themes are reported in a narrative manner. Results: Telemonitoring appears to be linked to a reduction in side-events and side-effects, which represent some of most commons risk factors for re-hospitalization and for delayed discharge during hospitalization. The main perceived advantages are increased patient safety and the quick response in case of emergency. The main disadvantages are believed to be related to low patient compliance and an infrastructural lack of optimization. Conclusions: The evidence of wireless monitoring studies, combined with the analysis of activity data, suggests the need for a model of patient management that envisages an increase in the territory of structures capable of offering patients subacute care (the possibility of antibiotic treatments, blood transfusions, infusion support, and pain therapy) for the timely management of chronic patients in the terminal phase, for which treatment in acute wards must be guaranteed only for a limited time for the management of the acute phase of their diseases.

Background and Objectives: The objective of this study is to evaluate the economic impact of the device Navina Smart on patients affected by neurogenic bowel dysfunction and dependent on transanal irrigation within the Italian context. This study employs the perspective of the Italian National Health Service. Methods: The analysis was conducted through a Markov model, comparing two scenarios: standard bowel care vs. transanal irrigation. The model operates on a 30-year time period. The results were reported in terms of net monetary benefit. Results: Transanal irrigation therapy was dominant in all scenarios with lower costs and higher effectiveness. The population was assumed to be composed of 1,000 subjects. Setting the willingness to pay at €35,000.00/QALYs (quality-adjusted life years), the analysis yielded a net monetary benefit of €81,087 and cost savings of €66,101 per patient over 30 years. Conclusion: The results of this study substantiate that transanal irrigation therapy treatment employing the Navina Smart device can significantly benefit patients suffering from neurogenic bowel dysfunction by relieving their symptoms. In addition, this therapy offers important cost savings for the Italian National Health Service by reducing resource utilization.

Fungicides used to control Fusarium head blight (FHB) are commonly applied at the wheat growth stage considered to be most susceptible, i.e., anthesis. We compared the efficacy of the most commonly used fungicide groups that were applied following two strategies: (i) at pre-defined growth stages, from the first half of heading to the end of flowering (experiment 1, in 2013 to 2015), or (ii) based on timing of infection by F. graminearum, specifically at 10, 7, 4, or 1 day before, or 3 or 5 days after artificial inoculation of the fungus (experiment 2, in 2017 and 2018). Fungicide efficacy was evaluated in terms of FHB incidence, FHB severity, and DON contamination by using generalised mixed models. In experiment 1, all fungicide groups reduced FHB severity and DON but only by <50% compared to an untreated control, with no differences among fungicides or growth stages at time of application. In experiment 2, the efficacy of fungicides was higher for applications at 1 or 4 days before inoculation than at 7 or 10 days before or 3 or 5 days after inoculation, with differences among fungicide groups. Based on our results, the timing of fungicide application for FHB control should be based on the time of F. graminearum infection rather than on wheat phenology.

Introduction: The current paradigm (CP) of hepatitis C virus (HCV) diagnosis and treatment in Italy’s National Health Service system has numerous steps. The European Association for the Study of the Liver recommends initiation of a pan-genotypic direct-acting antiviral regimen after a simple diagnostic process. The present study estimated the efficiency gains resulting from two simplified pathways from diagnosis to treatment of chronic hepatitis C patients in Italy over the next 5 years from a societal perspective. Methods: The CP, a New Paradigm 1 (NP1), and a New Paradigm 2 (NP2) were evaluated in a Markov model. The NP1 model simplifies monitoring and laboratory test requirements in the diagnosis and treatment phases. The NP2 model also eliminates the primary care referral requirement. Results: Treatment process time for non-cirrhotic patients was 48, 43, and 25 weeks in the CP, NP1, and NP2, respectively, and in cirrhotic patients was 49, 46, and 37 weeks. Under the CP, 19% of patients/year would be lost to follow-up, which decreases by 11% in NP1 and 100% in NP2. Compared with the CP, implementation of NP1 at 5 years would reduce compensated cirrhosis, decompensated cirrhosis, hepatocellular carcinoma, and liverrelated deaths by 12.6%, 12.4%, 8.1%, and 8.8%, respectively; these cases would be reduced by 94.0%, 93.8%, 61.0%, and 58.4% in NP2. Total 5-year costs with the CP, NP1, and NP2 are estimated at 135.6€ million, 110.5€ million, and 80.5€ million, respectively. Conclusions: Simplification of HCV diagnosis and monitoring requirements would allow Italy to move closer to international guidelines with significant health benefits and economic gains.

In a global context of population aging, gaining better knowledge of the mechanisms leading to loss of autonomy has become a major objective, notably with the aim of implementing effective preventive health policies. The concept of frailty, originally introduced in gerontology and geriatrics as a precursor state to functional dependency, appears as a useful tool in this specific context. The “Sarcopenia and Physical fRailty IN older people: multi-componenT Treatment strategies” (SPRINTT) project will provide a unique opportunity to explore health economics issues associated with frailty. In terms of health economics, the loss of autonomy approach retained here focuses on the economic and social causes and consequences of the onset of frailty in older adults, and examines the challenges not only in terms of health system efficiency but also in terms of social protection.

The COVID-19 pandemic has placed the world’s population in a state of unprecedented public health and global health vulnerability. Risks to public and global health have escalated due to COVID-19 contamination. This has raised the statistics of inequity and environmental concerns. A possible outlook entails reducing the pandemic consequences by prioritizing development, biodiversity, and adaptability, offering buffer solutions. It contains vital methods for studying, comprehending, and unraveling events—examining early responses to COVID-19, sustainability, and development, relating them with overall Coronaviruses reaction. This study maps out environmental, socioeconomic, and medical/technological issues using as statistical techniques multiple correspondence analysis and validated cluster analysis. The findings encourage rapid, long-term development policy involvement to address the pandemic. The resulting crises have highlighted the necessity for the revival of health justice policies anchored in distinctive public health ethical patterns in response to them. As a general rule, resilience and preparedness will be targeted at developing and vulnerable nations and are prone to include access to vaccines, public health care, and health investment. Our findings show the relevance of innovating on sustainable development routes and yardsticks. Sustainable global health requires crucial measures in prevention, preparation, and response. Long-term policy recommendations are needed to address pandemics and their interrelated crises and foster sustained growth and socioecological protection.

Activity-based costing and budget analysis of vedolizumab versus conventional treatments in ulcerative colitis and Crohn’s diseaseObjectiveTo assess the organizational impact of the introduction of vedolizumab compared to the biotechnological anti-TNF alternatives to date available in Italy for the management of Ulcerative Colitis (UC) and Crohn’s Disease (CD).MethodsA questionnaire aimed at acquiring data about the Italian real practice concerning the management of patients affected by UC and CD was administered to a panel of expert clinicians from three Italian centers of excellence. The determination of the cost of the therapies was realized through an Activity-Based Costing (ABC) analysis which identified the differential between the use of vedolizumab and the alternatives.ResultsThe reduced time of infusion of vedolizumab allows a total cost/infusion of €97.89, with savings vs. infliximab of €39.60 (UC and CD). Vedolizumab implies an expenditure of €17,229.84 (UC) and €17,459.63 (CD) in the first year which allows, compared to Infliximab originator (€17,739.60), a saving/patient of €509.76 and €279.97 for UC and CD respectively. In the following years, vedolizumab implies an expenditure of €13,870.55 and €14,049.95 for UC e CD, lower than infliximab (€14,284.73), with a differential of €414.18 for UC and €234.78 for CD. In the comparison with infliximab biosimilar, the results are the same with regard to the administration costs, but the combined cost administration + drug is lower than that of vedolizumab due to the lower expenditure for drugs.ConclusionsVedolizumab implies a reduction of the time spent by the professionals involved in the provision of the treatment, allowing a reallocation of the saved resources.