Italian National Healthcare System Research Articles

COVID-19 outbreak and acute cholecystitis in a Hub Hospital in Milan: wider indications for percutaneous cholecystostomy

BackgroundCOVID-19 pandemic has impacted the Italian National Health Care system at many different levels, causing a complete reorganization of surgical wards. In this context, our study retrospectively analysed the management strategy for patients with acute cholecystitis.MethodsWe analysed all patients admitted to our Emergency Department for acute cholecystitis between February and April 2020 and we graded each case according to 2018 Tokyo Guidelines. All patients were tested for positivity to SARS-CoV-2 and received an initial conservative treatment. We focused on patients submitted to cholecystostomy during the acute phase of pandemic and their subsequent disease evolution.ResultsThirty-seven patients were admitted for acute cholecystitis (13 grade I, 16 grade II, 8 grade III). According to Tokyo Guidelines (2018), patients were successfully treated with antibiotic only, bedside percutaneous transhepatic gallbladder drainage (PC) and laparoscopic cholecystectomy (LC) in 29.7%, 21.6% and 48.7% of cases respectively. Therapeutic strategy of three out of 8 cases, otherwise fit for surgery, submitted to bedside percutaneous transhepatic gallbladder drainage (37.5%), were directly modified by COVID-19 pandemic: one due to the SARS-CoV-2 positivity, while two others due to unavailability of operating room and intensive care unit for post-operative monitoring respectively. Overall success rate of percutaneous cholecystostomy was of 87.5%. The mean post-procedural hospitalization length was 9 days, and no related adverse events were observed apart from transient parietal bleeding, conservatively treated. Once discharged, two patients required readmission because of acute biliary symptoms. Median time of drainage removal was 43 days and only 50% patients thereafter underwent cholecystectomy.ConclusionsPercutaneous cholecystostomy has shown to be an effective and safe treatment thus acquiring an increased relevance in the first phase of the pandemic. Nowadays, considering we are forced to live with the SARS-CoV-2 virus, PC should be considered as a virtuous, alternative tool for potentially all COVID-19 positive patients and selectively for negative cases unresponsive to conservative therapy and unfit for surgery.

New Perspective to Improve Care of Patients with Infected Diabetic Foot Ulcer: Early Economic Impact of the Use of Photodynamic Therapy with RLP068 (Based) System.

ObjectiveTo perform an early economic evaluation of a system based on photodynamic advanced adjuvant therapy with photosensitizer RLP068/CI to facilitate the healing process of foot/leg skin lesions/ulcers with an excellent safety profile.DesignAn early short-term (10 weeks) cost-effectiveness and a budget impact analysis (over 5 years) comparing photodynamic therapy with photosensitizer RLP068/CI based (PDT-RLP068) system added to Standard of Care (SoC) vs SoC alone.SettingThe Italian National Healthcare System perspective considering both the outpatient and the day-hospital regimen.ParticipantsHypothetical patients with diabetic foot infection (DFI) grades I/IIB.InterventionsThe PDT-RLP068 system as an add-on to Standard of Care (SoC) vs SoC alone as the first-line treatment for the management of DFIs.Main OutcomesDays within which the clinical target was achieved and direct health costs for patients’ management.ResultsAdditional costs generated by the use of the PDT-RLP068 system progressively decreased as time to reach the target induced by the novel system decreased. In the outpatient regimen, when time to reach clinical target decreased in the range 7–28 days, ICERs varied from about 1€ to 70€ for each additional day gained with clinical target achieved. The system was dominant when halving time to reach the target in the outpatient regimen and even for modest reduction of time in day-hospital regimen. In terms of budget impact, when considering day-hospital regimen, if the PDT-RLP068 based system allowed a shortened duration to reach the clinical target of between 7–28 days, BI was 8,100,000€ to 700,000€, with saving less than 2,000,000€ with 50% reduction of time. Considering the inpatient setting, the use of the PDT-RLP068 system would result in saving even with the modest impact on the time needed to activate the healing process.ConclusionThe early economic evaluation performed suggested that, if the claimed effectiveness of the technology demonstrated in case reports and in preliminary clinical studies can be confirmed in larger population studies, and allowing for shortening of the time needed to activate the healing process, the PDT-RLP068 system could offer the chance to improve care for DFI patients without compromising the sustainability of the system.

MEDICINE AND MANAGERIALISM IN ITALY: EVIDENCE FROM A STUDY ON HEALTH MANAGEMENT TRAINING

Management training for doctors has become crucial with the introduction of market-inspired logics in the Italian national healthcare system. In this frame, the paper presents the main findings of a study with a twofold aim: providing an overview of health management training system by analyzing the Italian training provision; investigating perceptions and opinions of medical doctors involved in management courses. Results suggest, on the one hand, the heterogeneity of the Italian management training system and, on the other, a gradual reframing of medical professionalism.

WILLINGNESS TO RECEIVE COVID-19 VACCINATION IN COSTUMERS ACCESSING COMMUNITY PHARMACIES IN THE PROVINCE OF PALERMO, ITALY

In Italy, vaccination against COVID-19 began on December 27, 2020. To date, 13,713,224 people in Italy are fully vaccinated, which accounts for 25.3 % of the general population, and 44.8% received at least one vaccination dose. The present study aim to investigate willingness to receive COVID-19 vaccination in costumers accessing a sample of community pharmacies in the Province of Palermo, Italy. A self-administered and anonymous questionnaire was carried out among costumers older than 18 years old between December 2020 and March 2021. Three hundred and sixty-three subjects were enrolled in the study, 259 (71.3%) expressed their willingness to receive COVID-19 vaccination. The main determinants associated with vaccination acceptance resulted “trust in safety and effectiveness of vaccinations” and the absence of any previous negative vaccination experience. Unfavourable information on COVID-19 vaccination obtained through internet/media/social media and lack of confidence in COVID-19 vaccines and in the Italian national healthcare system are the main determinants associated with vaccine refusal. Male gender, younger age classes and influenza vaccination acceptance due to the impact of COVID pandemic were significantly associated with willingness to be vaccinated against COVID-19. In order to promote COVID-19 vaccination campaign accurate, informative and communicative campaign dedicated to subjects that are more hesitant regarding COVID-19 vaccination (e.g. female sex, adults, people that usually do not adhere to influenza vaccination campaign) should be implemented. © EuroMediterranean Biomedical Journal 2021.

Research protocol for the validation of a new portable technology for real-time continuous monitoring of Early Warning Score (EWS) in hospital practice and for an early-stage multistakeholder assessment

IntroductionThe real-time continuous monitoring of vital parameters in patients affected by multiple chronic conditions and/or COVID-19 can lead to several benefits to the Italian National Healthcare System (IT-NHS). The UBiquitous...

Post-Acute COVID-19 Rehabilitation Network Proposal: From Intensive to Extensive and Home-Based IT Supported Services.

Management of COVID-19 post-acute syndrome is an emerging health issue in rehabilitation. This article aims to present a proposal, based on the principles of clinical governance, health management and information technology (IT), and to respond to the need for a structured organization model for post-acute COVID-19 rehabilitation. The authors present a regional-based model of a network of clinicians and healthcare managers using a dedicated IT platform to achieve both effectiveness and efficiency objectives, to ensure coordination of the available resources and the most appropriate rehabilitative treatment for patients. The proposed post-acute COVID-19 rehabilitation network has been designed according to the model of a clinical management project within the Italian national healthcare system, and its context is an easily adjustable model for the European healthcare systems. The authors base the project on current laws and scientific guidelines in rehabilitation in Italy and in Europe and use the SWOT analysis technique to assess the proposal feasibility. The primary aims of the project are: (1) standardizing the minimum assessment tools of post-COVID-19 patients with disabilities; (2) ensuring an individual rehabilitation project for each patient with international classification of functioning, disability and health (ICF) coding and (3) reporting the activity performance with appropriate indicators. The secondary aims are: (1) developing educational programs for patients and care givers also aimed at acquiring better empowerment and positive behavior; (2) creating a regional database for data collection and (3) improving IT, and specifically tele-rehabilitation, as a suitable approach during the COVID-19 emergency and also in the future. Expected results are: continuum of care; effectiveness, efficacy and appropriateness in the delivery of rehabilitation treatments through a standardized minimum assessment and the wording of the individual rehabilitation project and a precise reporting of performance indicators to measure the effectiveness of clinical activities and the satisfaction of patients and caregivers. The assessment of results will be analyzed at three and six months to implement corrective actions according to the concept of continuous improvement of the Deming cycle. The IT remote approach allows the patient to meet the needs of proximity of care and empowerment, and, at the same time, to contain the spread of infection. This project could have a significant healthcare impact ensuring a more efficient and effective management of the demand of rehabilitation post-acute COVID-19, expanding the professional skills of the rehabilitation team members, improving both clinical and process data, in addition to optimal allocation of available economic resources.

Abstract PO-072: Doctors and nurses during COVID19 pandemic: A different perception of cancer care

Abstract Background: The spread of coronavirus disease brought the need to reorganize clinical activity in oncology. Cancer patients are very vulnerable, and it is well known that their treatment has to be strictly planned. The most critical considerations still relate to the entry of the virus into hospitals, the heart of health care, where cancer patients are protected. Instead, during the COVID19 pandemic the oncologic department had to limit access to care to protect patients from a more dangerous disease for them, witnessing a paradox of health care. This brought with it worries in oncologic health care professionals in replanning activities in order to guarantee therapeutic continuity and quality of care. It is well known that physicians and nurses have different role concepts and role expectations. The purpose of our study was to investigate doctors’ and nurses' perception of cancer patient reorganization during the COVID19 pandemic in a sample of Italian health care professionals in oncology. Methods: We submitted a survey to oncologic health care workers (physicians and nurses) of Italian National Health Care System during the pandemic to investigate clinical activity reorganization and cancer patient management through 12 closed questions. The survey promoted by Clinica Oncologica, AOU Riuniti di Ancona-Università Politecnica delle Marche was electronic and anonymous. Results: A total of 383 oncology health workers completed the survey, 60 nurses (15%) and 323 physicians (85%). 60% of interviewed physicians perceived qualitatively lower than usual the therapeutic path of patients taken in charge in this historical moment, while 45% of nurses declared it was the same (P<0.01). The continuity of the multidisciplinary team was defined as guaranteed for 68% of oncologists, while almost 40% of nurses declared to not know it. Almost all physicians (95%) answered that their clinical activity was reorganized, compared to a lower portion of nurses (80%) who replanned their care role (p<0.01). Deferring treatments caused fear and anxiety in 62% of physicians and 46% of nurses (P=0.027). Conclusion: The survey underlined the need to integrate skills and involve all professional figures in planning cancer patients’ treatment to guarantee optimal therapeutic strategies and a global take in charge in all its details, even during emergencies. Citation Format: Lucia Bastianelli, Filippo Merloni, Nicoletta Ranallo, Luca Cantini, Lorenzo Mariotti, Alessandra Lucarelli, Zelmira Ballatore, Rossana Berardi. Doctors and nurses during COVID19 pandemic: A different perception of cancer care [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr PO-072.

Cardiac arrhythmias and In-hospital mortality amongst patients with takotsubo cardiomyopathy: A retrospective study in an Italian population.

Takotsubo cardiomyopathy (TTC) is an acute non-ischemic cardiomyopathy classically associated with an intense emotional or physiologic trigger. Data on the relationship between arrhythmias and mortality in TTC have been limited by small sample sizes. The aim of this study is to assess the impact of ventricular and atrial arrhythmias and advanced atrioventricular block on in-hospital mortality in a large inpatient population with TTC. Data was obtained from the Italian National Healthcare System Databank from 2009 to 2016. Patients with TTC were identified using diagnosis codes and clinical characteristics were collected, with a primary outcome of mortality. Univariate and multivariate logistic regression analyses were used to identify significant predictors for mortality, and patients with TTC were further analyzed according to sex and age. There were 10,861 patients with TTC; 91.7% were women (9959) and the mean age was 70.7 +/- 11.9years. The mortality rate was 2.2%; while 1.2% of patients had ventricular arrhythmias, 10.0% had atrial arrhythmias, and 1.3% had advanced atrioventricular block. Male sex, increased age and ventricular arrhythmias were predictors of mortality. In a sex-stratified analysis, ventricular arrhythmias and advanced age remained independent predictors for mortality in women. In this large retrospective analysis, male sex and the presence of ventricular arrhythmias are strong predictors of mortality in patients hospitalized with TTC.

Obesity treatment within the Italian national healthcare system tertiary care centers: what can we learn?

The prevalence of obesity is soaring all over the world, and Italy is reaching the same pace. Similar to other countries, the Italian healthcare system counts on a three-tier model for obesity care, and each region has freedom in the implementation of guidelines. No national record is currently available to monitor the actual situation throughout the country. To provide a report of the current status on the availability of specialized public obesity care services in Italy. Regional prevalence of obesity was extrapolated from publicly available data. Data on facilities for the management of obesity were retrieved from records provided by national scientific societies. Whenever possible, data was verified through online research and direct contact. We report a north-south and east-west gradient regarding the presence of obesity focused facilities, with an inverse correlation with the regional prevalence of obesity (R = 0.25, p = 0.03). Medical-oriented centers appear homogeneous in the multidisciplinary approach, the presence of a bariatric surgery division, the availability of support materials and groups, with no major difference on follow-up frequency. Surgery-oriented centers have a more capillary territorial distribution than the medically oriented, but not enough data was retrieved to provide a thorough description of their characteristics. Obtaining a clear picture of the situation and providing consistent care across the country is a challenging task due to the decentralized organization of regions. We provide a first sketch, reporting that the model is applied unevenly, and we suggest feasible actions to improve the situation in our country and elsewhere. Level V, narrative review.

Infection control measures in ophthalmology during the COVID-19 outbreak: A narrative review from an early experience in Italy.

IntroductionThe novel coronavirus (SARS-CoV-2) is infecting people and spreading easily from person-to-person. Cases have been detected in most countries worldwide. Italy is one of the most affected countries as of 30 March 2020. Public health response includes a rapid reorganization of the Italian National Healthcare System in order to reduce transmission of COVID-19 within hospitals and healthcare facilities, while optimizing the assistance to patients with severe COVID-19 complications.MethodsWe analysed the actions that were taken in three ophthalmology centres in northern Italy during the SARS-CoV-2 outbreak and how these measures affected patient’s attendance. In addition, due to the rapidly evolving scenario, we reviewed the evidence available during the course of this pandemic.ResultsA full reorganization of ophthalmology services is mandatory according to current existing infection containment measures in order to continue dispensing urgent procedures without endangering the community with amplification of the diffusion chain. Ophthalmologists are considered at elevated risk of exposure when caring patients and vice versa, due to their close proximity during eye examination. High volumes of procedures typically generated by ophthalmologists with concurrent implications on the risk of infection are considered when re-assessing healthcare facilities reorganization.ConclusionContainment measures in the event of pandemic due to infective agents should be well known by healthcare professionals and promptly applied in order to mitigate the risk of nosocomial transmission and outbreak.

Economic Evaluation of Dulaglutide vs Traditional Therapies: Implications of the Outcomes of the Rewind Study.

BackgroundDiabetes represents a relevant public health problem worldwide due to its growing prevalence and socioeconomic burden, principally due to the development of macrovascular and microvascular complications as well as to the continuous launch of new and even more expensive drugs. The aim of our study is to evaluate the economic impact of dulaglutide, a weekly GLP-1 receptor agonist, on the treatment of diabetic patients as an alternative to both high dose sulphonylureas and insulin basalization at the failure of oral therapies alone. We carried out a cost-effectiveness analysis developed considering the economic implications of recent clinical studies regarding cardiovascular risk drug effects and especially of REWIND studies outcomes, focusing on the impact of weight changes on HRQoL.Material and MethodIn our analysis, we have applied the cost-utility technique to the above reported clinical outcomes and compared the global costs of dulaglutide versus sulfonylurea or basal insulin, all in add-on with metformin. We have chosen gliclazide, as a sulfonylurea and Abasaglar®, the less expensive among basal insulin analogues. Abasaglar was titrated to 20 IU, corresponding to the mean dosage used in the treatment of type II diabetic patients. The model aims to estimate total direct costs related to the above-reported treatments and find out the real gap in costs between dulaglutide, the apparently cheaper gliclazide and basal insulin glargine (IGlargine) based on the Italian National Healthcare System (INHS).ResultsThe total cost of dulaglutide has resulted in €859.66 higher than gliclazide (€1,579.73 vs €720.07) and basal insulin, although less significantly, reporting a difference of €396.54 (€1,579.73 vs 1,183.19). Except for the purchase cost, dulaglutide has reported reduced costs compared to insulin IGlargine and gliclazide. Dulaglutide showed lower self-monitoring blood glucose and hypoglycaemia costs, a significant reduction in costs related to cardiovascular complications, as well as savings in costs in other drugs. Dulaglutide can be considered a cost-effective antidiabetic therapy, due to the positive impact on the quality of life induced by weight reduction, despite the higher annual cost per patient, mainly influenced by drug purchase cost.Discussion and ConclusionIn this cost-utility analysis, dulaglutide has shown to be a cost-effective treatment option from the Italian healthcare system perspective as add-on therapy to metformin in patients with inadequately controlled type 2 diabetes mellitus. Study findings can provide stakeholders valuable evidence to support the adoption of this cost-effective second- or third-line therapy compared to gliclazide or basal insulin glargine. Dulaglutide cost-effectiveness has been particularly evident in the comparison with basal insulin glargine, indicating that, in patients who have treatment indication, this therapy may be preferred to basalization avoiding related complications and costs.

Accounting to ensure healthy lives: critical perspective from the Italian National Healthcare System

Purpose The aim of the paper is to understand the differences between “talking” and “walking” about sustainable development goals (SDGs) in state-owned enterprises (SOEs). Specifically, the authors have conducted an analysis on 202 entities that operate within the Italian National Healthcare System (INHS) to evaluate the overall degree of transparency in term of contribution to the SDG3. Design/methodology/approach The research evaluates the degree of contribution to SDG3 by INHS through the adoption of the theoretical framework proposed by Beck et al. (2010). Specifically, the authors assess the degree of contribution to this goal using an interpretive content analysis that combines the theoretical framework with the 13 targets that composed the SDG3. For the authors’ purposes, they analyze all INHS’s website to evaluate the presence/absence of social reports produced in the periods 2015-2018. Findings Although the great contribution to the SDG3, the INHS is characterized by a low degree of accountability. In fact, only 12.21 per cent of INHS’s entities disclosed at least one social report during the observed period. Moreover, the authors’ results denote how the approach of INHS’s entities to social reporting is different both in term of “quality” and “quantity.” Research limitations/implications The SOEs play a central role within the Agenda 2030 strategies. However, public managers are less oriented than private managers to adopt non-financial reporting tools. Furthermore, the authors’ results highlight the existence of asymmetric information between SOEs and citizens even if in presence of best practices such as the INHS. In this sense, the adoption of non-financial reports tool to engage in a more effective way with citizens could be a strategic driver for the achievement of highest degree of social legitimacy to operate. Practical implications The paper is of use to public managers operating in countries characterized by a high level of contribution to SDGs. Specifically, the authors’ results suggest how the adoption of reporting tools could impact positively in terms of stakeholder’s awareness to SDG themes. Originality/value This paper contributes to the understanding of the central role covered by academics, practitioners and public sectors to SDGs through the adoption of social reporting tools.

Cost-Utility Analysis of Saxagliptin/Dapagliflozin Versus Gliclazide and Insulin Glargine: Economic Implications of the Outcomes of the CVD-Real Studies I and II.

Diabetes treatment cost represents an ever-growing problem. The adoption of new drugs in therapy, although they can guarantee an improvement in patient’s quality of life, can meet obstacles when it involves an increase in costs. We decided to compare the costs and benefits of the new saxagliptin and dapagliflozin combination versus traditional therapies. Bodyweight loss and the sharp reduction in hypoglycemic episodes were the 2 main clinical outcomes that emerged from registered studies of saxagliptin and dapagliflozin compared with the sulfonylureas. These results, combined with the good cardiovascular risk profile, led to develop a cost-utility analysis. We aimed to show the economic value of this new association therapy. We carried out a cost-utility analysis from the Italian National Healthcare System (NHS) perspective, focused on direct costs related to the treatment and management of main diabetes complications. Utility scores adopted have been measured based on the patient’s perception of weight changes. In light of the better durability profile of saxagliptin/dapagliflozin compared with gliclazide, we also considered a simulation scenario to assess the impact on costs of switching to basal insulin, starting from gliclazide and the fixed combination, respectively, and based on the related probabilities to switch. To assess the robustness of the results, a 1-way sensitivity analysis was performed by changing the main parameters by ±20%. Furthermore, the sensitivity of the results was tested considering the addition of a percent discount, because the purchase costs of drugs are usually subject to hidden discounts. We calculated the total direct annual cost per patient of saxagliptin/dapagliflozin versus gliclazide and insulin glargine for patients with type 2 diabetes mellitus not achieving glycemic control on metformin plus saxagliptin alone, dapagliflozin alone, or gliclazide at a lower dosage. Total treatment costs have been obtained adding the direct cost of the drug, needles, glycemic self-monitoring, hypoglycemic events, cardiovascular complications, and effect on consumption of other drugs. The total direct cost of saxagliptin/dapagliflozin fixed dose combination was €414.62 higher than gliclazide (€1.067.72 vs €653.10), and greater than basal insulin, with a difference of €166.99 (€1067.72 vs €900.72). Despite the higher annual direct total cost, the additional cost per quality-adjusted life year (QALY) gained, compared with gliclazide, has been €11 517, and €4639, when compared with insulin glargine in the base-case scenario, and the robustness of the results has been shown in the sensitivity analysis. The results of our cost-utility analysis, expressed as incremental cost-effectiveness ratios, were fully compliant with the threshold adopted for Italy. Then, saxagliptin/dapagliflozin can be considered a cost-effective oral hypoglycemic agent. The positive effect of this drug on the quality of life, induced by the bodyweight loss, has allowed this outcome, despite the higher annual cost per patient, mainly determined by the drug purchase cost.

The Medical Emergency Team in Italy: an overview of in-hospital emergencies response.

Background and aim:Medical Emergency Team (MET), implemented in many hospitals worldwide, aims to improve the safety of in-hospital patients whose condition is deteriorating. This study describes MET presence and organization in the Italian National Healthcare System Hospitals.Methods:A national survey with an online questionnaire was performed. The questionnaire, created ad hoc, was sent by e-mail to the nursing coordinators and MET referents of the Hospitals affiliated to the Italian National Healthcare System with an Anesthesia and Intensive Care service.Results:One hundred-ninety-seven hospitals were interviewed (36.2% of the whole national network). A dedicated MET, composed at least by an intensivist and a nurse, was present only in 118 cases (59.9%). The team was composed by a non-dedicated staff (67.8% of doctors, 69.5% of nurses) and a minimum shared standard of education for the nurse component was absent. One third of the estimated hospitals did not use a warning score for emergency call activation.Discussion and conclusion:This survey showed a heterogenous and often lacking organization of in-hospital emergency management in Italy. MET system needs to be implemented in terms of presence in the Italian hospitals, and standardized for personnel structure and training, and equipment availability. A broader study is necessary to compare our data with those of other European Countries to better identify the specific areas which need to be improved more promptly. (www.actabiomedica.it)

Shadow cost of oral corticosteroids-related adverse events: A pharmacoeconomic evaluation applied to real-life data from the Severe Asthma Network in Italy (SANI) registry

BackgroundAsthma is one of the most common non-communicable respiratory diseases, affecting about 6% of the general population. Severe asthma, even if afflicts a minority of asthmatics, drives the majority of costs of the disease. The aim of this study is to create a pharmacoeconomic model to predict the costs of corticosteroid-related adverse events in severe asthmatics and applying it to the first published epidemiologic data from the Severe Asthma Network in Italy (SANI) registry. MethodsThe analysis was conducted from the perspective of the Italian National Healthcare System (INHS). Model inputs, derived from literature, included: asthma epidemiology data, frequency of adverse events, percentage of severe asthma treated with OCS and adverse event cost (Diagnosis-Related Group (DRG) national tariffs). We estimated costs per different patient groups: non-asthma controls, mild/moderate and severe asthmatics. Final results report estimated direct cost per patient and total direct cost for overall target population, showing economic impact related to corticosteroid complication. ResultsBased on epidemiological data input, in Italy, asthmatic subjects resulted about 3,999,600, of which 199,980 with severe asthma. The number of patients with severe asthma OCS-treated was estimated at 123,988. Compared to the non-asthma control cohort and to that with moderate asthma annual cost per severe asthmatic patient resulted respectively about €892 and €606 higher, showing a corticosteroids shadow cost ranging from 45% to 30%.Applying the cost per patient to the target population identified for Italy, the budget impact model estimated a total annual cost related to OCS-related adverse events of €242.7 million for severe asthmatics. In respect with non-asthmatic and moderate population, an incremental expenditure of about € 110.6 million and €75.2, respectively, were shown. ConclusionsOur study provides the first estimates of additional healthcare costs related to corticosteroid induced adverse events in severe asthma patient. Budget impact model results highlighted the relevant economic impact of OCS-related adverse events in severe asthma patients. The future extrapolation of additional data from SANI registry will support the development of a model to investigate the role of corticosteroids sparing drugs.

PMD16 - Comparing the Long-Term Impact on Healthcare Resources and Costs Due to Single-Piece Acrylic Intraocular Lens (IOL) Implantation During Cataract Surgery: A Cost-Consequence Analysis From Italian Healthcare System Perspective

Posterior Capsular Opacification (PCO) is a key secondary complication of IOL implant following cataract surgery and clinically significant PCO requires Nd: YAG laser capsulotomy treatment which in turn could lead to further complications. The objective of this analysis was to develop a cost-consequence model to estimate the healthcare resource utilization and cost impact of YAG procedures due to different single-piece acrylic IOLs. A cost-consequence model from Italian national healthcare system perspective was developed. For input parameters, three year incidence of Nd:YAG laser capsulotomy for five single-piece acrylic IOL s (2.4% for AcrySof, 5.1% for Tecnis, 9.2% for Akreos, 12.3% for Lenstec and 12.6% for Rayner) were derived from a retrospective electronic medical records database study. Weighted average calculations were performed to derive 3 year post-YAG incidence of retinal detachment (4.4%), glaucoma (8.8%), and cystoid macular edema (16.9%) using published data. National average of published YAG (€95.4) and Vitrectomy (€1641) DRG tariffs were used, and glaucoma (€522) and CME treatment costs (€79.8) were sourced from the literature. Number of cataract procedures per annum was derived from Eurostat statistics. For 526,966 cataract procedures carried out in a year, in 3-years post cataract surgery, single-piece hydrophobic AcrySof IOLs could result in substantially fewer Nd:YAG procedures compared to Tecnis (n=14,228), B&L Akreos (n=35,834), Lenstec (n=52,170) and Rayner (n=53,751) IOLs with subsequent reductions in vitrectomy, glaucoma and CME treatments. Total cost savings for the Italian healthcare system due to AcrySof IOLs could be in the range of €3.2 to €12.2 million. These results suggest that single-piece hydrophobic AcrySof IOLs are associated with significantly lower incidence of Nd:YAG capsulotomy compared to comparator IOLs resulting in significant reduction in healthcare resource utilization for facilities and cost savings for budget owners.

2399Weather conditions, pollution and incidence of acute coronary syndromes: a large-scale analysis of the italian national healthcare system administrative data

2399Weather conditions, pollution and incidence of acute coronary syndromes: a large-scale analysis of the italian national healthcare system administrative data

Team performance in the Italian NHS: the role of reflexivity

PurposeThe purpose of this paper is twofold: first, to investigate the goodness of the input-process-output (IPO) model in order to evaluate work team performance within the Italian National Health Care System (NHS); and second, to test the mediating role of reflexivity as an overarching process factor between input and output.Design/methodology/approachThe Italian version of the Aston Team Performance Inventory was administered to 351 employees working in teams in the Italian NHS. Mediation analyses with latent variables were performed via structural equation modeling (SEM); the significance of total, direct, and indirect effect was tested via bootstrapping.FindingsUnderpinned by the IPO framework, the results of SEM supported mediational hypotheses. First, the application of the IPO model in the Italian NHS showed adequate fit indices, showing that the process mediates the relationship between input and output factors. Second, reflexivity mediated the relationship between input and output, influencing some aspects of team performance.Practical implicationsThe results provide useful information for HRM policies improving process dimensions of the IPO model via the mediating role of reflexivity as a key role in team performance.Originality/valueThis study is one of a limited number of studies that applied the IPO model in the Italian NHS. Moreover, no study has yet examined the role of reflexivity as a mediator between input and output factors in the IPO model.

Il Fast-Track delle fratture di femore prossimale over 65: la realtà ospedaliera italiana

Fractures of the femoral neck in over-65 patients are today a topical subject owing to both their significant clinical and economic impact and their ever-increasing incidence. The growing and widespread adherence of the Italian National Healthcare System to the treatment of these fractures within 24–48 hours has allowed over the last few years to reduce the number of complications and the medium to long-term mortality rate associated with this important social and economic problem.

Initial combination therapy for patients with pulmonary arterial hypertension (PAH): a budget impact analysis from the perspective of the Italian national healthcare system

ABSTRACTBackground: Initial combination therapy in patients with pulmonary arterial hypertension (PAH) WHO functional class (FC) II or III has demonstrated clinical benefits over initial monotherapy. The objective of this study is to compare the financial impact of initial combination therapy with initial monotherapy for incident patients with PAH in Italy.Methods: A 3-year budget impact model compared a ‘status quo’ scenario of initial monotherapy with an endothelin receptor antagonist (ERA), phosphodiesterase 5 inhibitor (PDE5i) or prostanoid, with a ‘new’ scenario involving initial combination therapy, using Italian national healthcare system (NHS) data for incident patients with PAH WHO FC II or III. The hospitalisation hazard ratio (HHR) from the AMBITION study and expert panel advice on therapy use were employed. Univariate sensitivity analyses were performed.Results: A difference in costs of €16,070 favouring the ‘new’ scenario (initial combination therapy) was observed, and attributed to 101 fewer hospitalisations over 3 years. Sensitivity analyses showed that costs were driven by the proportion of patients receiving ERAs versus PDE5i, hospitalisation costs and prostanoid dose.Conclusion: Initial combination therapy instead of monotherapy could reduce the number and cost of hospitalisations without an increase in the total costs to the Italian NHS.