Economic analyses on the use of positron emission tomography for the work-up of solitary pulmonary nodules and for staging patients with non-small-cell-lung-cancer in Italy.

AIM: Increasing ageing of the population and tumor incidence, along with worldwide rationing of the resources for public health systems, spur the use of economic analyses for the choice of strategies and technologies in the assessment and management of cancer patients. Incidence and clinical managing of tumors vary in different countries even if positron emission tomography (PET) with 2-deoxy-2-[18F]-fluoro-D-glucose (FDG) is becoming a routine clinical method for diagnosis, staging, treatment monitoring and follow-up in a variety of tumors. Available data indicate that PET can be considered a superior alternative or complementary tool to other well-established methods. However, in spite of the above and of the rapidly increasing number of PET centers in Europe, USA and Japan, only a few studies have dealt with some of the economic aspects raised by the clinical use of PET because of differences in values of reimbursements and health costs. The main aim of this study is to propose and discuss an economic model of analysis for PET applications in the field of detection and management of pulmonary tumors. METHODS: In this study 2 assessments were performed by decision tree analysis on the economic impact of the availability of PET on decision-making processes for 2 conditions: solitary pulmonary nodules assessment and non-small-cell lung cancer (NSCLC) staging. In order to define a methodology consistent with the system of reimbursement and the prevalent clinical views of the Italian National Health Service, data on costs, death probability, and life expectancy were gathered from the literature and from the Italian system of reimbursement (ROD-DRGs). RESULTS: The results of the cost minimization analysis demonstrate that the use of PET in the diagnostic path for the workup of patients with SPN reduces the overall diagnostic costs, by approximately 50 Euro per patient, by reducing inappropriate invasive diagnostic investigation and their complications. The results of the cost effectiveness analysis demonstrate that the use of PET in the diagnostic path for the staging of patients with NSCLC reduces the overall diagnostic costs by approximately 108 Euro for added year, by reducing inappropriate surgical interventions and their complications. CONCLUSION: Both analyses are based on standard methods used in the literature, so our conclusions can be compared with results and assessments of similar studies in different countries and health care systems. Also in the Italian case, the use of an economic assessment provides relevant information on the efficacy and effectiveness of PET.

Management challenges and markets.

The scarcity of resources in healthcare systems has general causes and country-specific causes. Common to most healthcare systems is a strong emphasis on management and an increased attention to the role of the market. Management and market are concepts which need clarification: management applies not only to individual institutions but to systems of institutions. Market implies not only the pursuit of individual interests but also the assumption of responsibility. The design or redesign of healthcare systems must take into account the level of management skills which each system and its institutions can rely on. Cost patterns in a healthcare system develop around its institutional design. Different factors produce varying levels of costs in different healthcare systems. The same applies to the effort needed to reach a certain degree of effectiveness in output. An outline of strengths and weaknesses of options for the design of healthcare systems is presented in the final part of the article. These should always be considered together with the specific features of each country.

[An estimate of the health costs of chronic critical ischemia of the limbs]. / Stima dei costi sanitari dell'ischemia critica cronica degli arti.

The health costs for critical leg ischaemia, resulting from the prevalence of disease in a 1 year period have been estimated in this research. The estimation of overall health costs (diagnosis and therapeutic treatment) has been obtained by classifying patients into homogeneous groups based on the different kinds of treatment given. THE AIM OF THE RESEARCH. This research aims at identifying the specific costs involved in the diagnosis and treatment for critical leg ischaemia and then to quantify the economic implications. METHODOLOGY. The methodology used in this research is based on the data found in national and foreign publications on the subject which are then verified in the field. In order to carry the research out a number of angiology and cardiovascular surgery Divisions in Italian hospitals were involved. The methodology applied in the financial estimation of the health costs were calculated by taking into consideration costs sustained by both the Public Health Service and patients. PATIENT CLASSIFICATION. The prevalence of critical leg ischaemia is between 500-1,000 cases per million inhabitants. Patients were classified on the basis of the treatment they undertook. CONCLUSIONS. The estimated overall health costs involved in treating critical leg ischaemia in Italy vary between a minimum of 389,717,930,700 and a maximum of 779,435,861,400 Italian lira. The results obtained are sustained by empirical observations. The number of patients receiving either anticoagulant or antiplatelets treatment and the average days of hospital stay for laboratory tests have been modified in order to verify the variations in the final results obtained based on changes in the original parameters.(ABSTRACT TRUNCATED AT 250 WORDS)