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Background: Spinal cord stimulation (SCS) is a treatment for chronic intractable pain powered by an implantable pulse generator that may be rechargeable or not rechargeable (NR). It is performed in 2 stages (a trialing phase followed by permanent device implantation) and necessitates 2 hospitalizations, which may increase infection risk. Objective: This analysis explores the cost impact of improvements in battery longevity and the adoption of 1-step (direct-to-implant [DTI]) SCS implantation. Methods: Since 2019, 3 leading NR-SCS devices have been launched: Device A (2019), Device B (2020), and Device C (2021). The battery longevity of the newest Device C was estimated at comparable stimulation settings for Devices A and B. A Markov model simulated individual patient pathways across 2 scenarios: Device A vs Device C and Device B vs Device C (both with the DTI approach and 2-step approach). Costs considered were the initial device implantation procedure, device replacements, and serious adverse event (SAE) management. Italian diagnosis-related group (DRG) tariffs were applied for costs, and a 15-year time horizon was used. Results: Over 15 years, using a DTI approach, the undiscounted total costs for Device A vs Device C were 26 860 and 22 633, respectively, and 25 111 and 22 399 for Device B vs Device C, respectively. Compared with Devices A and B, Device C offered savings of 4227 and 2712, respectively; similar savings were predicted with a 2-step implant approach. Discussion: The battery longevity of NR-SCS devices directly impacts long-term costs to a payer. The longer the device lasts, the lower mean total cumulative costs the patient will have, especially with regard to device replacement costs. With novel devices and specific programming settings, the lifetime cost per patient to a payer can be decreased without compromising the patient's safety and positive clinical outcome. Conclusions: Extended SCS battery longevity can translate into tangible cost savings for payers. The DTI approach for SCS supports National Healthcare System cost efficiencies and offers the additional benefits of optimizing operating room time while having only one recovery period for the patient.
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BACKGROUND: The treatment of end-stage chronic renal failure involves substantial costs for health care, which could be higher considering hemodialysis access complications management costs. Complications could be addressed by cannulation technique, but also by the needle. In particular, the use of a metal needle for cannulation is responsible for several complications that compromise dialysis delivery and require interventions. This analysis aims to evaluate, from a hospital perspective, the direct costs related to complications that may occur in hemodialysis patients in Italy. METHODS: To identify the main complications to consider in our analysis and related patient pathway for their management, we conducted an international literature search on PubMed and validated the data for Italy with an Italian Key Opinion Leader (KOL). A micro-costing analysis was developed to precisely assess the economic costs of healthcare interventions to manage complications due to vascular access cannulation. RESULTS: The major complications identified, and the average cost/per episode for their management are the following ones: Local infection 1455 (min 745 and max 2160); Sepsis, that requires hospitalization in ward 4401 (min 3693 and max 4623); Sepsis (ICU) 17,190; Hematoma 304 (min 252 and max 728); Aneurysm 3632 (min 3139 and max 4014); Pseudoaneurysm 3695 (min 3615 and max 4014); Stenosis 2229 (min 1874 and max 4857); Thrombosis 2151 (min 1941 and max 3395). CONCLUSIONS: In making decisions, hospital administration, and payer should take into consideration, not just the price of devices, but the entire patient's pathway. The use of plastic cannulae in hemodialysis patients shows improved outcomes compared to traditional metal needles. Furthermore, combining it with accurate and efficient cannulation techniques reduces complication rates, improves patients' quality of life, and reduces healthcare resource consumption.
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OBJECTIVES: Abdominal aortic aneurysm (AAA) is defined as a localized dilatation of an aortic vessel. Though predominantly asymptomatic, it is a chronic degenerative condition associated with life-threatening risk of rupture. The early diagnosis of AAA, ie, before it ruptures, is therefore important; a simple, effective diagnostic method is ultrasound examination. To assess the benefit of screening in Italy, we developed a cost-effective Markov model comparing screening vs nonscreening scenarios. METHODS: A 13-health-states Markov model was developed to compare two cohorts of 65- to 75-year-old men: the first group undergoing screening for AAA by means of ultrasound (US), the second following the current practice of incidental detection. The following health states were distinguished: no AAA, unknown small AAA (3-3.9 cm), followed-up small AAA (1 year), unknown medium-sized AAA (4-4.9 cm), followed-up medium-sized AAA (6 months), unknown large AAA (>5 cm), elective repair, emergency repair, postelective-repair AAA, postemergency-repair AAA, rejected large AAA, and death. Transitions between health states were simulated by using 6-month cycles. Transition probabilities were derived from a literature review of relevant randomized controlled trial and from a screening program that is currently ongoing at San Martino Hospital in Genoa, Italy. The Italian National Health Service (NHS) perspective was adopted and incremental cost per life-year saved was calculated with a lifetime horizon; costs and health benefits were discounted at an annual rate of 3% from year 2 onward. Uncertainty surrounding the model inputs was tested by means of univariate, multivariate, and probabilistic sensitivity analyses. RESULTS: Considering an attendance rate of 62%, the individual cost per invited subject was 60 (US $83.2); 0.011 additional quality adjusted life years (QALY) were gained per patient in the screened cohort, corresponding to an incremental cost-effectiveness ratio (ICER) of 5673/QALY (US $7870/QALY). The results were sensitive to some parameter variations but consistent with the base case scenario. They suggest that on the basis of a willingness-to-pay threshold of 50,000/QALY, screening for AAA is cost-effective, with a probability approaching 100%. CONCLUSIONS: As in economic evaluations developed in other countries, such as the UK, Canada, and The Netherlands, setting up a screening program for AAA can be considered cost-effective from the Italian NHS perspective.