LEAP Virtual Visit Assessment (VIVA): a structured protocol for virtual visits for patients with heart failure.

AIMS: Telemedicine may be of benefit in patients with heart failure (HF), although virtual visits are often carried out on an ad hoc basis. Herein, we discuss a structured protocol that defines all the steps needed for virtual visits, LEAP Virtual Visit, which includes guides and support kits for clinicians and patients. METHODS: A working group of clinicians was established to develop a protocol for virtual visits. The virtual model for monitoring HF patients was based on measurement and sizing of patient flows, type of services, and critical organizational points. The process of virtual visits was broken down to identify the specific activities, players, roles, and support tools needed for implementation in daily practice. RESULTS: In the protocol developed, sections were included on patient eligibility, exams, supportive tools, and practical organizational aspects. IT requirements were also considered and the most widely used teleconference platforms were compared according to features that were considered to be priority for virtual visits. Protocols and support kits were developed, including guides for clinicians and patients, two questionnaires to assess the level of satisfaction, patient diary, disease awareness brochure, and template to monitor key performance indicators. The phases include an enrolment phase, document sharing phase, pre-evaluation phase, the virtual visit itself, and the post-visit phase. The protocol for the virtual visit was divided into 8 sequential steps to be carried out between the clinic and patient/caregiver. CONCLUSION: The protocol described can be expected to have a number of benefits for the patient, clinic, and healthcare structure.

Italian Public Health Expenditure for Vitamin D is still high: New Outlook to Saving From a Consumption Analysis in the Liguria Region.

PURPOSE: Italian expenditure for vitamin D greatly increased in the last few years, reaching €314 million ($376.8 million) in 2019. In Italy, the main cause of the increase in public spending for vitamin D is the marketing of high-cost medicines. At national and regional levels, some interventions have been performed to reduce expenditure, but spending has continued to increase. The aim of this work is to propose a new saving strategy determined by an analysis of a significant sample of the market. METHODS: Data on the use of vitamin D formulations, including data for the different active substances that represent its pharmaceutical analogue and composition of groups of equivalence, were extrapolated from the Italian Medicines Agency transparency lists and from the Farmadati database. Data on pharmaceutical expenditure were obtained from the Data Warehouse of Liguria Region; the composition of this expenditure was analyzed in detail, focusing on the characteristics of the pharmaceutical preparations and their cost (price per defined daily dose). FINDINGS: Vitamin D expenditure paralleled that of cholecalciferol, the most used active ingredient, which in Liguria increased from €643,352 ($772,022.4) in 2010 to €8,006,574 ($9,607,888.8) in 2019 (increase of 1144%). Spending focused on high-cost formulations, exceeding 90% of total cholecalciferol cost in 2019. We simulated a possible optimization of the expense for cholecalciferol by applying a revised price to all the cholecalciferol consumptions in high-cost products because these formulations do not have an added therapeutic value, finding that the saving would be at least 60%. National data on the detailed expenditure composition for vitamin D are not available, but we found a strong resemblance between total cholecalciferol expenditure time series in Italy and the Liguria Region. IMPLICATIONS: The expense of cholecalciferol and consequently the expense of vitamin D could be optimized by modifying the reimbursement of high-cost formulations. At a national level, savings should be proportional to that estimated for the Liguria Region. On the basis of the 2019 data, Italian savings with respect to total cholecalciferol expenditure should be €170.65 million ($204.78 million); per capita cholecalciferol expenditure would shift from €4.66 ($5.59) to €1.84 ($2.21).

CO2-enhanced oil recovery and CO2 capture and storage: An environmental economic trade-off analysis.

CO2 enhanced oil recovery can play a significant role in stimulating carbon capture and storage because of additional oil revenues generated. However, it also leads to additional greenhouse gas emissions. We estimate the global warming potential of different CO2 capture scenarios with and without enhanced oil recovery. During a 10 year period in which oil and electricity are produced without CO2 being captured, the global warming potential is 11 MtCO2 equivalents. We show that if CO2 is captured and used for 15 years of enhanced oil recovery, the global warming potential decreases to 3.4 MtCO2 equivalents. This level is 100% higher compared to the scenario in which the captured CO2 would be stored in an offshore aquifer instead. If the capture of CO2 is stopped when the oil reservoir is depleted, the global warming potential resulting from 10 years electricity production is 6 MtCO2 equivalents. However, if CO2 is stored in the depleted reservoir, the global warming potential is six times lower during that period. Electricity production and oil refining are the main contributors to the global warming potential. The net present value analysis indicates that for CO2 prices lower than or equal to 15 €/t and oil prices greater than or equal to 115 €/t, it is most profitable to capture CO2 for enhanced oil recovery only. Because of the low CO2 price considered, large incomes from oil production are required to stimulate CO2 capture. The environmental economic trade-off analysis shows that if CO2-enhanced oil recovery is followed by CO2 capture and storage, costs increase, but the net present value remains positive and the global warming potential is reduced. Authorities could use these outcomes to support the development of economic mechanisms for shared investments in CO2 capture installations and to mandate both oil producer and large CO2 emitting firms to store CO2 in depleted oil fields.