Cost and effectiveness of autologous haematopoietic stem cell transplantation and high-efficacy disease-modifying therapies in relapsing-remitting multiple sclerosis.

BACKGROUND: Autologous haematopoietic stem cell transplantation (AHSCT) is a highly effective one-off treatment for relapsing-remitting multiple sclerosis (RR-MS), potentially representing an optimal front-loading strategy for costs. OBJECTIVE: Exploring cost/effectiveness of AHSCT and high-efficacy disease-modifying treatments (HE-DMTs) in RR-MS, estimating costs at our centre in Italy, where National Health Service (NHS) provides universal health coverage. METHODS: Costs (including drugs, inpatient/outpatient management) for treatment with AHSCT and HE-DMTs were calculated as NHS expenditures over 2- and 5-year periods. Cost-effectiveness for each treatment was estimated as "cost needed to treat" (CNT), i.e. expense to prevent relapses, progression, or disease activity (NEDA) in one patient over n-years, retrieving outcomes from published studies. RESULTS: Costs of AHSCT and HE-DMTs were similar over 2 years, whereas AHSCT was cheaper than most HE-DMTs over 5 years (€46 600 vs €93 800, respectively). When estimating cost-effectiveness of treatments, over 2 years, mean CNT of HE-DMTs for NEDA was twofold that of AHSCT, whereas it was similar for relapses and disability. Differences in CNT were remarkable over 5 years, especially for NEDA, being mean CNT of HE-DMTs €382 800 vs €74 900 for AHSCT. CONCLUSIONS: AHSCT may be highly cost-effective in selected aggressive RR-MS. Besides priceless benefits for treated individuals, cost-savings generated by AHSCT may contribute to improving healthcare assistance at a population level.

Early discharge criteria in patients with acute bacterial skin and skin structure infections in a large tertiary-care teaching hospital in Florence, Italy.

The study is aimed at retrospectively estimating the percentage of inpatients with severe acute bacterial skin and skin structure infections (ABSSSI) who met the early discharged (ED) criteria adapted from Nathwani et al. (Int J Antimicrob Agents. 2016 Aug;48(2):127-36) and to calculate the number of hospitalization days that could be potentially saved. A retrospective study was conducted in a tertiary care hospital in Florence, Italy. We included all patients admitted for cellulitis and post-surgical infections from 2014 to 2017. Demographic and clinical data were obtained from electronic medical records. We a priori defined the following as a risk factor for non-adherence (RFNA): active or on methadone intravenous drug users, homeless, migrants without health care assistance, and patients who need a caregiver to take prescribed medications. One hundred sixty-two subjects were enrolled. Of them, 94 (58.0%) were male, and 113 (69.7%) had cellulitis/erysipelas. A microbiological isolate was obtained in 51 patients (31.4%); Staphylococcus aureus was the most frequent (47%). Eighty-four (51.8%) were ED suitable, with 258 (49.0%) patient days potentially saved. Among the 78 not ED suitable patients, the most common reason for prolonged length of stay (LOS) was having at least one RFNA (34.6%). Fourteen (18.0%) had one RFNA. Half of the patients admitted in our hospital met the ED criteria with a sparing close to 50% in terms of hospitalization days. Unstable social and personal factors were the most frequent causes for prolonged LOS. In this selected subset of patients, more recent and easier to administer treatments, including long-acting agents, could be proposed.

[Pulmonary arterial hypertension in Health District 11: a patient-oriented drug utilization analysis]. / Terapia per ipertensione arteriosa polmonare nella USL 11 di Empoli: una analisi di farmaco-utilizzazione.

Dispensing medication at the discharge of patients is an activity that allows to the Pharmacy Department to have a privileged point of view about prescribing new drugs and therapies. During last year we met several prescriptions for new drugs utilized in the treatment of pulmonary arterial hypertension (PAH), These prescriptions are the mirror of the avalaibility of new specific drugs. PAH is a rare and fatal disease; current disease-specific therapeutic interventions in PAH established pathways in disease treatment: prostacyclin, endothelin receptors antagonist. Several studies indicate that sildenafil, an oral phosphodiesterase type-5 inhibitor, may also offer benefits in the pharmacological management of PAH as well as tadalafil or vardenafil too. We collected data from our Pharmacy patient's database to evaluate the impact of this rare disease on our setting, to analyse the patterns of prescription of our physicians and to think specific health policy or pathways for the patients suffering from this disease.

Mouse light/dark box test reveals anxiogenic-like effects by activation of histamine H1 receptors.

Effects of substances that are able to alter the histamine level, a histamine H(1)-receptor agonist and antagonist, and a histamine H(2)-receptor agonist were investigated in an anxiety-like state in mice by means of the light/dark box test. Diazepam was used as positive control. The histamine H(3)-receptor antagonist, thioperamide (2, 5, and 20 mg/kg s.c.), showed an anxiogenic-like effect that reached a maximum with the dosage of 5 mg/kg. The histamine-N-methyltransferase (HMT) inhibitor, metoprine (5 and 20 mg/kg s.c.), also decreased the time in the light at the highest dose used and, likewise, the highly selective histamine H(1)-receptor agonist, 2-(3-trifluoromethylphenyl)histamine (FMPH) (2.65 and 6.5 microg/mouse, i.c.v.). On the contrary, the histamine H(2)-receptor agonist, impromidine (3, 10, 20, and 30 microg/mouse, i.c.v.), dose-dependently showed an anxiolytic-like effect. The selective histamine H(1) antagonist, pyrilamine (20 mg/kg i.p.) was able to prevent the anxiogenic-like effect of FMPH significantly, and that of thioperamide partially, while the effect caused by metoprine remained unvaried. It is suggested that the histaminergic system modulates anxiety-like states via the activation of both postsynaptic receptors in a contrasting manner: activation of the H(1) receptor causes an anxiogenic-like effect, while that of the H(2) receptors reduces anxiousness. However, on the basis of effects observed with the substances capable of releasing endogenous histamine, it seems likely that the anxiogenic-like effect is prevalent.