Transformation of Cancer Care during and after the COVID Pandemic, a point of no return. The Experience of Italy.

Policymakers everywhere struggle to introduce therapeutic innovation while controlling costs, a particular challenge for the universal Italian National Healthcare System (SSN), which spends only 8.8% of GDP to care for one of the world's oldest populations. Oncology provides a telling example, where innovation has dramatically improved care and survival, transforming cancer into a chronic condition. However, innovation has also increased therapy duration, adverse event management, and service demand. The SSN risks collapse unless centralized cancer planning changes gear, particularly with Covid-19 causing treatment delays, worsening patient prognosis and straining capacity. In view of the 750 billion Euro "Next Generation EU", released by the European Union to relieve Member States hit by the pandemic, the SSN tapped a multidisciplinary research team to identify key strategies for equitable uptake of innovations in treatment and delivery, with emphasis on data-driven technological and managerial advancements - and lessons from Covid-19.

European diabetes research and its funding, 2002-2013.

AIM: This study examined the outputs of research papers in diabetes from 31 European countries between 2002 and 2013, and their funding. METHODS: Diabetes research papers in the Web of Science were identified by means of a filter based on journals and title words. For 2009-2013 papers, the funders were coded to show their sector and nationality. RESULTS: Europe published 40 547 diabetes papers in the 12 years between 2002 and 2013. Denmark, Sweden and Finland published the most relative to their wealth, but the UK published the most absolutely despite an apparently low burden (as measured by disability-adjusted life years). The largest source of funding was government (30%), followed by the non-profit sector (18%) and industry (13%). The European Commission supported 2.7% of papers, but more in Latvia (33%) and Estonia (16%). Based on an estimated cost per paper of €260 000, the annual research expenditure in Europe was approximately €986 million in 2013. CONCLUSIONS: The European diabetes burden in disability-adjusted life years increased by one third between 2002 and 2012, but its output of research papers has decreased from 44% to 36% of the world total. This decrease needs to be reviewed in the context of European non-communicable disease research policy.

The economic burden of stroke in Italy. The EcLIPSE Study: Economic Longitudinal Incidence-based Project for Stroke Evaluation.

Stroke is the second most common cause of death in the world. The aim of this study is to estimate stroke's direct costs and productivity losses in Italy from a societal perspective and to explain cost variability. A prospective observational multicentre cost of illness study was designed. Four hundred and forty-nine consecutive patients admitted because of acute first-ever stroke in 11 Italian hospitals were enrolled. Costs and outcomes were assessed at patients' enrollment, and at 3, 6 and 12 months after discharge. Overall, social costs in the first six months following the attack were euros 11,600 per patient; 53% of this was health care costs, 39% non-health care costs and the remaining 8% productivity losses. Age, level of disability and type of hospital ward were the most significant predictors of six-month social costs. The acute phase counted for more than 50% of total health care costs, leaving the remaining 50% to the post-acute phase, indicating that follow-up should be on the agenda of policy makers also.

Direct and indirect costs of schizophrenia in community psychiatric services in Italy. The GISIES study. Interdisciplinary Study Group on the Economic Impact of Schizophrenia.

BACKGROUND: The present work is a cost-of-illness (COI) study that aims at assessing total direct and indirect costs of schizophrenic patients in community psychiatric services in Italy and identifying the variables that influence costs. METHODS: A retrospective prevalence-based multi-centre COI study, was designed. Ten community mental health centres (CMHC) were involved and 100 patients were recruited. Data on patients' costs were gathered through specifically designed instruments. RESULTS: More than half total direct costs were attributed to CMHC interventions. The yearly average costs of schizophrenia per patient amounted to nearly ITL 50 million: 30% for direct costs and 70% for indirect costs. CONCLUSION: CMHCs tend to manage long-term ill patients by adopting a strong community-based system of care. Schizophrenia is correlated to loss of working days and lack of well-being. From the results of this study, it might be argued that the de-institutionalisation programme has produced 'spillovers' in terms of families' greater involvement in patients management.

The costs of pharmacological treatment for major depression. The Italian Prospective Multicentre Observational Incidence-Based Study.

OBJECTIVE: To describe the pharmacological treatment for major depression under the conditions of routine Italian public mental health facilities, assess its costs, and study its main predictors according to a societal perspective. DESIGN: This was a prospective multicentre observational study designed to evaluate the economics of treatment of major depression using a specifically designed 65-item questionnaire. Data on drug consumption were collected in a section of the questionnaire and are presented here. PATIENTS AND PARTICIPANTS: 60 mental health facilities were selected and 556 patients were enrolled and followed up for 15 months. RESULTS: Pharmacological treatment appears to be the most common treatment for major depression. 98% of patients were prescribed an antidepressant. Selective serotonin reuptake inhibitors (SSRIs) were the most prescribed antidepressants. Patients treated with SSRIs suffered from less severe depression than those treated with tricyclic antidepressants. Benzodiazepines were prescribed for 84% of patients enrolled. The total drug cost was 1,120,000 Italian lire ($US707) per patient (1995 values). Less than 20% of this cost was borne by the Italian National Health Service, as the majority of drugs used were not reimbursed. CONCLUSIONS: The costs of the most widespread approach to treating major depression (pharmacological treatment) are not currently covered by the Italian National Health Service. Prescribing of drugs seems to diverge from the standards of treatment indicated by the Italian Drug Committee.

[Percutaneous treatment of peripheral obstructive arteriopathy: the reasons for a choice]. / Il trattamento percutaneo delle arteriopatie ostruttive periferiche: i perché di una scelta.

Progressive aging of the Italian population is a relevant fact and this increases the occurrence of peripheral vascular disease in this subset of the population. At the same time, due to the national demographic decline, more and more aged people are going to live on their own. In this category the problem of self-caring is becoming highly relevant considering that only 12-13% of patients who had a limb amputation will walk with an artificial leg. This implies relevant social costs which are somewhat hidden because of their distribution in society (hospital, home care, individuals). Undoubtedly, there will be a dramatic reduction in the quality of life for these people. New technological progress and the development of new treatment modalities in the last decade have had a profound impact on the care of these patients. The role of peripheral vessel arteriography as a gold standard for the final evaluation of the disease and for the possibility of endovascular treatment has been widely accepted. Percutaneous transluminal intervention has proven to be more efficient economically with less morbidity and mortality than traditional vascular surgery, mainly in the limb salvage subgroup of patients. Health organization authorities should take these changes into account and modify their attitude towards the treatment of this pathology in order to provide better care for patients and to better allocate the economical resources of the National Health System.

[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)