Cost-effectiveness of kidney transplantation from DCD in Italy.

INTRODUCTION: Kidney transplantation represents the best therapeutic option for patients with end-stage renal disease (ESRD), providing the best outcomes for survival, quality of life, and cost-effectiveness. To increase kidney donations, in 2007, the Italian IRCCS Policlinico San Matteo Foundation in Pavia designed and conducted Programma Alba, a protocol for organ donation after cardiac death (DCD). This study evaluated the costs and health outcomes of DCD transplantation and in all types of transplants compared with current clinical practice. PATIENTS AND METHODS: A Markov-based model was used to assess costs and health outcomes for new ESRD patients for 2008 to 2013. A health care founder perspective was used. Data sources were the Italian National Institute of Statistics and the Lombardy Registry of Dialysis and Transplantation. A microcosting analysis was performed to calculate costs related to clinical pathways for DCD. We assessed costs, survival, quality-adjusted survival, and cost-effectiveness. FINDINGS: Changing the actual practice pattern for new patients with ESRD and increasing the availability of kidneys from DCD to 10 extra transplants per year will induce an incremental cost per quality-adjusted life-year of €4255. Increases in transplantation to reach an extra 10% by transplant type would result in reduced costs and increased patient survival and quality of life compared with the current scenario. INTERPRETATION: Our data show that increasing DCD transplants would result in a cost-effective policy to expand the kidney donor pool compared with current ESRD treatment patterns. Italian policies should make an effort to increase transplant rates to optimize cost-effectiveness in ESRD service supply.

IMPACTO EN LA CALIDAD DE VIDA EN PACIENTES CON DERMATITIS ATÓPICA

Resumen Introducción: la dermatitis atópica es una enfermedad inflamatoria crónica de la piel de etiología multifactorial que produce un impacto en la vida del paciente. Resulta de interés conocer cómo valorar la calidad de vida del paciente relacionada con la salud (CVRS), cuando está en tratamiento de mantenimiento para el control de la DA. Objetivo: evaluar la calidad de vida en pacientes con Dermatitis Atópica durante el tratamiento de mantenimiento y el cumplimiento del mismo. Materiales y Métodos: se realizó un estudio epidemiológico, observacional, multicéntrico y transversal. Se analizó a pacientes con diagnóstico clínico de DA, se realizó cuestionarios de calidad de vida (DLQI, CDLQI y IDQOL) y de cumplimiento de tratamiento (Test de Morisky-Green). Resultados: se encuestaron a 41 pacientes. Se observó afección severa el 29%, moderada el 34%, y solo una minoría (5%) no afecto su calidad de vida; casi el 10% presento extremada afectación en calidad de vida. Los niños menores de 5 años tuvieron como predominio gran afectación en la calidad de vida, mientras que en los grupos etarios mayores de 6 años esta afectación resultó moderada. Al evaluar el cumplimiento del tratamiento, el 76% resulto NO cumplidor. De los cumplidores, el 75% presentó gran afectación en la calidad de vida (p:0,05), sin predominio de sexo. Conclusión: en la población estudiada la mayoría presentó una afectación en la calidad de vida moderada a grave. El 76% de la población se consideró como NO cumplidora de tratamiento. De los cumplidores, el 75% presentaba extremada afectación de la calidad de vida.

Summary Introduction: Atopic dermatitis is a chronic inflammatory skin disease of multifactorial etiology that has an impact on the patient's life. It is interesting to know how the patient value their health related quality of life (HRQoL), when they are in maintenance treatment for the control of AD. Objective: to evaluate the quality of life in patients with Atopic Dermatitis during maintenance treatment and its compliance. Materials and Methods: an epidemiological, observational, multicenter and cross-sectional study was carried out. We analyzed patients with a clinical diagnosis of AD, quality of life questionnaires (DLQI, CDLQI and IDQOL) and compliance with treatment (Morisky-Green test). Results: 41 patients were surveyed. A severe condition was observed in 29%, moderate in 34%, and only a minority (5%) did not affect their quality of life; almost 10% presented extreme affectation in quality of life. Children under 5 years of age had a high prevalence of quality of life, whereas in age groups older than 6 years, this affectation was moderate. When evaluating the compliance of the treatment, 76% was NOT compliant. Of the compliers, 75% presented a great impact on the quality of life (p: 0.05), without predominance of sex. Conclusion: in the studied population, the majority presented moderate to severe quality of life. 76% of the population was considered non-compliant of treatment. Of the compliers, 75% presented extreme affectation of the quality of life.

The economic and social burden of Alzheimer disease on families in the Lombardy region of Italy.

The purpose of this study was to measure resource consumption associated with the provision of nonmedical care to noninstitutionalized patients with Alzheimer disease (AD) residing in the Lombardy Region of Italy. A questionnaire was mailed to 1,501 caregivers who sought advice from the "Federation Alzheimer Italia" in 1995. On the basis of 616 returned questionnaires, the authors estimated that a patient with AD requires 18 hours per week of paid nonmedical services and 45 hours per week of personal care provided by a primary caregiver. Primary caregivers are more likely to be women, spouses, and retired. Almost 7 of 10 patients are supported by at least a second caregiver. Annual expenditure for nonmedical cost per patient with AD is estimated to be L 13,388,000 (U.S. $8,218). Using the replacement cost approach, the authors estimated the economic cost of informal (unpaid) care to be L 72,877,000 (U.S. $44,736). Despite some limitations in the design of the survey, this first Italian study on primary data highlights the impressive economic burden of AD on families. It also shows that AD puts many Italian families at great financial risk. Adequate and timely funding arrangements should be urgently found to make resources available to future generations of patients.

[Cost of ICU in Italy. Results from an empirical study on a sample of 12 hospitals]. / Il costo del reparto di terapia intensiva in Italia. Risultati da un'indagine empirica su un campione di 12 centri.

BACKGROUND: The Italian hospital payment system based on DRG doesn t properly include Intensive Care Units (ICU) costs. Since great emphasis has been recently given to rationing health care resources, assessing ICU costs seems to be dramatically relevant. Aim of the study was to assess the average yearly cost and the cost per diem of a sample of Italian multispecialistic ICU wards. METHODS: In September 1995, a questionnaire concerning data on variable and fixed cost was sent to 25 Italian ICU wards, 11 NHS hospital-based (Northern Italy: 5; Central Italy: 4; Southern Italy: 2) and 14 school of medicine-based (Northern Italy: 7; Central Italy: 5; Southern Italy: 2). Variable cost data included: disposable, drugs, blood and blood-derived products, physical tests, chemical and microbiological routines, instrumental diagnostic procedures and physiotherapy. Concerning fixed costs, data on personnel and equipment were requested. In addition, some hospital overheads data (utilities; power; heating; maintenance; cleaning; laundry; accounting; waste disposal; cafeteria) were collected. RESULTS: On the basis of the 12 questionnaires returned (Northern Italy: 9; Central Italy: 3; Southern Italy: 0), the yearly cost of an ICU ward is Liras 4,580,032,000 (range 2,739,277,000-7,704,292,000), whereas the average cost per diem is Liras 1,802,000 (range 1,234,000-3,179,000). Cost of personnel is about 61% of the above mentioned costs. CONCLUSIONS: Despite the lack of questionnaires from Southern Italy and the unavailability of some data concerning both the cost of equipment and the overheads, the remarkable average cost values obtained could support further research.