Letizia Orzella

Bio: Letizia Orzella is an academic researcher from Mario Negri Institute for Pharmacological Research. The author has contributed to research in topics: Pharmacoeconomics & Health economics. The author has an hindex of 1, co-authored 1 publications receiving 15 citations.

The Valuation of Social and Economic Costs of Mosquito-Transmitted Ross River Virus

Abstract: Insect pests (such as mosquitoes) and their associated impacts have become important social, economic and environmental health issues. Mosquitoes transmit diseases, are widely perceived as a nuisance and are becoming a serious health concern for the public. The incidence of contracting mosquito-transmitted diseases has markedly increased in recent decades in Australia (Russell 1994). Currently, Ross River virus is the most prevalent mosquito-transmitted viral disease in Australia with up to 8,000 cases reported annually (Curran et al. 1996). The absence of documented evidence about the full social costs of mosquito-transmitted diseases is a critical issue as there is currently no economic rationale underlying existing resource allocation for intervention programs. This study of the full social costs of Ross River virus was conducted between April and July 2002. Demographic, health-state and disease-related data were collected using survey questionnaires for 201 notified Ross River virus victims from across Queensland. Two self-administered surveys were conducted at the time approximately onset and six months from onset while a phone survey was conducted at 12 months after onset. Direct impacts such as the costs of health care (medical consultations, pathology services and medicines), non health care resources (treatment-related transport) and indirect impacts such as the opportunity cost of lost productivity (due to disability and treatment-related waiting times) of the viral illness were recorded in the questionnaires and were valued using market prices. A non-market valuation method (willingness-to-pay), in conjunction with a self-assessed standard health measure (Short Form 36) were used to quantify more intangible health-related quality of life effects such as change in physical, mental and social functioning. Estimated full social costs of the disease were analysed across age and gender groups. Based on the mean cost estimates for the study sample, the total disease costs have been extrapolated by local government areas as the appropriate administrative areas. A wide range of social and economic costs of the virus has been addressed in this thesis. However, the derived costs cannot be summed into a total estimate as several of these values overlap in terms of coverage. Therefore, only the major cost components, with a minimum of overlap, have been used to estimate the aggregate social cost of the disease. Given the methodological and empirical limitations of the study, the most accurate estimate of the average per capita full costs of Ross River virus in Queensland is estimated at $AUD (2002) 1,070 per case. The estimate of the full social cost of Ross River virus disease can be a vital input for many relevant policy applications. For example, disease costs together with resource costs of current interventions, are essential inputs for ongoing economic evaluations of mosquito control programs at local level. In this thesis, the cost minimisation approach has been presented to evaluate mosquito control programs at the local level where the policy analyst’s task is to minimise the overall social costs (that is, disease costs plus control costs). These economic evaluations have substantial potential benefits to society in terms of the efficient allocation of scarce resources. In addition, estimated disease cost is a significant input for economic impact assessment of regional disease outbreaks. It also can be used to highlight disease impact upon the economy and community and hence draw attention to the scale and scope of such problems to policy makers at all levels so that they can respond appropriately to the mosquito problem, and mosquito-transmitted diseases, as priority issues in the political agenda.

Direct costs of schizophrenia and related disorders in Italian community mental health services: a multicenter, prospective 1-year followup study.

Abstract: The behavior that accompanies schizophrenia and related disorders interferes with professional and social activities. As a result, schizophrenia is one of the most costly psychiatric illnesses. Direct medical costs associated with schizophrenia were estimated from the Italian National Health Service perspective. This was a multicenter observational 1-year study conducted in 14 Italian community mental health centers (CMHCs). Eligible patients were those with a diagnosis of schizophrenia or schizoaffective or schizophreniform disorder who had been followed by the CMHCs for at least 2 years at study entry. Exactly 643 patients were enrolled in the study. The mean direct cost per year was ?6,964 (?27,025 for schizophrenia and ?6,587 for patients with related psychotic disorders) (1998 exchange rate U.S.$1 = ?1.121). The present study provides further estimates of the cost of schizophrenia treatment in Italian mental health services and highlights the variability in the single cost components across clinically defined subgroups of patients.

Dutch guidelines for economic evaluation: 'from good to better' in theory but further away from pharmaceuticals in practice?

Abstract: Economic evaluation (EE) is still a historically young discipline in healthcare. Originally started as a technique for assessing investments in the public sector, EE has been applied to healthcare since the last decades of the previous century and disseminated rapidly to many countries, thanks partly to a successful English manual, which was later translated into many other languages. The first edition of the manual mainly referred to EE on health procedures, services or programmes, and not to products like drugs. Then, very soon, the Canadian State of Ontario and Australia issued the first pharmacoeconomic guidelines for drugs reimbursement, followed later by many Western European countries (e.g. The Netherlands, Norway, Portugal and Sweden). Last year the Dutch National Health Care Institute issued new guidance for EE in healthcare. Although the latest guidelines (Box 1) go beyond drugs (differently from the past), covering five further areas (prevention, diagnostics, medical devices, longterm care and forensics), pharmaceuticals are still the main field of application. Several elements of novelty reflect the methodological developments in EEs, two of which have been judged the most important recommendations for drugs: value of information analysis and indirect medical costs. Both concern EE ‘borderline’ subjects coping with uncertainty. The first is a statistical tool intended to be useful for assessing uncertainty related to the consequences of inappropriate decision-making in healthcare; the second concerns the unrelated future medical costs induced during the life years gained indirectly from a technology which prolongs the life of patients. In general, although we do not dispute that the new Dutch guidelines can be considered a scientific step forward in improving the requirements for EEs in healthcare, moving from good to better recommendations and still open to further improvement in the future, we still feel that health decisionmakers should be fully aware of the general intrinsic limits of EE that have been underlined in the last two decades, moving from theory to practice. Thus, here we critically analyse the main key points for conducting an EE, underlining the main weaknesses of EE as pragmatic tools for public decision-making, particularly in the perspective of pharmaceutical pricing and reimbursement.

Direct medical costs unequivocally related to diabetes in Italian specialized centers.

Abstract: This study estimated the resource utilization and direct medical costs in Italian diabetes centers (DCs). Hospital admissions for major chronic complications were not considered since DCs deliver primary care and follow up only complications unequivocally related to diabetes-acute complications and diabetic foot. The multicenter, prospective, observational study involving 31 Italian DCs included a total of 1,910 patients classified into eight prognostic groups by type of diabetes (types 1 and 2), metabolic control (HbA1c >7.5%, HbA1c 60). The average total cost of type 1 diabetes per patient per year ranged from 762 euro in group 2 (age 7.5%) to 1,060 euro in group 4 (age >60, HbA1c >7.5%), and that the cost of type 2 diabetes from 423 euro in group 5 (age 60, HbA1c >7.5%). The study brought to light the wide variability in the single cost components across clinically defined groups of patients. The cost of diabetes management in the strict sense was significantly affected by the type of diabetes and metabolic control.