Showing papers by "Lorenzo G. Mantovani published in 2008"
TL;DR: In primary care, CKD stages 3 to 5 are frequent, but its awareness is scarce because of limited rates of serum creatinine testing and difficulty recognizing decreased eGFR in the absence of increased serum creat inine testing.
107 citations
TL;DR: The acceptability curve showed that there would be a 97% likelihood that anti-TNF therapy would be considered cost-effective at willingness-to-pay threshold of €60 000 per QALY gained, and cost–effectiveness ratios are within the commonly accepted willingness to pay threshold.
Abstract: Objective. To evaluate costs, benefits and cost–effectiveness of anti-TNF agents in PsA patients with inadequate response to conventional treatment. Methods. A total of 107 patients, from nine Italian rheumatology centres, with different forms of PsA were given anti-TNF treatment, mainly etanercept (87%). Information on resource use, health-related quality of life, disease activity, function and laboratory values were collected at baseline and through out the 12 months of therapy. Cost (expressed in euro 2007) and utility (measured by EuroQol) before and after antiTNF therapy initiation were compared in order to estimate the incremental cost per quality-adjusted life year (QALY) gained, and cost– effectiveness acceptability curve was calculated. Results. At the end of 12 months, there was a significant increase in direct cost due to an increase of drug cost caused by TNF inhibitors that was only partially offset by the decrease in indirect cost. In the last 6 months of therapy, the direct cost increased by E5052, the cost for the National Health System (NHS) by E5044 and the social cost by E4638. However, a gain of 0.12 QALY resulted in a cost per QALY gained of E40 876 for the NHS and of E37 591 for the society. The acceptability curve showed that there would be a 97% likelihood that anti-TNF therapy would be considered cost-effective at willingness-to-pay threshold of E60 000 per QALY gained. Conclusion. Cost–effectiveness ratios are within the commonly accepted willingness-to-pay threshold. These results need to be confirmed in larger samples of patients.
97 citations
TL;DR: The management of β-TM patients undergoing transfusions and ICT is efficacious, although costly, but overall benefits were not always perceived as optimal by patients, so efforts must be focused to improve patients' acceptance and satisfaction with their therapy.
Abstract: Objectives: Iron chelation treatment (ICT) in β-thalassemia major (β-TM) patients undergoing blood transfusions can cause low satisfaction, low compliance, with possible negative consequences on treatment success, patients' wellbeing, and costs. The purpose was to estimate the societal burden attributable to β-TM in terms of direct and indirect costs, health-related quality-of-life (HRQoL), satisfaction and compliance with ICT in patients undergoing transfusions and ICT.Research design and methods: The naturalistic, multicenter, longitudinal Italian-THAlassemia-Cost-&-Outcomes-Assessment (ITHACA) cost-of-illness study was conducted involving patients of any age, on ICT for at least 3 years, who were enrolled at 8 Italian Thalassemia Care Centers. Costs were estimated from the societal perspective, quantified with tariffs, prices, or net earnings valid in 2006.Results: One-hundred and thirty-seven patients were enrolled (median age = 28.3, 3–48 years, 49.6% male) and retrospectively observed for a ...
81 citations
TL;DR: This cost-effectiveness analysis indicated that the addition of cetuximab to high-dose radiotherapy offers a good value-for-money alternative to radiotherapy alone in the treatment of locally advanced head and neck cancer in five European countries.
62 citations
TL;DR: This study examines the value of having two different cohort models based on similar assumptions, one comprehensive and one simplified, which can be used to evaluate the impact of cervical cancer vaccination, and shows that the models produce comparable results and therefore can be use independently.
44 citations
TL;DR: In this paper, the burden of renal cell carcinoma (RCC) in epidemiologic and economic terms was assessed in the region of Italy by using an administrative database, with the aim of quantifying direct medical costs in the perspective of the FVG Regional Health Service.
Abstract: Objective To assess the burden of renal cell carcinoma (RCC) in epidemiologic and economic terms. Methods Retrospective, naturalistic longitudinal study on the occurrence, outcomes and cost of RCC using an administrative database. We selected residents of Friuli-Venezia-Giulia (FVG), a North-eastern Region of Italy, who had a RCC first hospital admission during the period 2000–2004, and we followed them up until: 30th June 2005, death or transfers. Direct medical costs were quantified in the perspective of FVG Regional Health Service. Results We enrolled 1358 patients (63% male), the 18.8% presenting a metastatic-stage, leading to a crude incidence of 23/100.000 person-years. During the follow-up, 76% of the metastatic patients and 21% of the non-metastatic patients died. Total health care costs per-patient over the maximum of follow-up were 16,090€ for the localised stage group and 17,656€ in the metastatic-stage group. Discussion RCC imposes a significant epidemiologic and economic burden to the healthcare-system and the society.
7 citations
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TL;DR: EQ-5D’s brevity, and its immediateness of data reading and interpretation are reasons for considering its introduction into the physicians’ armamentarium for practice.
3 citations
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TL;DR: In this paper, a probabilistic patient level simulation model was developed to estimate long-term costs and health outcomes of abatacept versus anti-TNFs in RA patients.
Abstract: Objective: a substantial number of patients with rheumatoid arthritis (RA) have an insufficient or unsustained response to Tumor Necrosis Factor-α antagonists (anti-TNFs). The aim of the present study was to estimate the cost-utility of abatacept, a new selective T-cell co-stimulation modulator, in patients with moderately to severely active RA and an insufficient response or intolerance to anti-TNFs in the Italian setting. Methods: a probabilistic patient level simulation model was developed to estimate long-term costs and health outcomes of abatacept versus anti-TNFs (etanercept, adalimumab, infliximab) in RA patients. The model predicted patients’ HAQ (Health Assessment Questionnaire) scores over time based on the initial response to treatment (% change in HAQ score at six months). Responding patients continued treatment with a reduced rate of HAQ progression until long-term treatment failure. Health-state utilities and use of health care resources (excluding RA therapies) were assumed to depend on HAQ scores. The model used data from a Phase III clinical trial of abatacept in patients with inadequate response to anti-TNFs (Abatacept Trial in Treatment of anti-TNF Inadequate Responders [ATTAIN]) and various secondary data sources. The study was performed using the National Health Service (NHS) perspective. Cost-utility of abatacept vs other anti-TNFs was derived in terms of incremental cost per quality-adjusted life-year (QALY) gained based on a lifetime horizon with costs expressed in Euros. Single-way sensitivity analyses were performed on key parameters. Costs and health effects were discounted at 3% annually. Results: abatacept therapy was estimated to yield 1.18 additional QALYs per patient (5.02 abatacept vs 3.84 anti-TNFs) at an incremental cost of € 21,996.41 based on a 20 years time horizon. Cost per QALY gained was € 18,567.24. These results were robust to variation of key model parameters and are well within the usual cost-utility acceptance ranges. Conclusions: This study shows that in Italy, compared to anti-TNFs, abatacept therapy is cost-effective in patients with moderately to severely active RA and with an insufficient response or intolerance to anti-TNFs.