Search

Uterine fibroids can have a significant economic impact on the National Healthcare Service and on Society overall (absenteeism and disability). Women with uterine fibroids have higher use of medical services and procedures. The management and treatment of uterine fibroids thence imposes a burden on the existing National Healthcare Service and it is important to understand the economic implications between treatment options and key cost drivers. Our analysis is limited to describe the disease management and pharmacological costs of uterine fibroids. Our focus is on clinical data, therapeutic options, treatment costs and unmet needs (therapeutic diagnostic path). Knowledge of these aspects can be a useful tool for the clinician in order to select the most effective treatment in clinical practice, tailored on patients' characteristics.

l'articolo esamina in chiave critica la legge delega n. 124/2015, di riforma dell p.a., mettendo in evidenza luci e ombre.

Background. Vaccination of all healthy children against rotavirus (RV) has been recommended, since the availability of vaccines, both in Europe (PIDJ) and Italy (pediatricians). The aims of universal vaccination against RV include the protection of children against moderate/severe gastroenteritis forms by RV (GARV), prevent hospitalizations, reduce the severity and duration of the disease, and reduce morbidity and socio- economic costs. Payers need to informed regarding the efficacy and the healthcare utilization related to RV vaccination in order to decide in favour of its extensive implementation. The aim of this paper is to assess the clinical and financial impact of the extensive vaccination aganist RV both at National and Regional level. Particular attention, compared to the previous analysis (Standaert et al, 2008) has been given to the influence of herd immunity (HI) on cost-utility results of vaccination against-RV. Methods. The analysis was conducted with the Markovian model previously used by Standaert B et al and updated for comparing costs and benefits associated with a situation of vaccination anti-RV that includes efficacy data due to HI, with a situation without vaccination. For the base case is assumed an annual cove- rage of 90%, where the effect of HI is present in the population at risk (0-5 years) and extended to children who have not been vaccinated, adding as conservative assumption, a further 10% to the efficacy of the vaccine, compared to 15% determined by several published studies. Two analysis have been made based on this model: a cost-utility analysis that compared vaccination with two doses of RIX441410 administered at 2 and 3 months after birth compared with no vaccination from National Health Service and Society per- spective; a budget impact analysis at National and Regional level. The evaluation has as its main element the reduction of cases of infection through universal vaccination and consequent reduction of Garv events and nosocomial infections. Results. From the NHS perspective, in a cohort of 555,791 born in Italy in 2011, the annual number of hospitalizations due to RV infections in the absence of vaccination is estimated to be 14,550 units. Assu- ming that 90% of newborns receive two doses of the vaccine, and including an additional effect of HI to the efficacy of the vaccine, vaccination would lead to a reduction of 71% of cases of Garv (176,804 cases in less) and a 86% of hospitalizations due to Garv (12,913 fewer cases), with an impact on quality of life and mortality as a consequence of vaccination. The introduction of the vaccine would lead to a gain of 0.0014 QALYs and 0.0022 life-years gained per child compared to a situation without vaccination (assuming a discount rate of 3% on future benefits). The reduction of GARV also would lead to a strong economic impact. The introduction of the vaccine would lead to a saving of € 25.41 per child or a saving of more than € 14 million for the whole population included in the analysis. Cost reduction increase significantly from the perspective of society and introducing the indirect costs due to lost productivity. In this case, the savings due to the introduction of vaccination would increase to € 67,747,654 in the total cohort, or € 121.89 per child. In an alternative scenario, where HI is excluded, RIX4414 remains dominant (0.0013 QALYs gained and € 22.14 per child saved). The budget impact analysis shows that, as early as the second year, the additional cost of the vaccine is more than offset by a reduction in costs of the disease, which leads to savings for the NHS, which increases from year 3. In a time horizon of 5 years (without the discount rate), the savings for the NHS amount to € 34,440,314. These savings would amount to a cost reduction of € 4.64 per child over 5 years (€ 0.93 per year). The savings due to the introduction of the vaccine were mainly due to a reduction in costs associated with hospitalizations. The budget impact analysis at regional level, has taken a vaccine cost of € 30.00 per dose. Cases of diarrhoea before and after vaccination are reduced in each region, based on the number of births, ranging from a minimum of 399 cases avoided for Valle d’Aosta to a maximum of 31,116 cases avoided in Lombardy. In a similar way, the number of hospitalizations due to GARV are reduced considerably, from a minimum of 36 cases in Valle d’Aosta to a maximum of 3,096 in Lombardy. Obviously, these reductions are greater in regions with 30,000 or more births per year. Conclusions. This study suggests that a universal vaccination anti-RV with 2 doses of RIX4414 brings significant clinical and economic benefits both at National and Regional level. The indirect effects of the vaccine (HI) could generate protection even in unvaccinated children with health gain and a number of cases by GARV much less than those that would vaccinating small groups of children and with a cost of illness, for NHS, which would be reduced significantly, despite the additional costs of the vaccine as early as the second year of vaccination. Productivity losses due to absence from work of a parent, as well as all other costs included in the model, show that is precisely the society to pay the consequences, from economic and social point of view. Considering the citizen in the role of private payer, we must stress as for him, the savings generated by vaccination, whether universal or with demand for cost-sharing by the health service, prove significant with a major health gain for the population under study.

Il capitolo analizza i flussi finanziari di origine nazionale e comunitaria, di cui ha beneficiato il sistema agroalimentare regionale nel corso del 2011

Nelle colture di grano duro (Triticum turgidum var. durum Desf.) la scelta varietale, la difesa fogliare e la concimazione azotata sono tra i mezzi tecnici che maggiormente infl uenzano le rese e le caratteristiche merceologiche e tecnologiche della granella. Nell’ambito del progetto SIGRAD, al fi ne di valutare le interazioni tra questi tre fattori, è stata realizzata una sperimentazione poliennale in quattro località, dove sono stati posti a confronto differenti percorsi agronomici ottenuti dalla combinazione di due livelli di difesa fogliare, quattro varietà e tre livelli di concimazione azotata. I dati ottenuti mostrano che la scelta di opportune varietà, insieme a effi caci trattamenti fungicidi e un’adeguata fertilizzazione, possono incrementare considerevolmente e in modo equilibrato resa e qualità della granella . L’esperienza condotta ha inoltre permesso di ribadire il concetto che lega lo sfruttamento delle potenzialità genetiche di ogni costituzione ad un adeguato “libretto d’uso” delle stesse, per poter conoscere e gestire i punti di debolezza e di forza delle diverse varietà durante l’intero ciclo colturale. La sperimentazione evidenzia inoltre che scelte tecniche effettuate valutando attentamente le reali esigenze della coltura (anche con apposite e ripetute ispezioni di campo) possono risultare decisive per il conseguimento di elevati risultati produttivi e qualitativi anche in condizioni ambientali sfavorevoli. Abstract Within the SIGRAD project, a three years research was carried out in four locations in order to evaluate different combinations of two fungicide treatment levels, four durum wheat (Triticum turgidum var. durum Desf.) cultivars and three nitrogen fertilization levels. The overall results showed that it is possible to increase both grain yield and quality by choosing suitable wheat cultivars, effective fungicide treatments and optimal nitrogen fertilizations. Furthermore, our experience suggests that agronomic practice schedules should not be planned in advance and it remarks the importance of fi eld inspections for a correct evaluation of the real durum wheat culture input demand.

Introduction. Protocols which contribute to the long-term success of orthodontic treatment, in both adult and young patients, and which establish a proper routine for oral hygiene at home, must be personalized and followed strictly. Materials and methods. Our protocol includes the following steps: before orthodontic treatment (initial examination, initial preparation and reassessment); during orthodontic treatment (first session, treatment session in association with oral hygiene check-ups, recall, if oral hygiene is insufficient); after orthodontic treatment (postreatment support). The differences in treatment and approach necessary when dealing with adults or children and with removable appliance or fixed appliance are also highlighted.