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This study explores the behaviour of hospitals in Lombardy in attracting patients from outside the region and investigates the effects on the quality of care to regional patients, where treatment of the latter is constrained by a budget cap while extra-regional patients represent an unconstrained source of revenue. The data suggest that hospitals use waiting time and length of stay to attract extra-regional patients. Regional patients in both private and public hospitals with higher proportions of extra-regional patients are characterized by lower mortality rates and reimbursement costs. These results suggest that the market for extra-regional patients has no negative effects on resident patients. Finally, the pattern of reimbursement for extra-regional care generates a financial flow in favour of wealthier regions, exacerbating the North–South divide in the National Health Service. Some form of regulation for extra-regional mobility is advisable to reduce the gap. • We study the effects of patients mobility on quality and price for hospital care in Italy. • Hospitals attract patients from southern regions through better quality and from border regions through lower waiting times. • Resident patients are not discriminated and enjoy higher quality. • The price to treat patients from southern regions is higher than for resident. • Some form of regulation in cross border patients mobility might be advisable. [ABSTRACT FROM AUTHOR]

Purpose: To report (1) the costs of verteporfin photodynamic therapy (VPDT) in routine treatment of neovascular age-related macular degeneration (nAMD), (2) the relationship between health and social service costs and best-corrected visual acuity (BCVA), (3) the cost-effectiveness of VPDT versus a best supportive care (BSC) group who were assumed to have no active treatment, and (4) lessons for future cost-effectiveness analyses (CEAs). Design: The CEA of VPDT versus BSC that uses health-related quality of life (HrQoL), resource use, and visual acuity data from the United Kingdom (UK) VPDT Cohort Study. Participants: Data on VPDT use were collected from patients attending 45 ophthalmology provider units in the UK National Health Service, 15 units collected data on self-reported use of services. Methods: Incremental costs of VPDT versus BSC were calculated from treatment costs, change in cost associated with declining BCVA, and difference in BCVA previously attributed to VPDT. Similarly, incremental quality-adjusted life years (QALYs) were calculated from change in HRQoL associated with declining BCVA, giving an incremental cost per QALY of VPDT versus BSC over 2 years. Main Outcome Measures: Incremental costs (UK pounds [£]; United States dollars [$]); incremental QALYs; costs per QALY. Results: The treatment costs of VDPT were £3026 ($4544) in year 1 and £845 ($1269) in year 2. For patients who used services, a 5-letter decrease in BCVA was associated with an increase in annual costs of approximately £110 ($165; 95% confidence intervals, approximately £48 [$72] to £174 [$261]). The incremental costs and QALYs for VPDT were £3514 ($5276) and 0.021, respectively, giving incremental costs per QALY gained of £170000 ($255000). Conclusions: Verteporfin photodynamic therapy is unlikely to be cost effective for patients with nAMD. This article provides realistic estimates of VPDT costs and the costs associated with declining vision. Future studies can follow this approach to assess accurately the cost effectiveness of new interventions for nAMD. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references. [Copyright &y& Elsevier]

Purpose: To quantify decreases in health-related quality of life (HRQoL) for given deterioration in clinical measures of vision; to describe the shape of these relationships; and to test whether the gradients of these relationships change with duration of visual loss. Design: A prospective, longitudinal study of patients treated with verteporfin photodynamic therapy in the United Kingdom National Health Service. Participants: Patients with neovascular age-related macular degeneration (AMD) treated in 18 ophthalmology departments in the United Kingdom with expertise in management of neovascular AMD. Methods: Responses to HRQoL questionnaires (Short Form 36 [SF-36] and National Eye Institute Visual Functioning Questionnaire [NEIVFQ]) and clinical measures of vision were recorded at baseline and at follow-up visits. Mixed regression models were used to characterize the relationships of interest. Main Outcome Measures: Measures of vision were best-corrected visual acuity (BCVA) and contrast sensitivity (CS). The SF-36 physical and mental component scores (PCS and MCS), SF-6D utility, and distance, near, and composite NEIVFQ scores were derived to characterize HRQoL. Results: The SF-6D, PCS, and MCS were linearly associated with BCVA; predicted decreases for a 5-letter drop in BCVA in the better-seeing eye were 0.0058, 0.245, and 0.546, respectively (all P<0.0001). Gradients were not influenced by duration of follow-up. Models predicting distance, near, and composite NEIVFQ scores from BCVA were quadratic; predicted decreases for a 5-letter drop in BCVA in the better-seeing eye were 5.08, 5.48, and 3.90, respectively (all P<0.0001). The BCVA predicted HRQoL scores more strongly than CS. Conclusions: Clinically significant deterioration in clinical measures of vision is associated with small decreases in generic and vision-specific HRQoL. Our findings are important for further research modeling the cost effectiveness of current and future interventions for neovascular AMD. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references. [Copyright &y& Elsevier]