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Background. Seasonal influenza has a significant impact on public health, generating substantial direct healthcare costs, production losses and fiscal effects. Understanding these consequences is crucial to effective decision-making and the development of preventive strategies. This study aimed to evaluate the economic and the fiscal impact of implementing an incremental strategy for seasonal influenza prevention using the cell-based quadrivalent influenza vaccine (QIVc) among healthcare workers (HCWs) in Italy.Methods: To estimate the economic impact of implementing this strategy, we performed a cost analysis that considered direct healthcare costs, productivity losses and fiscal impact. The analysis considered a 3-year time horizon. A deterministic sensitivity analysis was also conducted.Results: Assuming a vaccination coverage rate of 30% among HCWs, the analysis considered a total of 203 018 vaccinated subjects. On analysing the overall differential impact (including direct costs, indirect costs and fiscal impact), implementing QIVc vaccination as a preventative measure against influenza among HCWs in Italy would yield societal resource savings of euro23 638.78 in the first year, euro47 277.56 in the second year, and euro70 916.35 in the third year, resulting in total resource savings of euro141 832.69.Conclusions:The study demonstrated that implementing the incremental use of QIVc as part of a preventive strategy for seasonal influenza among HCWs in Italy could yield positive economic outcomes, especially in terms of indirect costs and fiscal impact. The resources saved could be utilized to fund further public health interventions. Policy-makers should consider these findings when making decisions regarding influenza prevention strategies targeting HCWs.

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Introduction: An ostomy is a procedure in which an opening is made in the abdominal wall to establish a communication between the intestinal or urinary system and the external environment. Peristomal skin complications pose a constant challenge for the majority of individuals with a stoma, as they represent the most common postoperative complication. The aim of this study was to develop an economic evaluation model for assessing the costs associated with peristomal skin complications. Methods: In order to identify these costs, a survey was conducted in collaboration with the Coloplast Ostomy Forum group with the aim of mapping and documenting the timelines and all activities in the management of these complications. The data obtained from the survey were subsequently analyzed using the Activity Based Costing methodology. Results: The results of this analysis clearly indicate that the expenditure for initial visits is higher compared to subsequent ones, and that severe peristomal skin complications impose a greater economic burden than less severe complications. Specifically, the average total cost for managing severe peristomal skin complications amounts to € 104.6. Conclusion: This kind of analysis could provide support to decision-makers in dealing with a more accurate estimate of costs related to healthcare processes, aiming to implement rates able to “cover” the overall cost of certain healthcare activities. Specifically, there is currently no specific rate aimed at defining the value associated with the care and management of this type of complication, so this study confirms that this is an economic challenge that the National Health Service must address.

Background: The distribution of ostomy and incontinence devices takes place through different modalities according to the regional provisions in force. A first possibility is represented by direct distribution by the local health authorities. A second possibility consists of indirect distribution through affiliated retailers, typically pharmacies and authorized retailers of medical devices. A third form of distribution concerns home distribution. Methods: A survey has been administered to patients’ associations in order to investigate the degree of patients’ satisfaction with the distribution methods of medical devices necessary for the conditions associated with ostomy and incontinence and to provide an estimate of the indirect costs associated with distribution methods in the Italian healthcare context through the development of a budget impact model. Results: The distribution methods associated with a greater degree of satisfaction seem to be indirect and home distribution. Regarding the results of the budget impact mode, in our simulation, a diffusion of home distribution compared to direct and indirect distribution could lead to savings equal to 2,479,519 € over the three-year time horizon considered. Conclusion: The analysis conducted demonstrates how an increase in home distribution in the context of devices associated with people with ostomy or who practice self-catheterization can be associated with resource savings for the entire society (indirect costs avoided). The survey also demonstrates how this distribution method is associated with a good degree of satisfaction on the part of the users who use it.

Introduction: Adherence to long-term asthma control drugs is one of the key factors in improving disease management among patients with asthma. Poor adherence to long-term therapies significantly compromises the effectiveness of treatment and represents a problem in controlling the disease in terms of quality of life and economic impact. A budget impact analysis has been developed taking into account that Turbo+ technology (electronic monitoring device) can increase adherence to therapy in patients suffering from asthma. Methods: Coherently with the budget impact model methodology, we developed two different scenarios. One represents the clinical practice assuming a constant market share of 0,99% for Turbo+ and the other one assumes an incremental market share of Turbo+ over the time horizon considered. An increase in adherence to therapy will likely correspond to a reduction of exacerbations and a lower rate of hospitalizations, thus generating savings in terms of use of health resources. Results: The differential analysis shows an incremental saving in terms of resources absorbed by the National Health Service (NHS) over the time horizon considered. In the first year the savings are equal to € 795,658.64 and in the fifth year they are equal to € 3,520,636.34 for a total of resources saved in 5 years of € 10,882,028.50. Conclusions. The model shows how the diffusion of the Turbo+ programme can lead to savings in terms of health resources consumed by the NHS. Further analyses with new real-world data on adherence in asthmatic patients could be useful in confirming the results of the present analysis.

L’influenza rappresenta un problema di sanità pubblica con un considerevole impatto dal punto di vista epidemiologico, clinico, economico e sociale. Ciò è riconducibile a più fattori, quali: l’ubiquità e la contagiosità della malattia, la variabilità antigenica dei virus, l’andamento epidemico (e talvolta pandemico) e stagionale, la possibilità di complicanze gravi specialmente in alcune categorie di soggetti (bambini, anziani, persone con comorbosità e malattie croniche), i costi di gestione in caso di complicanze e i costi sociali (giorni lavorativi persi, perdita di produttività, ecc.) [1-4]. Globalmente, ogni anno, il virus influenzale colpisce tra il 5 e il 15% della popolazione adulta (vale a dire da 350 milioni a 1 miliardo di persone) [5], un’incidenza che sale al 20-30% nella popolazione pediatrica [6, 7], in cui il rischio di infezione è maggiore a causa della limitata immunità preesistente dei bambini [8]. Tra i 3 e i 5 milioni di casi di influenza riportati annualmente evolvono in complicanze che causano il decesso in circa il 10% dei casi (vale a dire da 250 a 500 mila persone), soprattutto tra i gruppi di popolazione a rischio (bambini sotto i 5 anni, anziani e persone affette da malattie croniche) [5, 9]. Le infezioni del tratto respiratorio inferiore e superiore sono le principali conseguenze dell’influenza stagionale. È stato stimato che circa 290.000-650.000 decessi per cause respiratorie sono attribuibili all’influenza ogni anno [10]. Inoltre, diverse complicazioni extra-respiratorie, come quelle del sistema cardiovascolare e nervoso, hanno un impatto importante, soprattutto nei pazienti più vulnerabili [10]. In Europa, l’influenza provoca 4-50 milioni di casi sintomatici all’anno, circa 15.000-70.000 decessi [11] e 150.000 ricoveri ospedalieri correlati all’influenza [12]. Specifici gruppi vulnerabili (anziani, pazienti con malattie croniche e comorbosità, bambini di età inferiore ai 5 anni e donne in gravidanza) sono maggiormente

Influenza has a significant impact on the health care system and also on production and economic systems. Vaccinated health care workers (HCWs) are more likely to have improved productivity compared to unvaccinated workers. The study aim was to estimate the economic and fiscal impact of an influenza vaccination program for HCWs in Italy. We performed a cost analysis aimed to estimate the indirect costs (productivity losses due to working days lost) and the increase in tax revenues derived from the increase in vaccination coverage among HCWs. Assuming an incremental increase in vaccination coverage of 10% per year over a period of 5 years, total savings could be obtained in terms of a reduction in productivity losses equal to -(sic)4,475,497.16 and an increase in tax revenues of (sic)327,158.84. This revenue could be used to finance other health interventions. Our results are fundamental in view of the sustainability of health systems and of a value-based allocation of health resources. Therefore, a complete social perspective, including the fiscal impact of flu vaccination, should be adopted to assess the economic value of influenza vaccines. Currently, health policies based on the whole value of flu vaccination are needed.

Introduction. Influenza is a widespread acute respiratory disease and represents a serious Public Health problem, both from the NHS and society perspectives. The High Dose quadrivalent influenza vaccine (QIV HD) is a flu vaccine containing 4 times the antigens of a Standard Dose vaccine, resulting in demonstrated superior protection in the population aged 65 years and over. Methods. The analysis has been conducted from the perspective of the NHS. The CEA focuses on the comparison between QIV HD and the QIV SD vaccine. The BIM aims to estimate the potential economic impact for the National Health Service (NHS) resulting from the use of QIV HD in clinical practice in subjects aged 65 or over, when considering its introduction in combination with currently used vaccines, QIV SD and adjuvanted TIV. Results. In a scenario which considers hospitalizations possibly related to influenza, so including cardio-respiratory events, a dominant cost-effectiveness profile emerges in the comparison with QIV SD. In terms of budget impact, overall savings obtained by comparing the two scenarios regarding hospitalizations are equal to 92,766,429 € over the three years’ time horizon considered in the analysis. Conclusions. Nowadays, also considering the state of emergency due to the spread of the SARS-CoV-2 virus, it is crucial to implement innovative health technologies that improve the efficiency and sustainability of the health system. Also, it is essential to protect the elderly population, helping to avoid overload and healthcare systems disruption due to the many COVID-19 hospitalizations.

Background: The current clinical practice for patients affected by chronic myeloid leukemia (CML) is based on the evaluation of second generation alternatives following therapeutic failure that leads to a lengthening of patients’ management times and a consequent negative impact in terms of quality of life. Objective: To determine the economic absorption of resources associated to the management of patients with CML in a scenario in which an early recourse to ponatinib is considered as compared with a scenario based on the current Italian clinical practice characterized by a cyclical recourse to the available therapies. Methods: A Budget Impact model was developed to compare the resources absorbed in the scenarios under assessment considering a 3-year time horizon and the perspective of the Italian National Health Service. Results are expressed in terms of differential resources absorbed in the alternative scenarios. Results: The increase in the recourse to ponatinib allowed a saving of resources for the Italian NHS over the 3-year time horizon of –€ 1,979,322 (€ 825,104,350 vs € 823,125,028). The parameter affecting the most of the results achieved in the base-case is the monthly cost of bosutinib used as a third-line treatment. Conclusions: The increase in the recourse to ponatinib in patients affected by CML that failed to respond to a previous pharmacological therapy resulted to be associated to a lower level of resources’ absorption in the Italian NHS allowing to re-allocate health founds to other fields of the care sector ensuring greater sustainability of the system.

As the COVID-19 outbreak traveled through various Italian regions, all national and local administrations issued measures to counter the spread of the contagion and organize healthcare. The Italian healthcare system is, indeed, a decentralized system with 21 regional health systems (RHSs), with different models of healthcare service delivery and organization. This study investigates whether a different organization of RHSs would have led to different management of the COVID-19 epidemic, and evaluates the effect of different approaches in epidemic management on the COVID-19 epidemiological trend. A set of indicators is identified by conducting an online synchronous Focus Group, involving an experts panel. A Pearson's correlation test was performed on the values assumed by the historical series of indicators investigate correlations among the trends represented by the indicators or between them and external factors. The comparison between the experiences of the different Italian regions, regarding the management of the epidemic, has helped to confirm and emphasize the importance of a community-based approach in health care—integrated with the hospital’s functions for the care of complex conditions and the need for specialized assistance.

L’Health Policy Forum 20191 , nell’analizzare l’Hta nella sua prospettiva europea, ha dedicato attenzione al contributo che i principi e i metodi dell’Hta possono dare allo sviluppo di approcci innovativi per la programmazione sanitaria. Lo scenario del Sistema sanitario nazionale (Ssn), già prima dell’emergenza legata alla diffusione del Sars-CoV-2, si caratterizzava per una debole crescita del finanziamento e una strenua ricerca di spazi di efficientamento, sempre più difficili da trovare. Anche per effetto della lunga stagione dei piani di rientro, il Ssn appare sempre più diversificato ed ineguale. Le differenze in termini di dotazioni infrastrutturali, tecnologiche e professionali segnano sempre più un solco tra le varie Regioni italiane. Questo aspetto sembra riverberarsi non solo sulla diversa percezione della qualità dei servizi da parte dei cittadini, ma anche in alcuni fondamentali indicatori di salute. Una potenziale risposta a questi problemi risiede in una crescente capacità di programmazione e allocazione delle risorse che vede nel livello nazionale uno snodo fondamentale.

Introduction: Osteoarthritis (OA) is a common chronic joint disease characterized by pain, deformity, instability, reduction of motion and function. It is one of the main causes of disability in older adults, affecting about 10% of men and 18% of women over the age of sixty. There are several Guidelines that support the general clinical decision-making process. However, it is necessary to define an integrated management model for patients with OA to ensure an appropriate and quality healthcare. Methods: The objective of the analysis is to determine the economic burden linked to the prevalence and incidence of OA in the acute and chronic phases from the perspective of the National Health Service (NHS) and the entire society. A comparison was made between the management according to the clinical practice and the appropriate management according to National and International Guidelines, determining for each scenario the level of resources absorbed. Results: Patients who started a nonsteroidal anti-inflammatory drug (NSAID)-based therapy in clinical practice resulted in a higher absorption of resources of €363.87 than the same patient managed by referring to National and International Guidelines. Conclusions: OA is associated with a high economic burden and it is a priority problem for public health internationally. The savings resulting from our research, if generalized to the entire Italian population, would lead to a significant reduction of OA economic burden, thus allowing a reallocation of the available resources to other NHS’ sectors.

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