Clinical epidemiology of hand eczema in patients accessing dermatological reference centres: results from Italy.

BACKGROUND: Data on the epidemiological impact and clinical characteristics of chronic hand eczema in Southern Europe are lacking. OBJECTIVES: To estimate the prevalence of chronic hand eczema in its different stages of severity and refractoriness to standard therapy in patients accessing Italian dermatological reference centres, and to evaluate sociodemographic and clinical factors associated with each stage. METHODS: A cross-sectional multicentre study was conducted. Adult patients with hand eczema, consecutively accessing 14 centres over a 6-month period, were enrolled. Patients were classified according to disease duration, severity and response to standard therapy with potent topical corticosteroids. Logistical regression was performed to investigate the relationship between sociodemographic and clinical data with different stages of eczema. RESULTS: The total number of participants was 981. Hand eczema was chronic in 83·5% of patients; 21·3% had severe eczema, with 62·0% of these patients refractory to standard therapy. Food processing and related work, the health professions, craft and related trade works (building, plumbing, electrical), hairdressing/beauty and handicraft work were most frequently associated with chronic hand eczema. Severe chronic hand eczema was more likely to be seen in men, older patients and those with less education. Severe and refractory hand eczema was also more likely among the unemployed and patients with allergic rhinitis and/or atopic dermatitis. CONCLUSIONS: Chronic hand eczema is frequent among patients with hand eczema accessing dermatology centres. Many patients were severe and refractory to standard therapy. The appropriate identification of hand eczema is the first step in implementing effective and efficient treatments.

The cost of hospital-related care of patients with psoriasis in Italy based on the AISP study. Associazione Italiana Studi Psoriasi.

The objective of this study was to assess the cost of caring for patients with psoriasis in Italy according to the AISP study (Associazione Italiana Studi Psoriasi or Italian Association for Studies on Psoriasis), involving 104 university and hospital centres and 7992 patients in 1994. The mean yearly cost of care for a single patient was calculated at 905 Euros. Hospitalization accounted for more than four-fifths of the costs, therapy for about one-eighth (systemic therapies were the most expensive) and office visits and day hospitals for the remainder. In our study series less than 20% of patients accounted for more than 90% of the total costs.

Pharmaco-economic aspects of in-vitro fertilization in Italy.

Given the higher efficacy of follitropin-beta, a new recombinant follicle stimulating hormone (r-FSH), versus urinary-FSH (u-FSH), the present study was carried out to evaluate the cost-effectiveness ratio (CER) of follitropin-beta in comparison with u-FSH in women undergoing in-vitro fertilization (IVF) in Italy. Clinical decision analysis techniques were used to retrospectively model the direct medical costs of women undergoing IVF treatment. Seven Italian experts were interviewed, using a semi-structured questionnaire, in order to adapt the results of all clinical trials to the Italian patterns of care. Three analyses were conducted considering the public, the private sectors and a mixture of them (currently representing the Italian situation). The estimated total cost of IVF treatments varies from 106.9 and 211.7 billion Lire (63.2 and 125.2 million US$) depending on setting and type of treatment. The average CER varies from 21.5 and 37.7 million Lire (12, 700 and 22,300 $US) in the different hypotheses considered. The incremental CER varies from 19.2 and 26.0 million Lire (11,300 and 15,400 $US) depending on setting and type of treatment.

Suspected adverse drug events requiring emergency department visits or hospital admissions.

OBJECTIVE: To analyse the contribution of adverse drug events (ADEs) to the overall number of referrals or visits at an emergency department, to determine the proportion of more severe episodes requiring hospital admission and to characterize the different causes of drug-related visits or admissions. METHODS: A 1-year prospective collection of data on visits performed at an emergency department. All visits, observed during 1 week every month, were analyzed in order to identify suspected ADEs. The effects of age and sex on the frequency of ADE-related visits and admissions were evaluated. All patients hospitalized because of an ADE were followed up in order to collect information about progress and outcome of the events, which were also assessed in terms of avoidability. RESULTS: Among the 5497 patients who visited the Emergency Department over 1 year, 235 (4.3%) experienced an ADE, 45 of these (19.1%) were subsequently hospitalized, among whom there were five deaths. Dose-related therapeutic failures were the main causes of drug-related admissions (55.6%), whereas adverse drug reactions caused the most frequent drug-related visits to the Emergency Department (63.8%). Although the frequency of drug-drug interactions leading to a visit to the Emergency Department was small (3.8%), this type of event was more severe, because most of these patients were hospitalized. No age/sex effect was observed in the proportion of ADE-related hospital admissions. Twenty-five (1.4% of the total admissions) of the 45 ADE-related admissions were evaluated as preventable, contributing by more than 61% of the overall length of hospital stay. CONCLUSION: The high proportion of drug therapeutic failures leading to an admission highlights the need for public education, particularly to prevent non-compliance.

Can Europe afford not to implement evidence-based medicine in heart failure?

Technological change in cardiovascular medicine is extremely rapid and is likely to continue to accelerate. Society, of course, demands that new products and services are clinically effective in combating disease, reducing disability and extending life. Society also requires them to be cost-effective. Within this framework there is a vital need to produce authoritative information to assist in making very important healthcare decisions. A strategy for assessing both the effectiveness and the economics of cardiovascular disease management programmes has four discrete, mutually reinforcing tasks: (1) identifying the technologies that need to be assessed, (2) collecting data on the selected technologies, (3) synthesizing the data collected, and (4) disseminating the information collected. There is no single strategy to prevent a global financial crisis in heart failure care. However, a set of recommendations have been proposed as a means to overcome major obstacles. These recommendations have been elaborated mainly from a practical point of view and, while they are not meant to be exhaustive, they may represent an agenda for action. Future research, and especially experience relating to the economics and outcomes of heart failure care developments, will be of utmost interest and may act as a basis for further healthcare decisions.

Captopril in the management of patients after acute myocardial infarctions. A cost effectiveness analysis in Italy.

The prevalence of acute myocardial infarction (AMI) is found in approximately 500,000 individuals in Italy. The annual incidence can be crudely estimated to be 100,000 events. This represents a major health care problem and generates questions about the rational allocation of public resources devoted to health care, specially since Italy has a National Health Service. We focused on the economics of adding captopril administration to standard care in Italy in AMI patients matching the entry criteria of the SAVE study. The cost effectiveness ratio(s) was explored under different assumptions on the effectiveness and on the cost of the intervention. In our base case, administering captopril has an incremental Cost Effectiveness Ratio of 14.708 million lira (1 US $ = 1529 lira in December 1996) per life year saved (LYS) (maximum range 7.171-21.003). This means that a net investment to the NHS of approximately 12 billion lira over 4 years to treat 10,000 patients matching the entry criteria of the SAVE trial will prevent 410 cardiovascular deaths (i.e. 33.229 million lira per cardiovascular death prevented) and save approximately 928 (discounted) to 1027 (not discounted) LYS over the same time period. Results are sensitive to the cost of captopril and of revascularisation procedures.

Is preventive medical care worth the cost?

Preventive medical care is seen as a way to reduce medical costs because screening for diseases is likely to catch them earlier, thus making treatment less expensive. Such an argument does not take into account the costs associated with massive testing. Less expensive ways are described.