The long process by which HTA became a paradigm: A longitudinal conceptual structure analysis.

This study maps the conceptual structure of health technology assessment (HTA) research with the aim of contributing to a better understanding of this research stream. A bibliometric analysis of 1,198 HTA articles retrieved from the Web of Science database was conducted. The analysis of descriptive performance indicators identified the main traits of the scientific debate about the HTA in terms of publications, productive countries, and sources. A co-word analysis was performed by adopting social network analysis tools to map the conceptual structure of the dataset. The results highlight the growing academic interest in the research topic, especially in recent years. The results revealed that HTA is a widely known term and represents the reference paradigm for assessment in healthcare technologies. This paper contributes to the field by providing an examination of the current state of the art of HTA research and identifying possible future research directions. This study differs from existing studies because it involved a conceptual analysis of the scientific literature using macro keywords.

Economic aspects and managerial implications of the new technology in the treatment of low back pain.

BACKGROUND: The Human Body Posturizer (HPB), an innovative therapeutic tool able to correct postural changes dynamically, fits perfectly in this framework. OBJECTIVE: The aim of this paper is to consider the potential economic benefits of using the Human Body Posturizer both in terms of direct and indirect cost reduction in one year. METHODS: This study was carried out using an estimation method in order to investigate the possible economic impact related to the adoption of the HBP in subjects with low back pain as an attempt to quantify the costs (direct and indirect) generated at different levels of the path therapeutic. RESULTS: The use of therapy with HBP would generate a saving of € 971.40/year in case of sub-acute LBP and amounted to € 2,922.90/year in case of chronic low back pain. CONCLUSION: This paper provides guidance on the potential economic benefits resulting from the adoption of the Human Body Posturizer as an innovative therapeutic approach by the Italian Health System.

[Adapted Exercise in the management of Type II diabetes: a Budget Impact Analysis]. / L'Esercizio Fisico Adattato nel management del paziente con diabete di tipo 2: una Budget Impact Analysis.

Type II diabetes has a high prevalence rate worldwide, especially in industrialized countries. By requiring increasing health expenditures and resources, the disease and its complications generate a considerable economic burden. Since many years several institutions promote awareness and information programs regarding the most effective strategies to prevent and control diabetes. By reducing the severity of the disease and its complications, Adapted Exercise therapy (AE) represents an ideal instrument to remodulate the Therapeutic Healthcare Management Protocol (THMP) of patients with type II diabetes and may be defined as a new health technology. On the basis of these considerations, a Budget Impact Analysis (BIA) was carried out from the healthcare management perspective to evaluate advantages deriving from the introduction of a structured program of AE for diabetics in Campania, one of the Italian regions with the highest prevalence of diabetes. The analysis has examined two scenarios: the basic one, in which is not provided a program of AE and alternative that, instead, contemplated it. In a horizon of 5 years, the implementation of integrated THMP would entail, as demonstrated by the present analysis, a decrease in the estimation of the number of diabetic subjects complicated and related costs. The sensitivity analysis, adapted to check the soundness of this result, has supported the basic assumptions.

[Economic evaluation of the stroke units in Campania]. / Impatto economico delle Stroke Unit in Campania.

The Stroke Units (SU) delivers high quality care and treatment in patients affected by strokes. In Italy stroke is the second leading cause of death and the first of disability in adult people. There is significant evidence in literature indicating the better quality assistance SU provide in the treatment of neurological acute disease, with significant improvements in mortality and disability, when the therapeutic intervention (thrombolysis) is carried out within 3 hours after the onset of symptoms. Two are the aims of the present study: to evaluate the economic impact of both the start-up of Stroke Units in the Campania Region and the use of thrombolytic therapy for all treatable population. In the first case, the authors assume charges and costs on the national health service in absence of SU, rather than in the presence of these: the analysis compares the two alternatives to identify the most affordable one. Moreover, the authors try to estimate the potential savings achievable through the use of thrombolytic therapy: savings resulting from the difference between the number of cases treated in 2009 against the targeted population. By the results of the anticipate analysis, the global economic advantage for the Regional Banks is constituted by the sum of the savings hypothesized in two considered hypothesis. In the synthesis, the activation of SU and trombolytic treatment for all people whit eligibility criteria, may be considered health policy strategies extremely convenient for economic and social impact without causing high sacrifices for the Regional Banks.

[Health Technology Assessment to evaluate the economic advantage of offering of low-protein diet to pre-dialysis patients in Campania (Italy)]. / Un modello HTA a sostegno dell'offerta della dieta ipoproteica ai nefropatici della Campania.

A low-protein diet is well known to slow the progression of chronic renal failure, delay initiation of dialysis, while achieving significant economic benefits. In the context of a Health Technology Assessment (HTA), a budget impact analysis model was implemented to evaluate the economic advantage of offering of low-protein diet to nephropathic patients in Campania (Italy). The implemented model takes into account only the direct costs to the national healthcare system. In particular, costs related to supplying low-protein foods are compared to dialysis costs avoided, in a scenario that evaluates different indices of Numbers Needed to Treat and compliance to treatment. Results indicate that when compliance to treatment is at least 50% and NNT is £ 50, supplying a low-protein diet to all kidney disease patients in the pre-dialysis phase, namely with an estimated Glomerular filtration rate > 45, in Campania (which in the year 2009 were equal to 25,000 subjects), is economically advantageous. In this perspective, the authors argue that distribution of low-protein foods by local pharmacies could be an appropriate choice as it would allow the products to be offered at a discounted price and create a favorable setting for increasing adherence to treatment.