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The Management of Psoriatic Arthritis in Italy: Organizational Impact Analysis of Optimized Pathwaystimized pathways 意大利银屑病关节炎的管理:优化途径刺激途径的组织影响分析
IF 0.5 Q4 HEALTH CARE SCIENCES & SERVICES Pub Date : 2019-07-02 DOI: 10.7175/FE.V20I1.1427
U. Restelli, C. Selmi, Valeria Pacelli, D. Croce, A. Costanzo
BACKGROUND: The management of psoriatic arthritis requires competencies in the fields of both rheumatology and dermatology, and a multidisciplinary approach.AIM: To propose an effective pathway for the diagnosis, monitoring and treatment of psoriatic arthritis in the Italian context, and to assess its organizational impact on the Regional Health Service of Lombardy Region.METHODS: The analysis was performed through interviews conducted with two key opinion leaders in the areas of dermatology and rheumatology. The current pathway of patients who present symptoms that might be related to psoriatic arthritis was defined and an optimized pathway was then proposed on the basis of the clinical practice, considering the implementation of a dermatology and rheumatology shared outpatient service. The organizational impact of the optimized pathway was then assessed from both the hospital and that of the Regional Health Service of Lombardy Region perspectives.RESULTS: The implementation of the service would have a positive impact on patients’ experience, improving the quality of the service provided, thanks to the multidisciplinary approach adopted, limiting the patients’ resources needed for the diagnosis, reducing the number of visits and time loss. The optimized pathway, therefore, would have a limited impact on the marketing mix, while potentially improving patients satisfaction, increasing the possibility of patients’ retention. To successfully implement the dermatological and rheumatologic multidisciplinary service, a precise communication strategy is mandatory.CONCLUSIONS: The optimized pathway for the diagnosis and management of psoriatic arthritis proposed would have a limited organizational impact at both hospital and Regional Health Service levels, while leading to theoretical benefits in terms of a prompt diagnosis of the pathology.
背景:银屑病关节炎的管理需要在风湿病学和皮肤病学领域的能力,以及多学科的方法。目的:提出意大利银屑病关节炎诊断、监测和治疗的有效途径,并评估其对伦巴第大区区域卫生服务的组织影响。方法:通过采访皮肤病学和风湿病学领域的两位关键意见领袖进行分析。定义可能与银屑病关节炎相关症状患者的当前路径,并结合临床实践,结合皮肤科和风湿科门诊共享服务的实施,提出优化路径。然后从医院和伦巴第大区区域卫生服务的角度评估了优化途径的组织影响。结果:该服务的实施将对患者的体验产生积极影响,提高所提供的服务质量,由于采用多学科的方法,限制了患者诊断所需的资源,减少了就诊次数和时间损失。因此,优化后的路径对营销组合的影响有限,但有可能提高患者满意度,增加患者保留的可能性。为了成功地实施皮肤病学和风湿病学多学科服务,精确的沟通策略是强制性的。结论:提出的银屑病关节炎诊断和管理的优化途径对医院和地区卫生服务水平的组织影响有限,但在病理及时诊断方面具有理论上的益处。
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引用次数: 1
Corrigendum: Treatments of Advanced Non‑Small Cell Lung Cancer (NSCLC) in an Italian Center: Drug Utilization and the Treatment Costs of Innovative Drugs 更正:意大利中心晚期非小细胞肺癌(NSCLC)的治疗:药物利用和创新药物的治疗费用
IF 0.5 Q4 HEALTH CARE SCIENCES & SERVICES Pub Date : 2019-06-05 DOI: 10.7175/fe.v20i1.1438
[No authors listed].
There was an error in Discussion section at page 36 in this article by Piantedosi et al. [Farmeconomia. Health economics and therapeutic pathways 2019; 20(1): 27-41; https://doi.org/10.7175/fe.v20i1.1376]. The online version has been corrected on June 5, 2019
在这篇由Piantedosi等人撰写的文章中,在第36页的讨论部分有一个错误。卫生经济学和治疗途径2019;20 (1): 27-41;https://doi.org/10.7175/fe.v20i1.1376]。网上版本已于2019年6月5日更正
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引用次数: 0
Cost Minimization Analysis of Radiofrequency Compared to Laser Thermal Ablation in Patients with Hepatocellular Carcinoma 肝细胞癌患者射频与激光热消融的成本最小化分析
IF 0.5 Q4 HEALTH CARE SCIENCES & SERVICES Pub Date : 2019-04-19 DOI: 10.7175/FE.V20I1.1401
M. Guarino, Lucia S D'Angiolella, L. Falco, Federica Morando, G. D. Costanzo, F. Morisco, G. Improta, L. Mantovani, N. Caporaso
BACKGROUND: Over the last decade of years, minimally invasive techniques have been developed for the treatment of hepatocellular carcinoma and liver metastases. We sought to investigate the health costs associated with the management of patients with hepatocellular carcinoma treated with radiofrequency vs laser thermal ablation and their clinical outcomes.METHODS: We performed a retrospective analysis of the ablations performed in two referral centers in southern Italy, from 2009 to 2013. Resource use was valued by year 2017 official prices, in €. Direct healthcare costs (drugs, visits, tests and hospitalizations) of different ablation techniques were compared. Total costs were analyzed from Italian NHS perspective.RESULTS: A total of 140 patients were identified. Baseline demographics and clinical outcomes of interest did not differ between the two groups. Patients treated with laser thermal ablation resulted in an expected annually cost savings of 258.9 € per patient, in one-year follow-up healthcare costs compared with radiofrequency. The largest components of annual medical expenditures were attributable to drugs, regardless of the type of ablative technique.CONCLUSIONS: The ablation using either laser thermal ablation or radiofrequency is equally effective. Laser thermal ablation would carry disposable cost savings as compared to radiofrequency. The costs associated with management of patients with hepatocellular carcinoma, treated with laser thermal ablation were lower than those treated with radiofrequency ablation.
背景:在过去的十年里,微创技术已经发展到治疗肝细胞癌和肝转移。我们试图调查射频与激光热消融治疗肝细胞癌患者管理相关的医疗费用及其临床结果。方法:我们对2009年至2013年在意大利南部两个转诊中心进行的消融进行了回顾性分析。资源使用按2017年官方价格计算,单位为欧元。比较不同消融术的直接医疗费用(药物、就诊、检查和住院)。从意大利NHS的角度分析总成本。结果:共发现140例患者。基线人口统计学和临床结果在两组之间没有差异。与射频治疗相比,采用激光热消融治疗的患者预计每年每位患者的一年随访医疗费用节省258.9欧元。无论采用何种消融技术,年度医疗支出的最大组成部分都是药品。结论:激光热消融与射频消融效果相同。与射频相比,激光热烧蚀可以节省一次性成本。与肝细胞癌患者管理相关的费用,激光热消融治疗比射频消融治疗低。
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引用次数: 0
Treatments of Advanced Non‑Small Cell Lung Cancer (NSCLC) in an Italian Center: Drug Utilization and the Treatment Costs of Innovative Drugs 意大利中心晚期非小细胞肺癌(NSCLC)的治疗:药物利用和创新药物的治疗费用
IF 0.5 Q4 HEALTH CARE SCIENCES & SERVICES Pub Date : 2019-03-29 DOI: 10.7175/FE.V20I1.1376
F. Piantedosi, Raffaela Cerisoli, Ciro Battiloro, F. Andreozzi, F. Vitiello, M. Gilli, Valeria De Marino, A. Letizia, A. Bianco, Ivana Caprice, A. Savoia, A. Cristinziano, Giorgia Smeraglio, D. Rocco
AIM: To provide an updated picture of the therapies most commonly used in the advanced Non-Small Cell Lung Cancer (NSCLC) setting, together with the relevant costs.METHODS: This study considered the clinical records of patients affected by stage IIIb and IV NSCLC treated in the AORN dei Colli - Plesso Monaldi in Naples during the period January 2016-July 2017 and diagnosed since 2014, as well as the pathology lab database. Multivariate analyses were performed in order to identify the main predictors of time to next treatment and the main cost drivers.RESULTS: Data were collected on 575 patients, who were mainly affected by adenocarcinoma (62%) and squamous cell carcinoma (34%). 64% of patients were reported having been tested for molecular biomarkers (among the patients tested, 13% were EGFR+, 4% Alk t, and 1% ROS1 t). In accordance with the international guidelines, chemotherapy – as single agent or platinum-based doublets – was the prevalent first-line treatment, except among EGFR+ and ROS1 t patients, for whom the target therapy was authorized as first-line therapy. As second-line treatment, the target therapy and immune checkpoint inhibitors (nivolumab) were the most commonly used treatments. Drug expenditure per patient was remarkably higher in mutated patients (€ 29,053) versus wild-type patients, or patients with unknown mutational status (€ 11,854), who received just chemotherapy. The costs sustained in 2017 are proportionally higher than those sustained in 2016, mainlydue to the increasing eligibility to target therapy and immune checkpoint inhibitors and the wider biomarker analysis performed. From multivariate analyses, among the predictors of a longer time to next treatment (TTNT) were a better performance status and target therapy both in first and second line. The therapy for squamous cell carcinoma and other nonadeno histotypes turned out to be less expensive in patients treated just in the first line than that for adenocarcinoma and adenosquamous carcinoma. The use of immune checkpoint inhibitors in the second line results in increased costs compared to the use of chemotherapy. Also the target therapy in the first line results in an increase in the total costs with respect to chemotherapy in patients who received just a first-line therapy.CONCLUSIONS: Generally, in this study population, the treatments administered are in accordance with the international guidelines. The costs borne by the Health Systems are higher for the target therapy and the immune checkpoint inhibitors.
目的:提供晚期非小细胞肺癌(NSCLC)最常用的治疗方法的最新情况,以及相关费用。方法:本研究考虑了2016年1月至2017年7月在那不勒斯AORN dei Colli - Plesso Monaldi治疗的IIIb和IV期非小细胞肺癌患者的临床记录,以及2014年以来诊断的病理实验室数据库。进行了多变量分析,以确定下一次治疗所需时间的主要预测因素和主要费用驱动因素。结果:收集了575例患者的数据,主要为腺癌(62%)和鳞状细胞癌(34%)。据报道,64%的患者进行了分子生物标志物检测(在检测的患者中,13%为EGFR+, 4%为Alk t, 1%为ROS1 t)。根据国际指南,化疗-单药或铂基双药-是流行的一线治疗,除了EGFR+和ROS1 t患者,其靶向治疗被授权为一线治疗。作为二线治疗,靶向治疗和免疫检查点抑制剂(nivolumab)是最常用的治疗方法。突变患者的人均药物支出(29,053欧元)明显高于仅接受化疗的野生型患者或突变状态未知的患者(11,854欧元)。2017年持续的成本比例高于2016年,主要是由于靶向治疗和免疫检查点抑制剂的资格增加以及更广泛的生物标志物分析。从多变量分析来看,较长时间到下一次治疗(TTNT)的预测因素包括一线和二线较好的表现状态和靶向治疗。事实证明,在一线治疗的鳞状细胞癌和其他非腺组织型患者的治疗费用低于腺癌和腺鳞癌。与化疗相比,在二线治疗中使用免疫检查点抑制剂导致成本增加。同时,一线的目标治疗导致了总费用的增加相对于只接受一线治疗的患者的化疗。结论:总体而言,在本研究人群中,给予的治疗符合国际指南。卫生系统承担的费用较高的是靶向治疗和免疫检查点抑制剂。
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引用次数: 0
Acknowledgement to Reviewers (January - December 2018) 向审稿人致谢(2018年1月至12月)
IF 0.5 Q4 HEALTH CARE SCIENCES & SERVICES Pub Date : 2019-02-15 DOI: 10.7175/fe.v19i1.1407
Ombretta Bandi
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引用次数: 0
Editorial Staff Disclosure (2018) 编辑人员信息披露(2018年)
IF 0.5 Q4 HEALTH CARE SCIENCES & SERVICES Pub Date : 2019-02-15 DOI: 10.7175/FE.V19I1.1408
Ombretta Bandi
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引用次数: 0
Effectiveness of Long-Acting Injectable Antipsychotics in Schizophrenia: A Literature Review and Bayesian Meta-Analysis Informing Economic Considerations 长效注射抗精神病药物治疗精神分裂症的有效性:文献综述和贝叶斯荟萃分析为经济考虑提供信息
IF 0.5 Q4 HEALTH CARE SCIENCES & SERVICES Pub Date : 2019-02-13 DOI: 10.7175/FE.V20I1.1393
O. Zaniolo, G. Ghetti, M. Povero, L. Pradelli
BACKGROUND: Although the use of long-acting injectable antipsychotics (LAIs) is considered an important option in the management of schizophrenia two recent meta-analysis, which aimed to compare LAIs vs oral antipsychotics (OAPs) in terms of relapse rate, showed discordant results.AIM: To investigate factors affecting the efficacy of antipsychotics in terms of relapse prevention in the real-world and to estimate the management cost of an episode of relapse.METHODS: We conducted a literature search using MEDLINE/PubMed with the aim to extract efficacy, effectiveness and adherence data of LAIs and OAPs. The primary outcome was the relative risk (RR) of relapse between two strategies. The extracted RR were included in a series of Bayesian statistical models based on the starting hypotheses. The RR rates obtained from the meta-analysis have been used as input for an economic evaluation of the total costs associated with the management of the patient with schizophrenia from the Italian NHS perspective.RESULTS: The literature search identified 34 studies which met the inclusion criteria and were analyzed. According to the model that best explains the data, in the real-world setting the effectiveness with LAIs is greater than with OAPs, with a more pronounced effect for SGAs than for FGAs. Taking into account generation, route and frequency of administration, the RR decreased with lower administration frequency, with SGA LAI administered once every 90 days which is associated with the greatest reduction in the risk of relapse (-85%). When the results of the meta-analysis are used to feed an economic evaluation the results show that the SGA administered every 90 days is the strategy with the least expected cumulative cost both at 1 (€ 3,509) and 5 years (€ 19,690).CONCLUSION: SGA LAIs administered every 90 days seems to be the best option for the treatment of patient with schizophrenia from both the clinical and economic perspectives.An erratum to this article is available online at: https://doi.org/10.7175/fe.v20i1.1406
背景:尽管使用长效注射抗精神病药物(LAIs)被认为是治疗精神分裂症的重要选择,但最近两项旨在比较LAIs与口服抗精神病药物(OAPs)复发率的荟萃分析显示结果不一致。目的:探讨现实世界中影响抗精神病药物预防复发疗效的因素,并估算一次复发的管理成本。方法:我们使用MEDLINE/PubMed进行文献检索,提取LAIs和oap的疗效、有效性和依从性数据。主要结局是两种策略之间复发的相对风险(RR)。将提取的RR纳入基于起始假设的一系列贝叶斯统计模型中。从荟萃分析中获得的RR率已被用作从意大利NHS角度对精神分裂症患者管理相关总成本进行经济评估的输入。结果:文献检索筛选出34篇符合纳入标准的研究并进行分析。根据最能解释数据的模型,在现实环境中,lai的有效性高于oap, SGAs的效果比FGAs更明显。考虑到产生、给药途径和给药频率,RR随着给药频率的降低而降低,每90天给药一次SGA LAI与复发风险降低最大(-85%)相关。当meta分析的结果用于经济评估时,结果显示每90天进行一次SGA是预期累积成本最低的策略,分别为1年(3,509欧元)和5年(19,690欧元)。结论:从临床和经济角度来看,每90天给药一次的SGA LAIs是治疗精神分裂症患者的最佳选择。本文的勘误表可在https://doi.org/10.7175/fe.v20i1.1406网站上找到
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引用次数: 1
Erratum: Effectiveness of Long-Acting Injectable Antipsychotics in Schizophrenia: A Literature Review and Bayesian Meta-Analysis Informing Economic Considerations 长期注射抗精神病药物治疗精神分裂症的有效性:文献综述和贝叶斯荟萃分析为经济考虑提供信息
IF 0.5 Q4 HEALTH CARE SCIENCES & SERVICES Pub Date : 2019-02-13 DOI: 10.7175/fe.v20i1.1406
[No authors listed].
There was an error in the relapse rate reduction reported in Figure 2 in this article by Zaniolo et al. [Farmeconomia. Health economics and therapeutic pathways 2019; 20: 13-24; https://doi.org/10.7175/fe.v20i1.1393]. The online version has been corrected on 13 February 2019.
Zaniolo等人[Farmeconomia]在这篇文章的图2中报道的复发率降低有一个错误。卫生经济学和治疗途径2019;20: 24里面;https://doi.org/10.7175/fe.v20i1.1393]。网上版本已于2019年2月13日更正。
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引用次数: 0
Economic Evaluation of Different Organizational Models for the Management of Patients with Hepatitis C 不同组织模式对丙型肝炎患者管理的经济评价
IF 0.5 Q4 HEALTH CARE SCIENCES & SERVICES Pub Date : 2019-01-28 DOI: 10.7175/FE.V20I1.1374
S. Fagiuoli, L. Pasulo, F. Maggiolo, R. Spinella, P. Poggio, R. Boldizzoni, M. D. Marco, A. Aronica, C. Benedetti, P. Correale, C. Garavaglia, C. Nicora
BACKGROUND: Access to Directly Acting Antivirals (DAAs) for Hepatitis C Virus (HCV) treatment in Italy was initially restricted to severe patients. In 2017, AIFA expanded access to all patients, to achieve elimination by 2030.AIM: To investigate the impact of different hospitals’ organizational models on elimination timing, treatment capacity and direct costs.METHODS: Most Regional healthcare systems in Italy deploy a Center of Excellence (CoE) organizational model, where patients are referred to a single major hospital in the area, which is the only one that can prescribe and deliver DAAs. The study was conducted at Bergamo’s (Lombardy, Italy) Papa Giovanni XXIII hospital (PG-23), which deploys a Hub&Spoke model: the Hub (PG-23) prescribes and delivers DAAs while Spokes (four smaller hospitals) can only prescribe them. The study compares the two models (CoE vs. H&S). Patient journey and workloads were mapped and quantified through interviews with hospital stakeholders. Cost data were collected through the hospital’s IT system; the sample comprised 2,277 HCV patients, over one year.RESULTS: The study calculated the average cost to treat HCV patients (~ € 1,470 per patient). Key cost drivers are lab tests (60%) and specialist visits (30%). Over one year, H&S can treat 68% more patients than CoE. As deferred patients absorb up to 40% of total costs, the “Optimized” model was designed by streamlining specialists’ visits and involving general practitioners during follow-up. “Optimized” model increases treatment capacity and reduces costs of deferred patients by 72% vs CoE.CONCLUSION: The study demonstrates the importance of organizational models in efficiently achieving 2030 elimination.
背景:在意大利,用于丙型肝炎病毒(HCV)治疗的直接作用抗病毒药物(DAAs)最初仅限于重症患者。2017年,AIFA扩大了对所有患者的覆盖,目标是到2030年实现消除。目的:探讨不同医院组织模式对消除时间、治疗能力和直接成本的影响。方法:意大利大多数区域医疗保健系统采用卓越中心(CoE)组织模式,患者被转介到该地区的一家大医院,这是唯一一家可以开处方和提供daa的医院。这项研究是在贝加莫(意大利伦巴第)Papa Giovanni XXIII医院(PG-23)进行的,该医院采用Hub和spoke模式:Hub (PG-23)开处方并提供daa,而Spokes(四家较小的医院)只能开处方。该研究比较了两种模型(CoE与H&S)。通过与医院利益相关者的访谈,绘制和量化了患者的旅程和工作量。成本数据通过医院的IT系统收集;该样本包括2277名HCV患者,持续时间超过一年。结果:该研究计算了治疗HCV患者的平均成本(每名患者约1470欧元)。主要的成本驱动因素是实验室检测(60%)和专家就诊(30%)。在一年的时间里,H&S比CoE多治疗68%的患者。由于延迟就诊的患者占总费用的40%,“优化”模式通过简化专家就诊并在随访期间让全科医生参与来设计。与CoE相比,“优化”模型提高了治疗能力,并将延迟患者的成本降低了72%。结论:研究表明组织模式对有效实现2030年消除的重要性。
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引用次数: 1
Cost-Effectiveness Analysis of Peginterferon Beta-1a in the Treatment of Relapsing-Remitting Multiple Sclerosis in Italy: Results of an Updated Analysis 聚乙二醇干扰素β -1a治疗意大利复发缓解型多发性硬化症的成本-效果分析:最新分析结果
IF 0.5 Q4 HEALTH CARE SCIENCES & SERVICES Pub Date : 2018-11-30 DOI: 10.7175/FE.V19I1.1385
D. Centonze, S. Iannazzo, L. Santoni, C. Saleri, E. Puma, L. Giuliani, P. Canonico
© 2018 The Authors. Published by SEEd srl. This is an open access article under the CC BY-NC 4.0 license (https://creativecommons.org/licenses/by-nc/4.0) background Multiple sclerosis (MS), a chronic inflammatory disease of the central nervous system, is causing a progressive disability that impacts patients’ quality of life and societal costs [1]. MS takes several forms, with new symptoms either occurring in isolated attacks (relapsing form) or building up over time (progressive form) [2]. Between attacks, symptoms may disappear completely; however, permanent neurological problems often remain, especially as the disease advances [2]. In 85% of patients with MS the onset form is relapsing-remitting MS (RRMS) [3]. While MS is currently considered incurable, treatment has advanced significantly over the past several decades. Disease modifying therapies (DMTs) can reduce the frequency of clinical relapses and delay disability progression [4]. As is the case in many different therapeutic areas, clinical progress in treating the disease has accompanied a rise in costs to purchase biologic products. In this light, economic evaluations are key elements for healthcare decision-making. In 2016 we published in this journal a cost-effectiveness analysis that compared subcutaneous peginterferon beta-1a 125 μg every 2 weeks (Plegridy®) to the other injectable DMTs used in first-line therapy of RRMS from both the perspective of the Italian National Healthcare Service (NHS) and of the Italian Society [5]. The comparators considered in the analysis were: interferon (IFN) beta-1a 30 μg (Avonex®), IFN beta-1a 22 μg (Rebif® 22), IFN beta-1a 44 μg (Rebif® 44), glatiramer acetate (GA, Copaxone®) 20 mg, IFN beta-1b 250 μg (Betaferon® and Extavia®). The 2016 analysis showed that peginterferon beta-1a was an alternative dominant or cost-effective vs IFNs and GA for the treatment of RRMS in Italy from the NHS and societal perspectives. While the design of the model and the choice of clinical parameters remains well aligned with the most recent cost-effectiveness studies published in the literature [6], some economic inputs of that analysis appear now outdated. The objective of the current work is thus to provide an update of the original analysis [5]. Corresponding author Prof. Diego Centonze centonze@uniroma2.it
©2018作者。由SEEd出版社出版。多发性硬化症(MS)是一种中枢神经系统的慢性炎症性疾病,导致进行性残疾,影响患者的生活质量和社会成本[1]。多发性硬化症有多种表现形式,新的症状要么在孤立发作时出现(复发型),要么随着时间的推移逐渐积累(进行性)[2]。在两次发作之间,症状可能完全消失;然而,永久性的神经问题往往仍然存在,特别是随着疾病的进展[2]。85%的MS患者发病形式为复发缓解型MS (RRMS)[3]。虽然多发性硬化症目前被认为是无法治愈的,但在过去的几十年里,治疗已经取得了重大进展。疾病修饰疗法(dmt)可以减少临床复发的频率,延缓残疾进展[4]。与许多不同治疗领域的情况一样,治疗该病的临床进展伴随着购买生物制品的成本上升。在这种情况下,经济评估是医疗保健决策的关键因素。2016年,我们在该杂志上发表了一项成本效益分析,从意大利国家医疗保健服务(NHS)和意大利社会的角度比较了每2周125 μg皮下聚乙二醇干扰素β -1a (Plegridy®)与用于RRMS一线治疗的其他注射DMTs的成本效益分析[5]。分析中考虑的比较物为:干扰素(IFN) β -1a 30 μg (Avonex®)、IFN β -1a 22 μg (Rebif®22)、IFN β -1a 44 μg (Rebif®44)、醋酸格拉替雷明(GA、Copaxone®)20 mg、IFN β -1b 250 μg (Betaferon®和Extavia®)。2016年的分析显示,从NHS和社会的角度来看,聚乙二醇干扰素β -1a是意大利治疗RRMS的替代优势或成本效益优于ifn和GA。虽然模型的设计和临床参数的选择与文献中发表的最新成本效益研究保持一致[6],但该分析的一些经济投入现在似乎过时了。因此,当前工作的目的是提供原始分析的更新[5]。通讯作者Diego Centonze教授centonze@uniroma2.it
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引用次数: 0
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