Background: Pulmonary arterial hypertension (PAH) is a rare and progressive disease characterized by high mortality and a significant impact on quality of life. Despite therapeutic advances, considerable heterogeneity persists in Italy’s diagnostic and therapeutic pathways, leading to delays in diagnosis and disparities in access to care.Objective: With this work we aim to define a roadmap for a shared diagnostic, therapeutic, and care pathway forPAH in the Triveneto region, aiming to reduce management variability, improve continuity of care, and optimizethe use of available resources.Methods: A multidisciplinary group of cardiologists, pulmonologists, and rheumatologists from Triveneto, alongwith a representative from the Pulmonary Hypertension Patients’ Association, convened in a series of meetingsto discuss diagnostic and therapeutic pathways.Results: Early identification of PAH should be based on the classification of symptomatic patients into three mainphenotypes (cardiac, pulmonary, and not better specified), followed by a specific diagnostic process based onupdated hemodynamic criteria.Therapeutic strategies should be defined according to risk stratification, with clear guidelines for comorbiditymanagement and monitoring through quality indicators (Key Performance Indicators) to assess the effectivenessof care pathways.Conclusions: The proposed roadmap represents a shared model for PAH management in the Triveneto region,promoting a multidisciplinary and integrated approach. Its adoption could enhance care quality, reduce regionaldisparities, and align with European guidelines, ultimately improving patient prognosis and quality of life.

Background: The availability of high-efficacy disease-modifying therapy (DMT), including natalizumab, improved treatment efficacy in adults with highly-active relapsing-remitting multiple sclerosis (RRMS). Natalizumab patent protection has expired, and the natalizumab biosimilar (Tyruko®) has been recently reimbursed by AIFA. As the price of natalizumab biosimilar is expected to be lower as compared with natalizumab originator’s price, a budget impact analysis was conducted to assess the economic impact associated to the introduction of natalizumab biosimilar for patients with highly-active RRMS. Methods: A budget impact model was developed, considering the INHS perspective and a 5-years time horizon. The number of patients treated with natalizumab was estimated based on historical natalizumab consumption data, disease prevalence rates and natalizumab market share. The budget impact population was divided into prevalent and incident patients. The model assumes that some patients in treatment with natalizumab originator will switch to natalizumab biosimilar and that some naïve patients will directly start treatment with natalizumab biosimilar. The ex-factory price of natalizumab originator (intravenous and subcutaneous) and biosimilar (intravenous) and the corresponding administration costs were included. All assumptions were validated by expert opinion. Results: Eligible population was estimated at 7,552, 7,779, 8,090, 8,494 and 8,834 in years 1, 2, 3, 4 and 5 respectively. The introduction of natalizumab biosimilar, considering a progressive increase in market share from 9.6% (year 1) to 40.5% (year 5), would provide an overall savings (5-years time horizon) over € 47 million to the INHS. The scenario analysis highlights that the lower treatment cost of biosimilar natalizumab compared to originator natalizumab would offset the higher cost associated with intravenous versus subcutaneous administration. Conclusion: Considering the results of this budget impact analysis, it is realistic to expect that the presence of biosimilar natalizumab will contribute to the sustainability of public pharmaceutical expenditure.

Considering other pharmacological approaches, also in the field of insulin therapy, the use of biosimilar drugs instead of originators could help to reduce the worldwide increasing costs of its related disease, that is, diabetes mellitus (DM), and the subsequent risk of insulin underutilization. Available evidences clearly demonstrate that biosimilar efficacy and safety are superimposable to those of the originator insulin with lower expenditure; despite this, however, their underutilization persists both in Eastern and in Western countries. Specific, regional activities are needed in order to improve biosimilar insulin use and to contribute to a substantial reduction of the costs of DM.

In the last years significant progress has been made in the understanding and treatment of hemorrhage caused by trauma which (along with the advances made in early resuscitation, and critical care) has led to a reduction of “late” deaths, meaning those due to trauma-induced organ failure/sepsis. Depending on the case, trauma is usually characterized by a variable equilibrium between hypo and hypercoagulation, with a majority of hypercoagulation cases. Trauma-induced coagulopathy (TIC), instead, is not only characterized by a coagulation disorder but also a state of inflammation which increases the need for transfusions, the risk of multiorgan failure and thromboembolic complications. In this clinical picture, hemostatic resuscitation, damage control resuscitation and homeostasis maintenance have been shown to reduce mortality. According to guidelines, the heart of TIC treatment is an early individualised goal-directed treatment relying on coagulation support and thromboprophylactic strategies (administration of tranexamic acid, fibrinogen concentrate and packed red blood cells), platelet function monitoring and viscoelastic Point-of-care testing. The implementation of the protocol suggested by the guidelines has allowed a more effective support of coagulopathy and has led to a reduction in hemoderivatives usage, hospitalization time and the death rate in severely injured trauma patients. The aforementioned improvements in TIC management were explicitly confirmed by a multicentric study in which the year the guidelines were implemented was compared with a prior year when no specific protocol was executed.

Venturi-based flow generators are commonly used for noninvasive continuous positive airway pressure (CPAP) of high-flow nasal oxygen (HFNO). The system is simple and allows to increase the total flow while decreasing the FiO2 starting from a single oxygen source. In this report we describe the characteristics and performance of a novel Venturi system (EasyVEE, Levate, BG, Italy), which allows to vary the size of the port through which ambient air is entrained, hence allowing a continuous modulation of FiO2. The system allowed to modify FiO2 continuously between 35% and 80% and, consequently, a 1.5- to 4.5-fold increase of the total flow rate. A minimal decrease in entrainment performance was observed for positive end-expiratory pressure levels above 12.5 cmH2O. EasyVEE system appears to be a simple, flexible, and reliable solution to generate continuous flow for noninvasive respiratory support interfaces.

Although it represents a valid alternative for patients with type 1 diabetes (T1DM) with insufficient glycemic control and/or with recurrent hypoglycemia, insulin pump therapy (Continuous Subcutaneous Insulin Infusion, CSII) in Italy is nowadays still relatively uncommon. The following review aims to investigate the barriers that limit the transition to CSII and the reasons behind the widespread cases of drop-out, particularly evident in younger patients. Among the interventions that could contribute to the solution of the problem, catheter-less insulin pumps (or patch-pumps) will be described: a tool potentially able to reduce, if not eliminate, some of the main obstacles encountered by patients. In particular, a new opportunity has become available today thanks to the evolution of the generation of catheter-less insulin pumps represented by Accu-Chek® Solo (Roche Diabetes Care GmbH), therefore three clinical cases of patients with T1DM undergoing therapy with the Accu-Chek® Solo insulin pump will be presented and discussed herein.

Introduction. We developed a Social Observatory in the HealthCare (HC) & Pharma sector to better understand how the focus by Pharma companies on social communication has been implemented, following the new legislation that allows social advertising for over the counter (OTC) drugs. Methods and results. Activity on social networks between 01/06/2018 and 31/05/2019 has been analysed. The social channels monitored were: Facebook, Instagram, LinkedIn, Twitter and YouTube. Activity from 13 companies with HQ in Italy (Abiogen, Alfasigma, Angelini, Chiesi, Doc Generici, Dompé, Italfarmaco, Kedrion, Mediolanum, Menarini, Molteni, Recordati, Zambon) and 16 companies with HQ elsewhere (Abbvie, Amgen, Amway, Bayer, Gilead, GSK - Glaxo SmithKline, J&J/Janssen, Merck Serono, MSD, Nature’s Bounty, Novartis, P&G, Pfizer, Reckitt Benckiser, Roche, Sanofi) was captured and analysed using both quantitative and qualitative techniques. Italy HQ companies seem to use these channels to a lesser extent compared to companies HQs elsewhere. Examples of all the different Brand characters (i.e. Friendly, Playful, Warm, etc), tones (personal, honest, humble, etc) and purposes (engage, entertain, educate, etc) were captured and discussed in detail in the article. Conclusions. Pharma companies have a wide-ranging approach to communicating through social media. These data represent an important baseline to carefully analyse the evolution of social communication of HC&Pharma sector in Italy.

Introduction: In 2017 the nursing staff of Health Local District no. 2 of Trieste followed 67 patients in charge at both the home and the outpatient services for long-term pathologies starting from the hospitalization.
 Case description: The Service administered the PHE-S® scale to these 67 patients, in the light of a strategical consideration of the importance of monitoring the levels of patients’ engagement and of personalizing dedicated initiatives to promote the active involvement of the patients, also thanks to the improvement of the clinical relationship. The level of engagement was measured at zero, one and four months after hospitalization. In the four months after discharge, the nursing staff applied specific strategies to promote engagement.
 Conclusions: This study shows that engagement of patients with long-term illnesses is strategically important to improve care and quality of life.

Background: Given limitations in economic resources, achieving sustainability in healthcare is an increasingly important issue driving policy decisions. Colorectal cancer (CRC) is a frequent oncological diagnosis with an incidence that is expected to increase, making the efficient utilisation of resources a major priority for its diagnosis and treatment. To assess potentially inappropriate utilisation of services in the integrated care pathway of patients with malignant CRC, a series of key performance indicators (KPIs) have been developed by a multidisciplinary panel of the E.Pic.A. project (Economic Appropriateness of an Integrated Care Pathway).Methods: The KPIs identified had to comply with criteria of reliability, representativeness, accessibility and operativity. A definition is provided for each of the KPIs, along with the methodology used to calculate it and a reference target.Results: Eight KPIs were identified that can measure inadequacies of services provided in the diagnostic and treatment pathways for CRC: four for instrumental diagnostics, three for surgery and one for oncologic therapy.Conclusions: Use of the methodology described can help payors to obtain detailed information on inappropriate and wasteful use of healthcare resources, which would then permit their reallocation for interventions with higher value for patients with CRC and other pathologies. (HTA & Market Access, Oncology)