In the article “Exploring the administrative burden faced by hematologists: a comprehensive study in Italy” (1), which appeared in Volume 11, Issue 1 of Global and Regional Health Technology Assessment, the affiliation 1 for authors Davide Petruzzelli and Silvia Della Torre was incorrect. The correct affiliation is: 1 “La Lampada di Aladino ETS”, Milan - Italy We apologize for any inconvenience caused to the readers by this error, which does not affect the overall results or conclusions of the study.

The use of fibrobronchoscopy increased significantly for collecting airway microbiological samples and during percutaneous tracheostomies and difficult intubations. Reusable bronchoscopes pose risks of contamination and damage due to their fragile structure and difficulties of cleaning and sterilization; single-use bronchoscopes have been introduced, offering reliability in terms of vision, maneuverability, suctioning capacity, and sterility, reducing the risk of hospital-acquired infections and improving logistical management. The study analyzed healthcare workers' and management's perceptions of single-use bronchoscopes versus reusable ones. Among the main objectives were to evaluate the organizational impact, quality, and performance of bronchoscopes, while also analyzing opinions on device features, safety in infection prevention, and ease of use during training. In this analysis 66% of clinicians rated optimal image quality, and 90% of respondents highly appreciated the "plug & play" feature of disposable endoscopes; also, 45% of clinicians noted no significant differences in aspiration performance. Healthcare professionals felt more exposed to infectious agents with reusable endoscopes, believing disposable endoscopes required less vigilance and monitoring. In training, 80% of doctors and 100% of nurses considered disposable endoscopes more suitable due to their greater ease of use. Finally, the Overall Satisfaction of all healthcare workers was 75%. The analysis of results demonstrated that the use of single-use bronchoscopes in anesthesia and resuscitation is highly comparable in terms of clinical effectiveness to reusable ones and that significant advantages in costs and organizational impact were highlighted, positively impacting the daily workflow of healthcare workers.

Objective: This study aims to provide an up-to-date analysis, for new chemical entities on the market, on the timingof pricing and reimbursement (P&R) in Italy, covering the entire period of activity (from September 2018 toJanuary 2024) of the last evaluation Commission (Technical Scientific Committee, CTS, and Price and Reimbursement Committee, CPR).Methods: The data used in this analysis were obtained from public official websites. The information was systematically collected to investigate the days required to complete the P&R process. The analysis was stratified into indications for rare diseases, orphan designation, innovation assessment, and anatomical therapeutic chemical(ATC) class L. Mann-Whitney U test was used to study the significance of the difference. A p-value < 0.05 wasconsidered significant.Results: Overall, 180 procedures were included in the final analysis. The median duration of the entire process,from MAH submission to final Gazette publication, was of 439.5 days. The timelines varied among the analyzeddrug classes. Rare disease drugs (n = 78) had a longer timeline than non-rare-disease drugs (n = 102) (462.0 daysvs 419.5 days, respectively). Among rare disease procedures, orphan designation was a predictor for time prolongation (orphan drugs, n = 66, 462.0 days vs 443.0 days non-orphan drugs, n = 12). Innovativeness status wasassociated with a shorter timeframe (-14 days), as was the ATC L classification (-68 days).Conclusion: The results indicate a methodological consistency with previous studies, suggesting a continuity ofanalysis, despite the increase in the complexity of evaluations and the number of drugs treated.

In the Italian healthcare landscape, the management of chronic pathologies is a priority. Often, the elderly patient suffers from several pathologies at once and is commonly on polytherapy: this can easily bring potentially harmful errors in drug therapy. The D.I.Ri.M.O. project took place in an Internal Medicine department and aimed to reduce medication errors and improve the state of health through the Pharmacological Reconciliation procedure. From June to October 2022, the team archived therapies for 70 hospitalized patients aged over 65 years and suffering from two or more chronic diseases. For each patient enrolled, the team developed a reconciliation board; afterward, the physician and the pharmacist proceeded to remodulate therapies, especially in those patients with serious interactions. The team collected 287 drug interactions and then classified them according to the Intercheck Web software classification: 36 class D (very serious), 49 class C (major), 174 class B (moderate), and 28 class A (minor). The modified therapies at discharge were 77.14%. This restriction brought about the removal of unnecessary drugs. After six months, the team observed an improvement in the health conditions of the patients enrolled. By increasing the patient's awareness and reducing the number of potentially inappropriate prescriptions, it is possible to improve the effectiveness of therapies. It is also possible to look at a saving policy to make the economic resources better allocated.

Heart valve diseases constitute a significant public health challenge with substantial clinical and economic implications. The ageing population, coupled with advancements in surgical techniques, has led to increased hospitalizations for cardiac valve interventions over the past decade. Despite progress, the economic burden of heart valve diseases remains underexplored, particularly in the context of the Italian healthcare system. This study aims to comprehensively assess the economic burden of heart valve diseases in Italy through a real-world analysis. Using data from the national Italian Hospital Discharge Records (SDO), we identified the number of adult patients undergoing interventions on the aortic, mitral, and tricuspid valves, along with the associated costs borne by the National Health System. Additionally, we estimated indirect costs by analyzing social security benefit applications related to valve diseases from 2016 to 2019. A notable rise in hospitalizations for cardiac valve interventions, particularly for the aortic (+53.3%) and mitral valves (+29.5%) was revealed through the study period. In-hospital mortality rates declined, reflecting advancements in perioperative care. The economic burden of heart valve diseases in Italy was substantial, with hospitalization costs reaching €808 million in 2018. Social security benefit applications also increased, adding an annual cost of €29 million. Heart valve diseases represent a growing clinical and socio-economic challenge in Italy. This study underscores the imperative for a multidisciplinary approach to effectively manage these conditions. Emphasizing prevention, early diagnosis, and timely interventions is crucial to mitigate the economic impact and enhance the quality of life for patients.

Objective: The aim of this study was to evaluate the economic consequences of the introduction of roxadustat on the market as treatment for chronic kidney disease (CKD)-related anaemia in Italy. Method: A budget impact model was developed to assess the economic impact of the introduction of roxadustat for the management of patient with CKD-related anaemia. The analysis was conducted considering National Health Service (NHS) perspective and three years’ time horizon. Eligible population for the treatment with roxadustat was estimated through published literature and clinicians’ support. Direct healthcare costs included drug acquisition (list prices for base case) and administration costs, monitoring costs, cost per blood transfusion, costs related to the management of adverse events and dialysis costs. Results: The model estimated a three years expenditure associated with the management of patients with CKD-related incident anaemia in Italy of about € 260 and € 44.6 million for non-dialysis dependent (NDD) and dialysis-dependent (DD) patients respectively. The introduction of roxadustat on the market could generate a reduction in the expenditure related to the iron supplementation both for NDD and for DD patients (−€ 397,305 and −€ 50,135 over three years of the analysis, respectively) and a reduction in the pharmaceutical expenditure for NDD patients (−€ 2.3 million, −€ 7.5 million and −€ 13 million at first, second and third year of the analysis). Overall, the introduction of roxadustat could generate a saving for NHS approximately equal to € 2.3, € 7.5 and € 13 million at first, second and third year of the analysis. Conclusion: The introduction of roxadustat could generate a reduction in the expenditure for the management of patients with CKD anaemia. A scenario analysis which used tender prices for ESAs and hypothesis of confidential discount for roxadustat showed that the saving for NHS will be kept if roxadustat’s discount is greater than 60.3%.

Dalbavancin is a semisynthetic lipoglycopeptide long-acting antibiotic approved for the treatment of acute bacterial skin and skin structure infections (ABSSSIs). Its features can be useful in the current healthcare scenario characterized by the shortage of available hospital beds. We implemented several actions in order to optimize the use of dalbavancin allowing an improvement strategy both from the healthcare system and the patient's perspective in two hospital settings. In the Emergency Department we hospitalized only patients who met the clinical criteria and not the logistic criteria (i.e., the need for antibiotic therapy infusion). During the years 2017-2023, this strategy was applied in 40 cases, thus avoiding 40 hospitalizations for a total saving of 280 days of hospitalization.In the Internal Medicine ward and surgery department when there was no longer any need for hospitalization, we discharged the patient as early as possible. During the years 2017-2023, this strategy was applied in 189 cases, saving at least 1,134 days of hospitalization. The outcome of the treated patients was favorable in 228 out of 229 patients (99.5%). Our experience using dalbavancin in ABSSSI has been very satisfactory overall. The efficacy was close to 100%. Minor adverse events of slight severity occurred rarely. At the same time, this strategy allowed a more efficient allocation of hospital beds. Dalbavancin presents an ideal pharmacodynamic/pharmacokinetic profile for the management of ABSSSI especially in settings where shortage of hospital beds is critical.

The therapeutic approach to the patient with acute bacterial skin and skin structure infection (ABSSSI) and complicated infections often involves the early transition from intravenous to oral therapy (early switch) or early discharge. Our study aimed to evaluate sustainable and innovative care models that can be transferred to community healthcare and the economic impact of dalbavancin therapy vs Standard of Care (SoC) therapy for the treatment of ABSSSI and other Gram-positive infections including those by multidrug-resistant organisms. We also described the organization of an infectious disease network that allows optimizing the treatment of ABSSSI and other complex infections with dalbavancin. We retrospectively studied all patients treated with dalbavancin in the University Hospital "S. Anna" of Ferrara, Italy, between November 2016 and December 2022. The clinical information of each patient was collected from the hospital's SAP database and used to evaluate the impact of dalbavancin in early discharge with reduction of length of stay promoting dehospitalization and in improving adherence to antibiotic therapy. A total of 287 patients (165 males and 122 females) were included in the study of which 62 were treated with dalbavancin. In 13/62 patients dalbavancin was administered in a single dose at the completion of therapy to facilitate early discharge. Assuming a 12-day hospitalization required for the treatment of ABSSSI or to complete the treatment of osteomyelitis or spondilodiscitis, the treatment with dalbavancin results in a cost reduction of more than €3,200 per single patient compared to SoC (dancomycin, linezolid or vancomycin). Dalbavancin has proven to be a valid therapeutic aid in the organization of a territorial infectious disease network given its prolonged action, which allows the dehospitalization with management of even patients with complex infections in outpatient parenteral antimicrobial therapy.

In this article the pivotal role of hospital pharmacists in the multidisciplinary management of epilepsy is discussed. Hospital pharmacists are members of national and local ethics committees, oversee clinical trials, and ensure adherence to regulations for patient access to novel therapeutic treatments. They actively contribute to regulatory processes and the definition of prescribing centers. In the post-launch phase, hospital pharmacists are a key member in the multidisciplinary team, they are involved in decisions relating to the local introduction of drugs, in the management of the drug within the hospital structure and with the direct distribution, and to ensure proper and timely treatment. The pharmacovigilance network, including hospital and community pharmacists, monitors and prevents adverse effects related to epilepsy medications and enhances a collaborative approach with specialists to promote prescription appropriateness, targeting therapy for better patient outcomes. Finally, the potential benefits of deprescribing are briefly discussed, underscoring the importance of a multidisciplinary approach involving doctors and clinical pharmacists to gather comprehensive data and enhance patient care in epilepsy management.

Introduction: The therapeutic control of LDL-cholesterol is essential in cardiovascular prevention, as recommended by the recent guidelines. Objective: To evaluate gender differences in terms of demographic and clinical characteristics, treatment pattern, treatment adherence and healthcare costs in patients on lipid-lowering therapy, stratified by cardiovascular risk in the Italian real clinical practice. Methods: An observational analysis was conducted on the administrative databases of healthcare institutions, covering about 6.1 million health-assisted subjects. After inclusion of all patients on lipid-lowering therapy between January 2017 and June 2020, the population was investigated in the period before the first prescription of a lipid-lowering drug and followed-up for at least 12 months. Clinical and demographic variables were compared after stratification by gender and by cardiovascular risk (very high/high/other risk). The main outcome measures were treatment adherence and direct healthcare costs during follow-up. Results: Of the 684,829 patients with high/very high cardiovascular risk, 337,394 were men and 347,435 women, aged on average 69.3 years and 72.1 years, respectively (p < 0.001). Men were characterised by a worse comorbidity profile. Regardless of cardiovascular risk, female subjects were associated with larger utilisation of low-potency statins and lower adherence (p < 0.001). The annual healthcare costs per patient during follow-up were higher in men than in women (p < 0.001). Conclusions: The results highlighted larger utilisation of low-potency statins, a lower adherence and a milder comorbidity profile in women, the latter feasibly explaining the reduced healthcare costs compared to men.