Economic impact of Enterosgel® in the hospital treatment of diarrhoeal syndromes associated with different disease conditions

Background: Enterosorbents are orally administered materials which pass through the gut where they bind various substances. In a randomized clinical trial, the efficacy and safety of enterosorbent Enterosgel® in the treatment of non-infectious diseases with diarrhoea have been proved. Objective: To assess the cost impact of Enterosgel® in the treatment of hospitalized patients with non-infectious diseases with diarrhoea adopting a cost/minimization approach. Methods: A cost analysis was conducted considering the hospital’s perspective. The analysis compared the treatment costs (drugs and hospital stays) of Enterosgel® in addition to the standard of care (SoC) to SoC alone. The main analysis focused on the comparison between the two therapeutic strategies regarding the economic valorization of hospital stays, while the secondary analysis estimated the hospital organizational efficiency with regard to the annual bed turnover. Results: Reducing the duration of inpatient admission, compared to SoC alone, Enterosgel® in addition to SoC let the hospital obtain a greater valorization of the hospital stays (range: € 68.54-€ 558.60). The shorter duration of inpatient admission results in an increased number of hospital admissions per year. For example, assuming a 10-bed ward, the total hospital annual gain would be € 82,616. Conclusions: Enterosgel® in addition to SoC is cost saving, allowing the hospital to achieve greater efficiency in managing patients with non-infectious diseases with diarrhoea.

Surveillance of hospital-acquired infections and monitoring of empiric antibiotic therapy in an internal medicine department

Introduction: Hospital-acquired infections (HAIs) are the most serious and frequent complication of healthcare systems. In 2019 the Marche Region has introduced a project to check HAIs and also the use of antibiotics in empirical therapy. The aim of this analysis was to conduct a periodic descriptive prevalence study according to the regional plan. Materials and Methods: In the quarter January-March 2020, the Internal Medicine Department of the Mazzoni Hospital of Ascoli Piceno has been considered, enrolling patients with HAIs to whom has been prescribed at least one antibiotic in empirical therapy. To assess the prevalence of multi-drug resistant organisms (MDRO), microbiological isolates were examined and laboratory response times were measured as a quality indicator. Besides, the incidence of HAIs from medical device, the clinical outcomes and the average length of stay have been analyzed. Results: The results show: high incidence of HAIs and high percentage of MDRO. The response time of the laboratory analysis is on average over 48-72 hours after sampling. The data show a widespread use of broad-spectrum antibiotics and low adherence to the new regional empiric therapy guidelines. Conclusions: The high incidence of HAIs implies the urgent need of an active surveillance of an Antimicrobial Stewardship team. This would represent a strategic solution to prevent and limit antimicrobial resistance and reduce morbidity, mortality and costs.

A novel Venturi system to generate high flow with titratable FiO2

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.

Brentuximab vedotin in adult patients with HL CD30+ at high risk of relapse or progression following ASCT: a cost-analysis in Italy

Introduction: In Hodgkin Lymphoma (HL), the early administration of brentuximab vedotin (BV) represents a highly effective treatment to consolidate patients after autologous stem cell transplantation (ASCT). For this indication, the Summary of Product Characteristics (SPC) reports a lower medical resource utilization in BV vs. placebo. This study aimed at assessing costs accrued by using BV in consolidation after ASCT and compare them with the resource consumption associated with the main options today used in Italy for HL. Methods and results: A cost-analysis based on patients at high risk of relapse (HL CD30+-HR) after ASCT was developed by collecting data about health care consumption (drugs and monitoring). The model is described by two arms, "A," where BV is used as consolidation therapy after ASCT, and "B", where patients are treated only at the time of relapse. A 3-year time horizon and the Italian National Health System perspective were adopted. All data inputs for the analysis were sourced from the available literature and official list prices. The simulation was integrated by sensitivity analysis. The introduction of BV as consolidation therapy would allow savings in terms of drug acquisition and resource consumption. Over a 3-year time frame, the Consolidation arm’s overall expenditure was 137,059€ vs. 225,418€ in the Non-consolidation arm. Early after the ASCT, BV administration guarantees a long period free from relapses (5-year PFS is not reached), thus reducing the clinical and economic burden of the subsequent therapies needed to treat further relapses. Conclusions: The present pharmacoeconomic analysis shows that the introduction of BV as consolidation therapy after ASCT represents a sustainable expenditure for the National Healthcare System (NHS) and a cost-saving paradigm when compared with the drug mainly used for treating the relapses.

Disseminating science: an illustration of present and future scenarios

The last years witnessed an unprecedented use of open access in scientific publishing to disseminate science beyond the border of the academic and research community. In this article, the classic paywall and the more recent open access scenario of publishing are summarized in four key images that may be helpful in illustrating opportunities and challenges for the researchers and academics. Combining their forces with institutions, journalists and life science executive to promote proper science and tackle pseudoscience should be a key priority for the next decade and beyond.

Gene therapy and hospital pharmacy: the experience of the Hospital Pharmacy unit of L. Vanvitelli university hospital

Background: Since hospital use of gene therapy requires close cooperation between doctors and pharmacists to ensure correct drug handling and administration, it is essential to define standard operating procedures (SOPs) for each phase of the process to ensure therapeutic success in compliance with the safety of patient and healthcare professionals. Among the available gene therapy medicines, voretigene neparvovec is used to treat hereditary dystrophy of the retina caused by biallelic mutations in the RPE65 gene. The aim of this article is to describe the experience of the Hospital Pharmacy unit of L. Vanvitelli university hospital in the management of treatment with voretigene neparvovec in the first two pediatric patients treated in Italy. Methods: SOPs were developed for all phases of gene therapy management process (procurement, receipt, storage, handling, transport of the finished product and waste disposal). Particular attention was paid to the training of personnel involved, to ensure maximum compliance with the procedures at all stages of the process. Results: SOPs were developed according to the European Association of Hospital Pharmacist (EAHP) policies and in full agreement with the operating procedures established by the manufacturer, ensuring correct storage and handling of the drug, as well as safe administration to patients. Conclusions: This example confirms the importance of close collaboration in a multidisciplinary team between hospital pharmacists, ophthalmologists experienced in the treatment of patients with hereditary retinal dystrophies and surgeons experienced in subretinal surgery to ensure the correct management of gene therapy with voretigene neparvovec, through compliance with shared operating procedures.

Beyond the barriers of the use of continuous subcutaneous insulin therapy in type 1 diabetes: a new opportunity from catheter-less insulin pumps

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.

Simultaneous multidisciplinary care pathway for back pain: a new approach for a first-level comprehensive evaluation and treatment to guarantee adequate pain relief and recovery

Low back pain continues to be a major clinical challenge with high direct and indirect societal costs. It is a complex disease with complex pathophysiology both for acute and chronic low back pain. Although there is consistent evidence about multidisciplinary treatment of low back pain, several different approaches and techniques are proposed, with different results often conflicting among them. In fact, even though the multidisciplinary approach is widely accepted, it is generally applied in different steps involving only one health care providing for each approach. This approach not only does not guarantee a real multidisciplinary vision of this disease but also lacks evaluation of the dynamic changes of the disease according to real patients’ needs. In our hospital setting we have developed a “simultaneous multidisciplinary care” of low back pain patients in order to overcome these problems and to satisfy all patients’ needs by evaluating and treating all problems causing and related to low back pain. Starting from the existing literature we propose our approach as a new pathway to treat low back patients with a simultaneous multidisciplinary approach.

Pharma industry social communication in Italy: quantitative and qualitative analysis of data from a Social Observatory

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.