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  Subjects -> HEALTH AND SAFETY (Total: 1278 journals)
    - CIVIL DEFENSE (18 journals)
    - DRUG ABUSE AND ALCOHOLISM (87 journals)
    - HEALTH AND SAFETY (509 journals)
    - HEALTH FACILITIES AND ADMINISTRATION (379 journals)
    - OCCUPATIONAL HEALTH AND SAFETY (106 journals)
    - PHYSICAL FITNESS AND HYGIENE (99 journals)
    - WOMEN'S HEALTH (80 journals)

HEALTH AND SAFETY (509 journals)                  1 2 3 | Last

Showing 1 - 200 of 203 Journals sorted alphabetically
16 de Abril     Open Access  
A Life in the Day     Hybrid Journal   (Followers: 9)
Acta Informatica Medica     Open Access   (Followers: 1)
Acta Scientiarum. Health Sciences     Open Access  
Adultspan Journal     Hybrid Journal   (Followers: 1)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10)
Advances in Public Health     Open Access   (Followers: 19)
African Health Sciences     Open Access   (Followers: 2)
African Journal for Physical, Health Education, Recreation and Dance     Full-text available via subscription   (Followers: 6)
African Journal of Health Professions Education     Open Access   (Followers: 4)
Afrimedic Journal     Open Access   (Followers: 2)
Air Quality, Atmosphere & Health     Hybrid Journal   (Followers: 2)
AJOB Primary Research     Partially Free   (Followers: 2)
American Journal of Family Therapy     Hybrid Journal   (Followers: 10)
American Journal of Health Economics     Full-text available via subscription   (Followers: 13)
American Journal of Health Education     Hybrid Journal   (Followers: 25)
American Journal of Health Promotion     Hybrid Journal   (Followers: 24)
American Journal of Health Studies     Full-text available via subscription   (Followers: 8)
American Journal of Preventive Medicine     Hybrid Journal   (Followers: 21)
American Journal of Public Health     Full-text available via subscription   (Followers: 175)
American Journal of Public Health Research     Open Access   (Followers: 27)
American Medical Writers Association Journal     Full-text available via subscription   (Followers: 2)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 2)
Annali dell'Istituto Superiore di Sanità     Open Access  
Annals of Global Health     Open Access   (Followers: 8)
Annals of Health Law     Open Access   (Followers: 3)
Annals of Tropical Medicine and Public Health     Open Access   (Followers: 15)
Applied Biosafety     Hybrid Journal  
Applied Research In Health And Social Sciences : Interface And Interaction     Open Access  
Archives of Medicine and Health Sciences     Open Access   (Followers: 2)
Asia Pacific Journal of Counselling and Psychotherapy     Hybrid Journal   (Followers: 8)
Asia Pacific Journal of Health Management     Full-text available via subscription   (Followers: 1)
Asia-Pacific Journal of Public Health     Hybrid Journal   (Followers: 8)
Asian Journal of Gambling Issues and Public Health     Open Access   (Followers: 3)
Association of Schools of Allied Health Professions     Full-text available via subscription   (Followers: 5)
Atención Primaria     Open Access   (Followers: 1)
Australasian Journal of Paramedicine     Open Access   (Followers: 2)
Australian Advanced Aesthetics     Full-text available via subscription   (Followers: 4)
Australian Family Physician     Full-text available via subscription   (Followers: 1)
Australian Indigenous HealthBulletin     Free   (Followers: 6)
Autism & Developmental Language Impairments     Open Access   (Followers: 1)
Behavioral Healthcare     Full-text available via subscription   (Followers: 4)
Best Practices in Mental Health     Full-text available via subscription   (Followers: 6)
Bijzijn     Hybrid Journal   (Followers: 2)
Bijzijn XL     Hybrid Journal   (Followers: 1)
Biomedical Safety & Standards     Full-text available via subscription   (Followers: 9)
BLDE University Journal of Health Sciences     Open Access  
BMC Oral Health     Open Access   (Followers: 5)
BMC Pregnancy and Childbirth     Open Access   (Followers: 19)
BMJ Simulation & Technology Enhanced Learning     Full-text available via subscription   (Followers: 7)
Brazilian Journal of Medicine and Human Health     Open Access  
Buletin Penelitian Kesehatan     Open Access   (Followers: 2)
Buletin Penelitian Sistem Kesehatan     Open Access  
Bulletin of the World Health Organization     Open Access   (Followers: 15)
Cadernos de Educação, Saúde e Fisioterapia     Open Access   (Followers: 1)
Cadernos Saúde Coletiva     Open Access   (Followers: 1)
Canadian Family Physician     Partially Free   (Followers: 11)
Canadian Journal of Community Mental Health     Full-text available via subscription   (Followers: 10)
Canadian Journal of Human Sexuality     Hybrid Journal   (Followers: 1)
Canadian Journal of Public Health     Full-text available via subscription   (Followers: 18)
Case Reports in Women's Health     Open Access   (Followers: 2)
Case Studies in Fire Safety     Open Access   (Followers: 11)
Central Asian Journal of Global Health     Open Access   (Followers: 2)
Central European Journal of Public Health     Full-text available via subscription   (Followers: 4)
CES Medicina     Open Access  
Child Abuse Research in South Africa     Full-text available via subscription   (Followers: 1)
Child's Nervous System     Hybrid Journal  
Childhood Obesity and Nutrition     Open Access   (Followers: 10)
Children     Open Access   (Followers: 2)
CHRISMED Journal of Health and Research     Open Access  
Christian Journal for Global Health     Open Access  
Ciência & Saúde Coletiva     Open Access   (Followers: 2)
Ciencia y Cuidado     Open Access  
Ciencia, Tecnología y Salud     Open Access  
ClinicoEconomics and Outcomes Research     Open Access   (Followers: 1)
CME     Hybrid Journal   (Followers: 1)
CoDAS     Open Access  
Community Health     Open Access   (Followers: 1)
Conflict and Health     Open Access   (Followers: 8)
Curare     Open Access  
Current Opinion in Behavioral Sciences     Hybrid Journal   (Followers: 1)
Day Surgery Australia     Full-text available via subscription   (Followers: 2)
Digital Health     Open Access  
Dramatherapy     Hybrid Journal   (Followers: 2)
Drogues, santé et société     Full-text available via subscription  
Duazary     Open Access   (Followers: 1)
Early Childhood Research Quarterly     Hybrid Journal   (Followers: 13)
East African Journal of Public Health     Full-text available via subscription   (Followers: 2)
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity     Hybrid Journal   (Followers: 16)
EcoHealth     Hybrid Journal   (Followers: 3)
Education for Health     Open Access   (Followers: 4)
electronic Journal of Health Informatics     Open Access   (Followers: 4)
ElectronicHealthcare     Full-text available via subscription   (Followers: 3)
Elsevier Ergonomics Book Series     Full-text available via subscription   (Followers: 4)
Emergency Services SA     Full-text available via subscription   (Followers: 2)
Ensaios e Ciência: Ciências Biológicas, Agrárias e da Saúde     Open Access  
Environmental Disease     Open Access  
Environmental Sciences Europe     Open Access   (Followers: 2)
Epidemics     Open Access   (Followers: 3)
Epidemiology, Biostatistics and Public Health     Open Access   (Followers: 18)
Ethics, Medicine and Public Health     Full-text available via subscription  
Ethiopian Journal of Health Development     Open Access   (Followers: 8)
Ethiopian Journal of Health Sciences     Open Access   (Followers: 7)
Ethnicity & Health     Hybrid Journal   (Followers: 14)
European Journal of Investigation in Health, Psychology and Education     Open Access   (Followers: 1)
European Medical, Health and Pharmaceutical Journal     Open Access  
Evaluation & the Health Professions     Hybrid Journal   (Followers: 8)
Evidence-based Medicine & Public Health     Open Access   (Followers: 4)
Evidência - Ciência e Biotecnologia - Interdisciplinar     Open Access  
Face à face     Open Access   (Followers: 1)
Families, Systems, & Health     Full-text available via subscription   (Followers: 8)
Family & Community Health     Partially Free   (Followers: 12)
Family Medicine and Community Health     Open Access   (Followers: 3)
Family Relations     Partially Free   (Followers: 11)
Fatigue : Biomedicine, Health & Behavior     Hybrid Journal   (Followers: 1)
Food and Public Health     Open Access   (Followers: 10)
Frontiers in Public Health     Open Access   (Followers: 8)
Gaceta Sanitaria     Open Access   (Followers: 3)
Galen Medical Journal     Open Access  
Geospatial Health     Open Access  
Gesundheitsökonomie & Qualitätsmanagement     Hybrid Journal   (Followers: 11)
Giornale Italiano di Health Technology Assessment     Full-text available via subscription  
Global Health : Science and Practice     Open Access   (Followers: 4)
Global Health Promotion     Hybrid Journal   (Followers: 15)
Global Journal of Health Science     Open Access   (Followers: 5)
Global Journal of Public Health     Open Access   (Followers: 9)
Globalization and Health     Open Access   (Followers: 5)
Hacia la Promoción de la Salud     Open Access  
Hastings Center Report     Hybrid Journal   (Followers: 7)
HEADline     Hybrid Journal  
Health & Place     Hybrid Journal   (Followers: 14)
Health & Justice     Open Access   (Followers: 5)
Health : An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine     Hybrid Journal   (Followers: 7)
Health and Human Rights     Free   (Followers: 8)
Health and Social Care Chaplaincy     Hybrid Journal   (Followers: 9)
Health and Social Work     Hybrid Journal   (Followers: 46)
Health Behavior and Policy Review     Full-text available via subscription   (Followers: 1)
Health Care Analysis     Hybrid Journal   (Followers: 11)
Health Inform     Full-text available via subscription  
Health Information Management Journal     Hybrid Journal   (Followers: 10)
Health Issues     Full-text available via subscription   (Followers: 1)
Health Policy     Hybrid Journal   (Followers: 32)
Health Policy and Technology     Hybrid Journal  
Health Professional Student Journal     Open Access   (Followers: 1)
Health Promotion International     Hybrid Journal   (Followers: 20)
Health Promotion Journal of Australia : Official Journal of Australian Association of Health Promotion Professionals     Full-text available via subscription   (Followers: 10)
Health Promotion Practice     Hybrid Journal   (Followers: 15)
Health Prospect     Open Access   (Followers: 1)
Health Psychology     Full-text available via subscription   (Followers: 47)
Health Psychology Research     Open Access   (Followers: 18)
Health Psychology Review     Hybrid Journal   (Followers: 39)
Health Renaissance     Open Access  
Health Research Policy and Systems     Open Access   (Followers: 9)
Health SA Gesondheid     Open Access   (Followers: 2)
Health Science Reports     Open Access  
Health Sciences and Disease     Open Access   (Followers: 1)
Health Services Insights     Open Access   (Followers: 1)
Health Systems     Hybrid Journal   (Followers: 2)
Health Voices     Full-text available via subscription  
Health, Culture and Society     Open Access   (Followers: 10)
Health, Risk & Society     Hybrid Journal   (Followers: 9)
Healthcare     Open Access   (Followers: 1)
Healthcare in Low-resource Settings     Open Access   (Followers: 1)
Healthcare Quarterly     Full-text available via subscription   (Followers: 8)
HERD : Health Environments Research & Design Journal     Full-text available via subscription  
Highland Medical Research Journal     Full-text available via subscription  
Hispanic Health Care International     Full-text available via subscription  
HIV & AIDS Review     Full-text available via subscription   (Followers: 9)
Home Health Care Services Quarterly     Hybrid Journal   (Followers: 5)
Hong Kong Journal of Social Work, The     Hybrid Journal   (Followers: 2)
Hospitals & Health Networks     Free   (Followers: 2)
IEEE Journal of Translational Engineering in Health and Medicine     Open Access   (Followers: 3)
IMTU Medical Journal     Full-text available via subscription  
Indian Journal of Health Sciences     Open Access   (Followers: 1)
Inmanencia. Revista del Hospital Interzonal General de Agudos (HIGA) Eva Perón     Open Access  
Innovative Journal of Medical and Health Sciences     Open Access  
Institute for Security Studies Papers     Full-text available via subscription   (Followers: 6)
interactive Journal of Medical Research     Open Access  
International Health     Hybrid Journal   (Followers: 4)
International Journal for Equity in Health     Open Access   (Followers: 7)
International Journal for Quality in Health Care     Hybrid Journal   (Followers: 31)
International Journal of Applied Behavioral Sciences     Open Access   (Followers: 2)
International Journal of Behavioural and Healthcare Research     Hybrid Journal   (Followers: 7)
International Journal of Circumpolar Health     Open Access   (Followers: 1)
International Journal of Community Medicine and Public Health     Open Access   (Followers: 5)
International Journal of E-Health and Medical Communications     Full-text available via subscription   (Followers: 2)
International Journal of Environmental Research and Public Health     Open Access   (Followers: 19)
International Journal of Evidence-Based Healthcare     Hybrid Journal   (Followers: 8)
International Journal of Food Safety, Nutrition and Public Health     Hybrid Journal   (Followers: 13)
International Journal of Health & Allied Sciences     Open Access   (Followers: 1)
International Journal of Health Care Quality Assurance     Hybrid Journal   (Followers: 7)
International Journal of Health Geographics     Open Access   (Followers: 6)
International Journal of Health Policy and Management     Open Access   (Followers: 2)
International Journal of Health Professions     Open Access   (Followers: 2)
International Journal of Health Promotion and Education     Hybrid Journal   (Followers: 12)
International Journal of Health Sciences Education     Open Access   (Followers: 2)
International Journal of Health Services     Full-text available via subscription   (Followers: 9)
International Journal of Health Studies     Open Access   (Followers: 3)
International Journal of Health System and Disaster Management     Open Access   (Followers: 2)
International Journal of Healthcare Delivery Reform Initiatives     Full-text available via subscription   (Followers: 1)

        1 2 3 | Last

Journal Cover Giornale Italiano di Health Technology Assessment
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   ISSN (Print) 2035-3510 - ISSN (Online) 2035-6129
   Published by Adis Homepage  [20 journals]
  • Dimensionamento di strutture sanitarie su scala provinciale: esempi di
           simulazione
    • Abstract: Background National Health Service has always played a key role in the economic growth of a Country. For this reason it undergoes a continuous change trying to find a balance between available resources and appropriateness of care. Objective The aim of this work was to develop a quantitative model which simulates the intra-regional health mobility in order to obtain an overall improvement in the quality of the service offered. Methods For this study we used two quantitative tools derived from spatial geography and operational research, which represent patient flow within a geographical area by studying the interactions between demand and supply of health services. Results The model allowed us to conduct several simulations in order to test the response of the local health system in the following cases: analysis of workload interactions between supply and demand with a fixed allocation of resources and assuming an increase in demand of 20–30%; planning availability of beds, in order to find a minimum solution for ICU and CCU; find the optimal number of hospital beds, to improve accessibility to Obstetrics and Gynaecology department with a stable supply of care. Conclusions Though evaluation of intra-regional health mobility is quite complicated, use of quantitative methods, like gravity models and location-allocation models, gives to policy makers a set of useful information to define regional health policy.
      PubDate: 2013-11-09
       
  • Valutazione economica del sistema di aferesi per la rimozione di
           granulociti e macrofagi (Adacolumn®) rispetto a biologico nel trattamento
           della colite ulcerosa moderata-severa in pazienti steroido-dipendenti o
           resistenti in Italia
    • Abstract: Background The treatment of chronic inflammatory bowel disease (IBD) is always a challenge for gastroenterologists dealing with this type of condition. The development of granulocyte-monocyte apheresis (GMA) appears to be an innovative approach, comprising both treatment safety and therapeutic potential. Objective To assess the cost-consequence of granulocyte monocyte adsorption—apheresis (GMA-Apheresis; Adacolumn®) versus infliximab in the treatment of moderate-to-severe ulcerative colitis (UC) in steroid-dependent or steroid-resistant patients. Methods One-year cost-consequence analysis from the Italian National Health Service (NHS) perspective using a decision tree model was carried out. Probabilities of each event were derived from literature and an expert panel. Direct medical costs were obtained from official sources (€2013). Results The average annual cost per patient who started the treatment with GMA-Apheresis was estimated to be €13,931.33; the cost was estimated to be €15,179.08, starting the treatment with infliximab. The sensitivity analysis confirmed the results of the base case. Conclusions We performed a cost-consequence analysis focused on the use of GMA-Apheresis (Adacolumn®) in the therapeutic management of moderate-to-severe UC in steroid-dependent or steroid-resistant patients. From the Italian NHS perspective, GMA-Apheresis is a cost-saving strategy compared with infliximab.
      PubDate: 2013-08-30
       
  • Aggiornamento dello studio peginterferone α-2a più ribavirina versus
           peginterferone α-2b più ribavirina: un confronto di efficacia clinica e
           di costo nel trattamento di pazienti naïve affetti da epatite cronica di
           tipo C
    • PubDate: 2013-08-03
       
  • Analisi di minimizzazione dei costi della tossina botulinica di tipo A
           (Dysport®) nel trattamento della spasticità post-ictus in Italia
    • Abstract: Background Stroke is the most frequent cause of acquired spastic paresis. Different studies have indicate that intramuscular injection of botulinum toxin A is an effective means of alleviating spasticity in stroke patients. Objective We estimated the cost (cost minimization analysis, CMA) of two treatment strategies for spasticity following a stroke: physiotherapy only and botulinum toxin A plus physiotherapy. Methods The sequence of medical interventions and health states in chronic spasticity following stroke was developed based on a Delphi Panel survey. The economic parameters were derived from direct medical costs incurred by the Italian National Health Service (NHS). The clinical parameters (severity of spasticity) were derived from a previous cost-effectiveness analysis. Results The mean cost of treatment was €7,376.57 for patient treated with botulinum toxin A plus physiotherapy and €9,452.25 for patient treated with physiotherapy only. The sensitivity analysis confirmed the results of the base case. Conclusions Based on data from a Delphi Panel survey, we performed a cost minimization analysis focused on the use of physiotherapy only or botulinum toxin A plus physiotherapy for spasticity following a stroke. From the Italian NHS perspective, botulinum toxin A plus physiotherapy is a cost-saving strategy compared with physiotherapy only in the treatment of patients with spasticity following stroke.
      PubDate: 2013-07-04
       
  • Il farmacista clinico nelle residenze socio-assistenziali per anziani:
           studio di budget impact
    • Abstract: Background Nursing Home (NH) residents are elderly subjects characterized by physical or mental disorders that often lead to permanent disability. The number of elderly individuals is constantly increasing in the Western world, with significant implications in terms of health assistance needs and expenditure. Objective To estimate the health expenditure allocated to NH and to identify how to reduce costs meanwhile improving services. Methods An observational study was conducted between January and December 2011 in 25 NHs, and involved 2010 elderly residents, assisted by the Local Health Authority No. 9, Treviso, Italy. For each patient, cost of hospitalizations, specialist visits, drug prescriptions and medical devices were collected and analysed. Results Costs for the assistance of elderly NH residents were different if the NHs were counselled by a pharmacist or not. The pharmacist intervention can yield important savings for the NHs participating in the project. Conclusion The collaboration between pharmacist and medical doctors/nurses improves the therapeutic appropriateness of treatments for elderly NH residents, with a positive budget impact.
      PubDate: 2013-06-08
       
  • Italian Horizon Scanning Project
    • Abstract: Background The often modest therapeutic value, the uncertain level of innovation, and the high costs of new drugs suggest a pressing need for early evaluation of emerging pharmaceuticals. The Italian Horizon Scanning Project (IHSP) critically reports on emerging drugs in order to timely assess their potential impact on the National Health System. Methods IHSP identifies, filters and prioritizes emerging drugs for which a European Marketing Authorization (MA) is expected within 12–36 months. The final New Product Information Report, issued 12 months before the MA, critically reports on efficacy and safety of selected drugs, on their possible level of innovation, place in therapy and social and economic impact. Results Since 2008, 39 new drugs were prioritized (corresponding to 44 indications) due to (i) their potential high epidemiological and economic impact; (ii) the limited availability or the complete lack of treatments; (iii) the uncertainty of the possible place in therapy of the emerging drug; (iv) the possible better efficacy and/or safety profile or possible better compliance of the new medicine versus the available therapies. Among the 39 drugs, 14 active principles were indicated in cancer patients, eight for cardiovascular diseases, and four for multiple sclerosis. Conclusions Horizon Scanning is a useful tool to support policy-makers in allocating resources more efficiently.
      PubDate: 2013-06-08
       
  • Neurostimolazione spinale per il trattamento del dolore cronico: analisi
           dei costi di ospedalizzazione
    • Abstract: Background In 2010 the Italian Government approved a law guaranteeing the access to pain therapies to patients suffering from chronic pain. Data on clinical pathways and costs are now needed to inform the decision-making process on these therapies, and in particular on Spinal Cord Stimulation (SCS), a technologically advanced option for the treatment of chronic pain. Objective To provide Italian health-policy makers with country-specific data on SCS procedures in terms of hospital management and hospitalization costs. Methods The study involved two Italian Centers, in which the learning curve for SCS is considered completed. Through a micro-costing approach and interviews to the medical staffs, the clinical pathway (from admission to discharge) of SCS procedures and the related costs were investigated. Resource consumption captured in the analysis was: staff, operating room, disposables, medical devices, drugs, diagnostic tests and general expenses. Results Depending on the device implanted and on the clinical management, the total hospitalization costs may vary from €17,500 to €38,400. These costs appear to be higher than the basic compensation recognized to the Italian hospitals through the DRG system. Conclusions Following the Italian “Pain Law”, this study could be useful in the process of a wider adoption of pain therapies, and in particular SCS.
      PubDate: 2013-06-08
       
  • Analisi critica di un campione di farmaci oncologici valutati dalla
           Commissione Tecnica Regionale della Regione Veneto
    • Abstract: Abstract In recent years, anticancer drug treatment was the main driver of hospital pharmaceutical expenditure. This expenditure is likely to increase as a result on the one hand of the entry of new biotechnological drugs, more costly than traditional therapies, and, on the other hand, from the extension of indications of many drugs already on the market. The objective of this study is to analyze the main trials conducted on a sample of anticancer drugs evaluated by the Regional Committee of Veneto Region, highlighting their criticalities. In the last two years, 11 anticancer drugs have been evaluated for one or more therapeutic indications and 13 HTA reports have been produced. Overall, 33 major studies in support of the efficacy have been identified: nine uncontrolled studies, 20 randomized controlled trials (RCTs) and four retrospective analysis of RCTs. Excluding the uncontrolled studies, the overall survival was the primary efficacy endpoint in only 50 % of trials. Because of the availability of many new anticancer drugs, expenditure for their acquisition has increased in importance over the last years and it is necessary to assess correctly the innovation of new technologies and the benefits for patients.
      PubDate: 2013-06-07
       
  • Analisi del modello organizzativo di ristorazione: valutazione di impatto
           attraverso l’Health Technology Assessment (HTA) nell’Azienda
           Ospedaliero Universitaria (AOU) di Udine
    • Abstract: Background Inappropriate feeding is a risk factor in many pathological conditions and causes direct and indirect costs. A number of inpatients are malnourished, resulting in complications and hospital stay prolongation. Objectives To compare, with HTA methodology, food distribution systems, i.e. “trolley service” versus “plate”. Materials and methods A review of the literature, analysis of organizational efficiency, a customer satisfaction survey and comparisons between systems were carried out. Results The “plate service” system requires less resources and a spare of time in delivering food to the patients but there remain some organizational activities and caring to patients who need help feeding. The “trolley” system is more economic (cost of a meal €6,650 versus €6,910). In the ethical-social analysis it has been shown a higher working-time availability with the “plate” system, that could be used to assist patients with their meals. Caregiving support must also be considered as a social cost. In the safety analysis, missed nursing care increased the risk of negative outcomes. The “tray” method qualitatively is considered to be better (it meets patient needs, respects patient preferences, allows variations related to changes in clinical conditions). The “cart” system allows portioning standardization, balanced meals, measuring real food intake and limiting any additions or changes. Conclusions There is no clear evidence indicating which system is better.
      PubDate: 2013-06-07
       
  • Commissione Tecnica per il Repertorio Unico Regionale dei Dispositivi
    • PubDate: 2012-01-01
       
  • Una rivista per contribuire all‘affermazione dell’Health Technology
           Assessment in Italia
    • PubDate: 2012-01-01
       
  • Commissione Terapeutica per il Prontuario Regione Veneto
    • PubDate: 2012-01-01
       
  • Istituti di Health Technology Assessment e portatori di interesse
    • Abstract: Background The involvement of stakeholders (internal — third party payers, health care organisations and research centres, external — industry and patients, and clinicians) by HTA Organisations is hugely debated. On the one hand their participation may provide important information for the assessment process and could promote consensus over recommendations. On the other hand stakeholders’ involvement increases complexity in the decision-making process. The actual role of stakeholders and reasons for their different involvement in HTA organisations have not been deeply scrutinised so far. The aim of this paper is to investigate these two issues in six European countries, with a focus on those HTA organisations that assess medical devices (France, Germany, England, the Netherlands, Spain, and Sweden). Methods We carried out a literature review (1999–2009), using PubMed, Ebsco, JStore and Wiley Science. In addition, 16 semi-structured interviews were conducted with key personnel in the organisations concerned, consistently with the explorative nature of the study. Results We found huge differences across countries and these differences seem to be due to the administrative tradition, the way the health care system is organised and (even if more doubtful) the role of HTA organisations. External stakeholders are much more involved when the national administrative system is contract-based (e.g. England), whereas an organic conception (e.g. Spain) is more closed to stakeholders’ participation. Internal stakeholders (expecially third party payers) participate more, when the health care system is modeled as social insurance. The impact of administrative tradition and the health care system seem to be less important when recommendations based on HTA are binding and used for policy purposes (reimbursement and, possibly, prices), thus providing for an organisation-specific (and not only country-specific) source of difference. Conclusions It may be concluded that stakeholders’ involvement may be strongly influenced by the general context where the HTA organisations operate. As a consequence, a stakeholders’ involvement model cannot be easily transferred from one country to another. Despite of this, it can be stated that external stakeholders’ involvement was generally increasing, expecially when recommendations are binding: this could provide an opportunity for HTA organisations to achieve consensus in advance, thereby facilitating the implementation of any recommendations made.
      PubDate: 2012-01-01
       
  • Innovazione e innovatività: definizione e strumenti, applicazioni ed
           esperienze
    • Abstract: Abstract Reference to ‘innovation’ in the pharmaceutical context has been applied in different settings and by several authors in these last years. All of them had as main scope to improve the methodology (or reduce discreptionality) in decision making. They reported and discussed methods for selecting and prioritizing their development speeding up the R&D process (fast track, innovation path), valuing the drug in comparison to the current therapies (added value) and/or accelerate the access of patients in a reimbursed environment. The impact generated by the adoption of different methodologies makes the “methodological issue” appealing for HTA agencies, regulators and manufacturers (all of them in clear “conflict of interest” with respect to use of the definition) and seems at the basis of the recent proliferation of several different definitions and processes. Despite these dishomogeneity the core of the evaluations is still represented by the concept of ‘relative therapeutic added value’ and is driven by the choice of comparator or standard of care. A wider approach to ‘pharmaceutical innovation’ should be addressed, trying to match public and private expectations in priority setting for R&D programs, in selecting and weighting the relevant value dimension of new health technologies, managing the issue of how each potential innovation could impact on the sustainability framework and on the social expectation of the society.
      PubDate: 2012-01-01
       
  • Sequenziamento mediante pyrosequencing: un’analisi rapida e sensibile
           per la determinazione delle mutazioni di EGFR nel carcinoma polmonare non
           a piccole cellule
    • Abstract: Abstract Lung cancer is the most common tumor and one of the most aggressive, with rates of survival at 5 years of about 10% in most countries. Studies reported EGFR (Epidermal Growth Factor Receptor) gene activating mutations in 10–15% of NSCLC (Non Small Cell Lung Cancer) in the European population. Molecular assessment of EGFR mutations became mandatory for gefitinib administration in NSCLC patients. Only tumors harboring at least one activating mutation in either exon 18, 19 or 21 are eligible for therapy with this drug. Several methods are available in order to study EGFR mutations, such as direct sequencing and Real Time PCR. Pyrosequencing is a DNA sequencing technique based on the principle of sequencing-by-synthesis and it is characterized by a greater sensitivity compared to direct sequencing. We compared pyrosequencing with Real Time PCR, both combined with CE-IVD approved commercially available kits for EGFR analysis, in terms of effectiveness, economic and logistic impact. In conclusion, although Real Time PCR has a greater sensitivity, pyrosequencing is an effective and reliable method, with an advantage in detecting new mutations whose clinical impact is yet unknown. More studies are needed in order to define which sensitivity level is really correlated to clinical response.
      PubDate: 2012-01-01
       
  • Il costo del paziente affetto da sclerosi multipla: l’esperienza di un
           Centro specialistico del Nord Italia
    • Abstract: Abstract Background: Multiple Sclerosis (MS) is an autoimmune disease of the central nervous system with onset in adults (age: 30–40 years). Irreversible functional disability occurs early, making MS the second most common cause of neurological disability in young adults. The World Health Organization described MS as one of the most socially costly disease, with an economic impact greater than Alzheimer’s disease and stroke. The aim of this work was to analyze the costs of patients with MS in a hospital in Northern Italy (Fidenza Hospital, Parma). Methods: Data were collected in a retrospective, prevalence-based, observational study, conducted from a societal perspective. Patients (N = 100) were recruited via Fidenza Hospital and asked to fill a detailed questionnaire, asking for details on disease characteristics (type of disease, level of functional disability) and on all medical and non-medical resource consumption, and work capacity (sick-leaves and early retirement). Results: Respondents mean age was 51.49 years. Up to 20% of patients had severe disease (Expanded Disability Status Scale [EDSS] score ≥ 7), 51% moderate disease (EDSS score 4–6.5) and 29% mild disease (EDSS < 4). The mean EDSS score in the sample was 5. The annual mean cost estimated for each patient was €16,926.74, of which 42.34% related to productivity losses (indirect costs), 39.32% to non-health direct costs and 28.34% to health direct costs. Conclusions: Results, consistent with those of other studies, showed that MS is a relevant economic burden as related indirect costs are high.
      PubDate: 2011-12-01
       
  • Peginterferone α-2a pié ribavirina versus peginterferone α-2b pié
           ribavirina: un confronto di efficacia clinica e di costo nel trattamento
           di pazienti naïve affetti da epatite cronica di tipo C
    • Abstract: Background and aims The goal of this study was to estimate the incremental efficacy and incremental cost of peginterferon α-2a plus ribavirin versus peginterferon α-2b plus ribavirin in treatment-naïve patients with chronic hepatitis C. Methods We used a published Markov model of disease progression in which two cohorts of patients received peginterferon α-2a plus ribavirin or peginterferon α-2b plus ribavirin for 48 (genotype 1/4) or 24 (genotype 2/3) weeks and were followed for their expected lifetimes. In the absence of a sustained virological response (SVR), the model simulated the progression from the initial health state (chronic hepatitis C) to one of five health states (compensated cirrhosis, decompensated cirrhosis, hepatocellular carcinoma, liver transplantation, death) during the patient lifetime, according to specific transition probabilities derived from the literature. The sustained virological responses with peginterferon α-2a plus ribavirin and peginterferon α-2b plus ribavirin were obtained from a national clinical study in Italy. Utilities and costs for each health state were based on literature estimates and Italian treatment patterns. Costs in 2010 Euros and benefits (life years and QALYs) were discounted at 3%. Sensitivity analyses on key clinical and economic parameters were performed. The analysis was conducted from the perspective of the Italian National Health Service. Results Expected life-years with peginterferon α-2a plus ribavirin versus peginterferon α-2b plus ribavirin were 27.53 and 26.00 years (genotype 1/4) and 31.02 and 29.74 years (genotype 2/3) for the two cohorts respectively. Quality-adjusted life years for peginterferon α-2a plus ribavirin were 14.34 (genotype 1/4) and 16.13 (genotype 2/3), and 13.57 (genotype 1/4) and 15.53 (genotype 2/3) for peginterferon α-2b plus ribavirin. The expected mean cost was €25,606.78 (genotype 1/4) and €9,848.44 (genotype 2/3) with peginterferon α-2a plus ribavirin and €28,510.05 (genotype 1/4) and €12,775.09 (genotype 2/3) with peginterferon α-2b plus ribavirin. Conclusions This economic evaluation suggests that peginterferon α-2a plus ribavirin is a dominant strategy versus peginterferon α-2b plus ribavirin for treatment of naïve patients with chronic hepatitis C, under the assumptions made regarding treatment effectiveness and model structure.
      PubDate: 2011-12-01
       
  • Erratum to: Giornale Italiano di Health Technology Assessment
    • PubDate: 2011-12-01
       
  • Azienda Ospedaliera Treviglio-Caravaggio: un nuovo database per la
           registrazione dell’immunoterapia specifica sublinguale per pollini in
           ottemperanza alle nuove normative regionali per il file F in Lombardia
    • PubDate: 2011-12-01
       
  • Il ruolo degli stakeholder nel processo di HTA
    • Abstract: Abstract The aim of this paper is to identify the stakeholders involved in the Health Technology Assessment (HTA) process with particular attention to their role and potential contribution from patients and citizens. Moreover, a focus on elements to be shared among stakeholders will be provided. These topics were discussed at the Health Policy Forum, an initiative promoted by the Italian Society of Health Technology Assessment (SIHTA) in partnership with other scientific societies. Manufacturers, regulators, institutions and citizens could talk freely under the “Chatham House Rules” in plenary sessions and subgroups, suggesting proposals on the issues addressed. Healthcare managers, policy makers, health providers, researchers, manufacturers, patients and the public were identified as main stakeholders. The contribution they provide to HTA process is closely related to their position within the “pertinence-relevance-weight matrix”. All participants focused on the need of rigorous methods and measures of assessment. Finally, the potential contributions of citizens and patients are related to the time of involvement and their level of information. In conclusion, there is a growing awareness of the need of greater stakeholders’ involvement in defining methods, responsibilities, quality and timing of interactions in order to improve the impact of HTA in healthcare decision-making.
      PubDate: 2011-12-01
       
 
 
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