Abstract The sustainability of health care systems, particularly those supporting universal health care, is a matter of current discussion among policymakers and scholars. In this article, we ...summarize the controversies around the economic sustainability of health care. We attempt to extend the debate by including a more comprehensive conceptualization of sustainability in relation to health care systems and by examining the dimensions of social and political sustainability. In conclusion, we argue that policymakers when taking decisions around universal health care should carefully consider issues of social, political, and economic sustainability, their interaction, and often their inherent trade-offs.
Although the scientific debate in the field of business economics is rich in contributions to the subject of sustainability, they mainly focus on a specific aspect represented by sustainability ...reporting. Consistent with this bibliographic evidence, the aim of this study was to investigate a sustainability management model in local authorities, which, by examining the dimensions of sustainability, goes beyond the focus of reporting highlighted in the literature to consider the entire sustainability cycle (from planning to measurement). To this end, the methodology of the single case study with multiple units of analysis is used, examining the case of an Italian local authority that has experimented with the sustainability management model described in this paper. The analysis of the case leads to some concluding remarks on the strengths and weaknesses of the model, contributing to the scientific debate on sustainability management and providing useful indications for public managers and political decision-makers.
: in the field of rare diseases (RDs) most of the European studies on budget impact analysis of drugs that have been conducted often lay on theoretical assumptions and focus only on Orphan drugs ...(ODs).
: we aimed to estimate the budget impact of specific drugs for non-oncological RDs, both ODs and non-ODs, using real-world data about patients residing in Veneto Region (Italy) and to describe its expenditure structure and dynamics.
: a population-based multi-source observational study was conducted using data from Regional administrative databases; an ad-hoc drugs' list specific for RDs including both ODs and non-ODs and classifying them by ATC codes has been created.
: In 2019, the total expenditure for drugs specific for RDs was EUR 97.2 million (6.6% of the total Regional budget). The RD drug list included 58 ATC codes, of which 15 ATC had an annual budget impact over EUR 1 million ("blockbuster drugs"). The most expensive treatment was a non-OD drug (Coagulation factor VIII). The two most represented therapeutical areas were the metabolic and the hematological ones.
: Cost analyses on RD high-cost drugs expenditure should consider any specific RD drug, not only ODs. Expenditure dynamics for RD drugs are peculiar showing "blockbuster drugs". Some therapeutical areas seem to be lacking in the drug research field.
BackgroundSierra Leone faces among the highest maternal mortality rates worldwide. Despite this burden, the role of life-saving critical care interventions in low-resource settings remains scarcely ...explored. A value-based approach may be used to question whether it is sustainable and useful to start and run an obstetric intermediate critical care facility in a resource-poor referral hospital. We also aimed to investigate whether patient outcomes in terms of quality of life justified the allocated resources. ObjectiveTo explore the value-based dimension performing a cost-utility analysis with regard to the implementation and one-year operation of the HDU. The primary endopoint was the quality-adjusted life-years (QALYs) of patients admitted to the HDU, against direct and indirect costs. Secondary endpoints included key procedures or treatments performed during the HDU stay. MethodsThe study was conducted from October 2, 2017 to October 1, 2018 in the obstetric high dependency unit (HDU) of Princess Christian Maternity Hospital (PCMH) in Freetown, Sierra Leone. Findings523 patients (median age 25 years, IQR 21-30) were admitted to HDU. The total 1 year investment and operation costs for the HDU amounted to €120,082 - resulting in €230 of extra cost per admitted patient. The overall cost per QALY gained was of €10; this value is much lower than the WHO threshold defining high cost effectiveness of an intervention, i.e. three times the current Sierra Leone annual per capita GDP of €1416. ConclusionWith an additional cost per QALY of only €10.0, the implementation and one-year running of the case studied obstetric HDU can be considered a highly cost-effective frugal innovation in limited resource contexts. The evidences provided by this study allow a precise and novel insight to policy makers and clinicians useful to prioritize interventions in critical care and thus address maternal mortality in a high burden scenario.
RESILIENCE AND LOCALISM Ricciardelli, Alessandra; Borgonovi, Elio
Rivista internazionale di scienze sociali,
2018, Volume:
126, Issue:
1
Journal Article
Peer reviewed
The paper contributes to the discussion over the development of a scientific paradigm that would enable scholars to analyse concepts of collaboration, its unfolding processes, dimensions and ...challenges within resilient community organisations. In the attempt to fill the gap in the literature, this study-case on the City of Matera represents a tool for understanding the complexities of governing systems in the perspective of Community Governance and for suggesting criteria for actions in creating a shared, integrated, networked-based and systemic public value. The analysis focuses on socio-economic and informal organisational systems that are necessary to implement modes and places of collaboration when delivering public services in a resilient community. Emphasis is also given to obstacles resulting from building resilience which require an increased collaborative and social entrepreneurship. Hence, key challenge for resilient initiatives is to become viable models in enhancing community's ability to learning and to self-organise to make decisions sustainably.
Low efficiency of public administrations is considered an obstacle towards overcoming the effects of the financial crisis and recovering growth. Why does this happen? It is for sure because ...principles, criteria, techniques of good management are not tailored to the peculiarity of public interest organizations, but also because public integrity distortions orient people to use it as an instrument to exercise power. New Public Management has not been sufficient to break the vicious circle of inefficient public administration and a new anti-corruption law has been introduced in Italy. Its main objective is to prevent and control “the negative corruption effect” attempts towards the common good – also characterized by capital rationing – which can compromise the present and future wealth of communities.
Retinitis Pigmentosa (RP) is a hereditary genetic disease causing bilateral retinal degeneration. RP is a leading cause of blindness resulting in incurable visual impairment and drastic reduction in ...the Quality of life of the patients. Second Sight Medical Products Inc. developed Argus II, a retinal prosthesis system for treating RP. Argus II is the world's first ever-commercial implant intended to restore some vision in the blind patients. The objective of this study was to assess the cost-effectiveness of the Argus® II Retinal Prosthesis System (Argus II) in Retinitis Pigmentosa (RP) patients.
A multi -state transition Markov model was developed to determine the cost-effectiveness of Argus II versus usual care in RP from the perspective of healthcare payer. A hypothetical cohort of 1000 RP patients aged 46 years followed up over a (lifetime) 25-year time horizon. Health outcomes were expressed as quality adjusted life years (QALYs) and direct healthcare costs expressed in 2012 €. Results are reported as incremental cost per ratios (ICERs) with outcomes and costs discounted at an annual rate of 3.5%.
The ICER for Argus II was €14,603/QALY. Taking into account the uncertainty in model inputs the ICER was €14,482/QALY in the probabilistic analysis. In the scenarios of an assumption of no reduction on cost across model visual acuity states or a model time horizon as short as 10 years the ICER increased to €31,890/QALY and €49,769/QALY respectively.
This economic evaluation shows that Argus II is a cost-effective intervention compared to usual care of the RP patients. The lifetime analysis ICER for Argus II falls below the published societal willingness to pay of EuroZone countries.
Sustainability of healthcare system is a critical issue, nowadays and in the next future. Most researches and analysis focus on efficiency and cost-containment of health delivery organizations, ...hospitals, ambulatories and outpatient delivery organizations. After an analysis of trends in public and private healthcare expenditure, the paper discusses the limitations of different policies. It argues that privatization cannot be a solution because of health's nature as a human right that market rules and profit maximization/optimization cannot guarantee. The challenge requires a proper mix of public and private contribution, both on delivery and financing side. The paper point out that usually the sustainability challenge is discussed with regard to the economic dimension, while it implies also the social and political aspects. The conclusive remark is that healthcare systems are under stress, not because they' are expensive but because scientific and technological progress increases the opportunities for a larger part of the population.
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