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London, United Kingdom

Colorectal cancer (CRC) is one of the most prevalent and deadly cancers in Italy. Its burden is expected to remain significant in the coming years, although it is mostly a preventable disease. Prevention and screening programmes will play an important role in the fight against CRC. A national formal screening programme was introduced in the 2003-2005 and 2005-2007 national health programmes, leaving the planning and implementation, respectively, to each region and local health unit. In 2007, screening programmes covered 46.6% of the eligible population, with a higher coverage in the North (71.6%) and in the Centre (52.1%) than in the South (7%). The majority of programmes used the guaiac faecal occult blood test (FOBT) as first-line test. Only few programmes used the flexible sigmoidoscopy, or a combination of both tests. The quality and efficacy of the screening programmes are evaluated using ad hoc indicators with acceptable and desirable targets. In Italy, there are formal guidelines for population-based and opportunistic screening, diagnosis, surgery, adjuvant and neoadjuvant treatments and surveillance, differentiating colon cancer from rectal cancer and advanced CRC. Guidelines are updated yearly. Overall, Italy is well positioned in the fight against CRC. Although many regions lag behind in the uptake of screening programmes, they are in the process of introducing them. © 2009 Springer-Verlag. Source

Schurer W.,LSE Health
European Journal of Health Economics

Cancer is now the primary cause of death in the Netherlands, with colorectal cancer (CRC) being responsible for a significant portion of cancer incidence (14%) and mortality (11.8%) in men and women. An aging population and the possibility of national CRC screening, currently under discussion, will likely increase this burden. Despite switching in 2006 to obligatory subsidized private health insurance, health expenditure continues to rise, along with increased cancer and drug expenditures. Despite rising drug expenditures, new targeted biological treatments are available under centrally subsidized provisions. CRC treatment guidelines are available, published online, regularly updated, and monitored for quality purposes. There are concerns regarding waiting times for diagnosis and treatment, as well as projected staff shortages; however, various plans are in place to combat these issues. Overall, it appears that the Netherlands is aware of the oncology issues affecting CRC management, and is contemplating the optimal course of action for the future. © 2009 Springer-Verlag. Source

Kanavos P.G.,International Health Policy | Vandoros S.,LSE Health
Health Economics, Policy and Law

This paper investigates the determinants of the prices of branded prescription medicines across different regulatory settings and health care systems, taking into account their launch date, patent status, market dynamics and the regulatory context in which they diffuse. By using volume-weighted price indices, this paper analyzes price levels for a basket of prescription medicines and their differences in 15 OECD countries, including the United States and key European countries, the impact of distribution margins and generic entry on public prices and to what extent innovation, by means of introducing newer classes of medicines, contributes to price formation across countries. In doing so, the paper seeks to understand the factors that contribute to the existing differences in prices across countries, whether at an ex-factory or a retail level. The evidence shows that retail prices for branded prescription medicines in the United States are higher than those in key European and other OECD countries, but not as high as widely thought. Large differences in prices are mainly observed at an ex-factory level, but these are not the prices that consumers and payers pay. Cross-country differences in retail prices are actually not as high as expected and, when controlling for exchange rates, these differences can be even smaller. Product age has a significant effect on prices in all settings after having controlled for other factors. Price convergence is observed across countries for newer prescription medicines compared with older medicines. There is no evidence that originator brand prices fall after generic entry in the United States, a phenomenon known as the generics paradox. Finally, distribution and taxes are important determinants of retail prices in several of the study countries. To the extent that remuneration of the distribution chain and taxation are directly and proportionately linked to product prices this is likely to persist over time. © 2011 Cambridge University Press. Source

Percutaneous pulmonary valve implantation (PPVI) using the Melody * transcatheter pulmonary valve is a new procedure introduced in 2000 as a less invasive treatment for right ventricular outflow tract (RVOT) dysfunction. The aim of this new procedure is to restore pulmonary valve competence without the need of open-chest operation. By prolonging the conduit lifespan, it delays surgical pulmonary valve replacement (PVR) and it can therefore potentially reduce the number of open-chest interventions over a patient's lifetime. PPVI has been shown to be feasible and safe and can be performed with a low complication rate. The aim of this study is to assess the cost of PPVI and the cost of surgical pulmonary valve replacement (PVR) in patients with right ventricular outflow tract dysfunction using a cohort simulation model applied to the UK population. The model resulted in an estimate of mean cost per patient of £5,791 when PPVI is unavailable as a treatment option and in an estimate of mean cost per patient of £8,734 when PPVI is available over the 25-year period of analysis. After sensitivity analysis was undertaken the results showed that the mean per patient cost difference in implementing PPVI over 25 years as compared to surgical PVR lies somewhere between £2,041 and £3,913. Given the lack of long-term data on treatment progression, the cost estimates derived here are subject to considerable uncertainty, and extensive sensitivity analysis has been used to counter this. Consequently this study is merely indicative of the levels of cost which can be expected in a cohort of 1,000 patients faced with a choice of treatment with PPVI or surgery. It is not a cost-effectiveness study but it helps place current knowledge on short-term benefits into context. As this analysis shows PPVI is associated with a relatively small increase in treatment management costs over a long time period. It is left entirely to the reader to value whether this inferred increase in long-term cost is worthwhile given the known short-term benefits and any personal judgement formed over long-term benefit. Source

Font J.C.,LSE Health | Fabbri D.,University of Bologna | Gil J.,CAEPS
Social Science and Medicine

This paper examines the influence of environmental factors on weight gain and obesity. We take advantage of a markedly different pattern of obesity between Italy in Spain to undertake a non-linear decomposition analysis of differences in the prevalence of overweight and obesity between the two countries. The analysis is based on cross-sectional national surveys for 2003. We have attempted to isolate the influence of lifestyle factors, socio-economic and socio-environmental effects in explaining cross-country differences in BMI status. Our findings suggest that when the social environment (proxied by different measures of peer effects and regional BMI) is not controlled for, we explain about 27-42% of the overall Spain-to-Italy overweight and obesity gap. Differences in eating habits and education between the two countries are the main predictors of the gaps in obesity and overweight. However, when social environment is controlled for, our estimates explain between 76 and 92% of the obesity and overweight gap and the effect of eating habits are wiped out. These results suggest healthy body weight depends on cultural or environmental triggers that operate through individual level health production determinants. © 2010 Elsevier Ltd. Source

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