Policy predictive model for better management of chronic obstructive pulmonary disease: economic-organisational implications in the Italian healthcare system

Authors

  • Debora Antonini ALTEMS Advisory, Università Cattolica del Sacro Cuore, Roma - Italy https://orcid.org/0009-0008-9294-1241
  • Fausto De Michele Azienda Ospedaliera di Rilievo Nazionale Antonio Cardarelli, Napoli - Italy
  • Claudio Micheletto Azienda Ospedaliera Universitaria Integrata Verona, Verona - Italy https://orcid.org/0000-0002-1138-3882
  • Dejan Radovanovic Dipartimento di Scienze Biomediche e Cliniche, Università degli Studi di Milano, UOC Pneumologia, Ospedale L. Sacco, ASST Fatebenefratelli-Sacco, Milano - Italy https://orcid.org/0000-0002-9013-3418
  • Michele Basile ALTEMS Advisory, Università Cattolica del Sacro Cuore, Roma - Italy
  • Eugenio Di Brino ALTEMS Advisory, Università Cattolica del Sacro Cuore, Roma - Italy https://orcid.org/0000-0001-7964-3348
  • Agostino Fortunato ALTEMS Advisory, Università Cattolica del Sacro Cuore, Roma - Italy https://orcid.org/0009-0004-8199-068X
  • Valentina Donati Università Cattolica del Sacro Cuore, Roma - Italy https://orcid.org/0009-0002-5083-2481
  • Filippo Rumi ALTEMS Advisory, Università Cattolica del Sacro Cuore, Roma - Italy

DOI:

https://doi.org/10.33393/grhta.2024.3114

Keywords:

Budget impact model, Chronic obstructive pulmonary disease, Policy making in healthcare, Predictive model

Abstract

Background: Chronic obstructive pulmonary disease (COPD) represents a significant public health problem in Italy, with a high prevalence and a substantial economic burden on the National Health Service (NHS). Effective management of the disease is crucial for reducing exacerbations and improving patients’ quality of life.

Methods: This study employs a dynamic predictive model to assess the economic impact of implementing three specific health policies aimed at improving COPD management over a five-year horizon. The analysis is conducted from the perspective of the NHS, focusing on the direct costs associated with disease management.

Results: The implementation of the proposed policies demonstrated potential significant savings in direct healthcare costs. The first policy, focused on increasing therapeutic adherence, generated an estimated savings of 202 million €. The second, concerning the wider use of triple therapies, led to savings of about 142 million €. Finally, the third policy, aimed at reducing the delay in prescribing appropriate therapies, contributed to an additional saving of over 175 million € in the time horizon considered in the analysis. Overall, these results suggest a substantial improvement opportunity in COPD management, with significant economic benefits for the Italian NHS.

Conclusion: The study confirms the importance of targeted policies in the management of COPD, highlighting how strategic interventions can lead to significant resource savings while simultaneously improving patient care. These results provide a solid foundation for further research and serve as a useful guide for decision-makers in planning effective intervention strategies, aimed at optimizing resources and enhancing disease management in the Italian healthcare context.

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References

Istituto Superiore di Sanità (ISS), - EpiCentro – L’epidemiologia per la sanità pubblica. Broncopneumopatia cronica ostruttiva. Online https://www.epicentro.iss.it/broncopneumopatia/ (Accessed May 2024)

National Heart, Lung, and Blood Institute. What is COPD? Online https://www.nhlbi.nih.gov/health/copd. (Accessed May 2024)

Global Initiative for Chronic Obstructive Lung Disease. Global strategy for prevention, diagnosis and management of COPD: 2023 Report. Online https://goldcopd.org/2023-gold-report-2/ (Accessed May 2024)

Rapporto Osservasalute 2022. Stato di salute e qualità dell’assistenza nelle regioni italiane. Online https://osservatoriosullasalute.it/wp-content/uploads/2023/06/ro-2022-volume_completo.pdf (Accessed May 2024)

National Institute for Health and Care Excellence (NICE). Chronic obstructive pulmonary disease in over 16s: diagnosis and management. Online https://www.nice.org.uk/guidance/ng115/chapter/recommendations (Accessed May 2024)

Ministero della Salute. La continuità assistenziale: Broncopneumopatia Cronica Ostruttiva (BPCO). Online https://www.salute.gov.it/imgs/C_17_pubblicazioni_1893_allegato.pdf. (Accessed May 2024)

IQVIA. Gestione della BPCO in Italia: impatto della pandemia e della Nota 99 sull’assistenza terapeutica. Online https://www.iqvia.com/-/media/iqvia/pdfs/italy/publications/01_bife_gsk_gestione_della_bpco_in_italia.pdf (Accessed May 2024)

National Heart, Lung, and Blood Institute. Treatment COPD. Online https://www.nhlbi.nih.gov/health/copd/treatment. https://www.iqvia.com/-/media/iqvia/pdfs/italy/publications/01_bife_gsk_gestione_della_bpco_in_italia.pdf (Accessed May 2024)

Agenzia Italiana del Farmaco (AIFA). AIFA pubblica la Nota 99 per la prescrizione dei farmaci per la BPCO. Online https://www.aifa.gov.it/-/aifa-pubblica-la-nuova-nota-99-per-la-prescrizione-dei-farmaci-per-la-bpco (Accessed May 2024)

Agenzia Italiana del Farmaco (AIFA). L’uso dei farmaci in Italia – Rapporto Nazionale Anno 2022. Online https://www.aifa.gov.it/documents/20142/1967301/Rapporto-OsMed-2022.pdf. (Accessed May 2024)

Mannino D, Bogart M, Wu B, et al. Adherence and persistence to once-daily single-inhaler versus multiple-inhaler triple therapy among patients with chronic obstructive pulmonary disease in the USA: A real-world study. Respir Med. 2022;197:106807. PMID:35429764 https://doi.org/10.1016/j.rmed.2022.106807 PMID:35429764

Agenzia Italiana del Farmaco (AIFA). Aderenza alle terapie e strategie per migliorare l’uso sicuro ed efficace dei farmaci. Online https://www.aifa.gov.it/-/aderenza-alle-terapie-e-strategie-per-migliorare-l-uso-sicuro-ed-efficace-dei-farmaci (Accessed May 2024)

Istituto Nazionale di Statistica (ISTAT). Popolazione residente al 1° gennaio: Per fascia di età. Online http://dati.istat.it/Index.aspx?QueryId=42869 (Accessed May 2024)

Global Initiative for Chronic Obstructive Lung Disease. Strategia Globale per la diagnosi, il trattamento e la prevenzione della BPCO – Revisione 2017. Online https://goldcopd.it/wp-content/uploads/materiali/2017/GOLD_Pocket_2017.pdf (Accessed May 2024)

Soriano JB, Hahsler M, Soriano C, et al; CHAIN investigators. Temporal transitions in COPD severity stages within the GOLD 2017 classification system. Respir Med. 2018;142:81-85. https://doi.org/10.1016/j.rmed.2018.07.019 PMID:30170807

Wallace AE, Kaila S, Bayer V, et al. Health Care Resource Utilization and Exacerbation Rates in Patients with COPD Stratified by Disease Severity in a Commercially Insured Population. J Manag Care Spec Pharm. 2019;25(2):205-217. PMID:30698096 https://doi.org/10.18553/jmcp.2019.25.2.205 PMID:30698096

Johansson G., Mushnikov V., Bäckström T., et al. Exacerbations and healthcare resource utilization among COPD patients in a Swedish registry-based nation-wide study. BMC Pulm Med. 2018 Jan 25;18(1):17. https://doi.org/10.1186/s12890-018-0573-0 PMID: 29370846

Miravitlles M, Kostikas K, Bizymi N, Tzanakis N. A Novel Figure and Algorithm for the Gold ABE Classification. Arch Bronconeumol. 2023;59(11):702-704. https://doi.org/10.1016/j.arbres.2023.06.001 PMID:37355409

Palmiotti GA, Lacedonia D, Liotino V, et al. Adherence to GOLD guidelines in real-life COPD management in the Puglia region of Italy. Int J Chron Obstruct Pulmon Dis. 2018;13:2455-2462. https://doi.org/10.2147/COPD.S157779 PMID:30147311

Agenzia Italiana del Farmaco (AIFA). Domande e risposte relative all’applicazione della Nota 99 per la prescrizione dei farmaci inalatori indicati nella terapia di mantenimento della BPCO. Online https://www.aifa.gov.it/documents/20142/1728122/FAQ_Nota_99_BPCO_15.11.2022.pdf (Accessed May 2024)

Weir DL, Bai YQ, Thavorn K, Guilcher S et al. Non-adherence to COPD medications and its association with adverse events: A longitudinal population based cohort study of older adults. Ann Epidemiol. 2024 Aug;96:88-96. https://doi.org/10.1016/j.annepidem.2023.12.003. PMID: 38141744

Toy EL, Beaulieu NU, McHale JM, et al. Treatment of COPD: relationships between daily dosing frequency, adherence, resource use, and costs. Respir Med. 2011;105(3):435-441. PMID:20880687 https://doi.org/10.1016/j.rmed.2010.09.006 PMID:20880687

Strange C, Tkacz J, Schinkel J, et al. Exacerbations and Real-World Outcomes After Single-Inhaler Triple Therapy of Budesonide/Glycopyrrolate/Formoterol Fumarate, Among Patients with COPD: results from the EROS (US) Study. Int J Chron Obstruct Pulmon Dis. 2023;18:2245-2256. https://doi.org/10.2147/COPD.S432963 PMID:37849918

Ministero della Salute. Tariffario delle prestazioni di assistenza ambulatoriale. Online http://www.salute.gov.it/portale/temi/p2_6.jsp?id=1767&area=programmazioneSanitariaLea&menu=lea (Accessed May 2024)

Koleva D, Motterlini N, Banfi P, Garattini L; Study Group BIC. Healthcare costs of COPD in Italian referral centres: a prospective study. Respir Med. 2007;101(11):2312-2320. PMID:17681461 https://doi.org/10.1016/j.rmed.2007.06.020 PMID:17681461

Istituto Nazionale di Statistica (ISTAT). Rivalutazioni e documentazione su prezzi, costi e retribuzioni contrattuali. https://rivaluta.istat.it/ (Accessed May 2024)

Kendall R, Martin AA, Shah D, Shukla S, Compton C, Ismaila AS. Cost-Effectiveness of Single-Inhaler Triple Therapy (FF/UMEC/VI) versus Tiotropium Monotherapy in Patients with Symptomatic Moderate-to-Very Severe COPD in the UK. Int J Chron Obstruct Pulmon Dis. 2023;18:1815-1825. PMID:37636901 https://doi.org/10.2147/COPD.S400707 PMID:37636901

Rettifica decreto commissariale N°U00265 1° settembre 2014. Online https://www.regione.lazio.it/sites/default/files/decreti-commissario-ad-acta/SAN_DCA_U00064_18_02_2015.pdf. (Accessed May 2024)

Agenzia Italiana del Farmaco (AIFA). Elenco dei Farmaci di Fascia A per principio attivo. Online https://www.aifa.gov.it/liste-farmaci-a-h. (Accessed May 2024)

Agenzia Italiana del Farmaco (AIFA). Elenco dei Farmaci di Fascia H per principio attivo. Online https://www.aifa.gov.it/liste-farmaci-a-h. (Accessed May 2024)

Additional Files

Published

2024-11-20

How to Cite

Antonini, D., De Michele, F., Micheletto, C., Radovanovic, D., Basile, M., Di Brino, E., Fortunato, A., Donati, V., & Rumi, F. (2024). Policy predictive model for better management of chronic obstructive pulmonary disease: economic-organisational implications in the Italian healthcare system. Global and Regional Health Technology Assessment, 11(1), 223–230. https://doi.org/10.33393/grhta.2024.3114

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Original Research Articles

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Received 2024-05-06
Accepted 2024-10-13
Published 2024-11-20

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