As in economic evaluations developed in other countries, such as the UK, Canada, and The Netherlands, setting up a screening program for AAA can be considered cost-effective from the Italian NHS perspective.

Our data show SNM to be an efficient investment with an acceptable incremental cost-effectiveness ratio and a limited impact on the total allocated budget for fecal incontinence.

No abstract

BACKGROUND: Highly Active Antiretroviral Therapy (HAART) has transformed HIV into a lifelong condition. Following the chronicity of the disease, and significant increase in lifespan -the prevalence of comorbidities increased in HIV+ subjects that are exposed both to a higher risk of developing cardiovascular disease, renal disease, osteopenia/osteoporosis and diabetes, and to the risk of developing them early. Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Fumarate (E/C/F/TAF), a complete, Single-Tablet antiretroviral Regimen (STR) that combines the effectiveness and tolerability of integrase inhibitors with an innovative backbone was recently introduced in Italy. Compared to Tenofovir Disoproxil Fumarate (TDF), TAF reaches the sites of action more efficiently, reducing tenofovir plasma concentration to more than 90% and the risk of off-target effects. OBJECTIVE: A patient-level micro-simulation model was adapted to the Italian context to evaluate E/C/F/TAF costeffectiveness vs three boosted regimens for HIV+ patients treatment. METHODS: A Markov micro-simulation model was adapted to the Italian context for the evaluation of the cost-effectiveness in patients with HIV. The total cost per patient accounts for drug therapies and the management of adverse events and comorbidities. The quality-adjusted life expectancy (in QALYs) is calculated by weighing the years of life lived by the utility weights. A 70-year time horizon was adopted to simulate a lifetime analysis; shorter time horizons were considered in the sensitivity analyses. 3.5% discount rate was applied both for costs and future benefits. The rate of virologic suppression at 48 weeks with E/C/F/TAF is 92.3%; for the other treatments such proportion is calculated by applying to the reference rate the relative risks, as calculated in a recent network meta-analysis (NMA). Alternative treatments considered in this analysis are three boosted regimens commonly used in Italy: tenofovir disoproxil fumarate/emtricitabine/elvitegravir/ cobicistat in STR; tenofovir disoproxil fumarate/emtricitabine + darunavir/ritonavir; tenofovir disoproxil fumarate/emtricitabine + atazanavir/ritonavir. RESULTS: E/C/F/TAF improves survival and quality of life (20.17 LY and 14.89 QALY), with the lowest total cost (€ 280,528), thus resulting dominant over three comparators considered as starting therapy. The sensitivity analysis confirms the results of the base case: at a willingness-to-pay threshold of € 30,000 per QALY, the E/C/F/TAF strategy is the most cost-effective, with a 90% probability and it is the most cost-effective even with a threshold of € 10,000 per QALY, with a 50% probability. CONCLUSION: E/C/F/TAF can be a sustainable alternative to currently available treatments, combining the advantage of the STR to lower risks of kidney and bone damage than observed in regimens based on TDF.

OBJECTIVES:To compare the clinical and cost consequences of Gadoxetic Acidenhanced magnetic resonance imaging (PV-MRI) to extracellular contrast mediaenhanced MRI (ECCM-MRI) and Multidetector Computed Tomography (MD-CT) in patients with suspected hepatocellular carcinoma (HCC) in South Korea and Thailand. METHODS: The clinical pathway of patients with suspected HCC from the initial imaging procedure (PV-MRI, ECCM-MRI or MD-CT) to the confirmed treatment decision was presented in an economic decision-tree model. The model compared payer relevant costs of the three diagnostic procedures as first line imaging for suspected HCC and the subsequent costs to reach a confirmed treatment decision. The probabilities and resource consumptions were estimated and validated by clinical experts through a Delphi panel process. Costs for diagnostic and treatment options were derived from published sources. , respectively. The higher acquisition cost of PV-MRI are more than compensated by the cost saving achieved through the reduced need for confirmatory imaging procedures and the reduced need for changes in the surgical protocol during resection. CONCLUSIONS: Using PV-MRI compared to ECCM-MRI and MD-CT for the first imaging in patients with suspected HCC leads to relevant cost savings for the statutory health insurance in both countries. The impact on health outcomes (e.g. mortality, quality of life) and total cost needs to be shown in an extended study approach. OBJECTIVES:To compare Gadoxetic Acid-enhanced MRI (PV-MRI) with extracellular contrast media-enhanced MRI (ECCM-MRI) and 3-phase MD-CT (MD-CT) in the planning of surgery for patients with colorectal cancer liver metastases (CRCLM). METHODS:A decision-tree model was used. The probabilities were collected and validated by radiologists and liver surgeons in Germany, Italy and Sweden using a Delphi panel process. Cost was derived from published sources and the mean costs A350