On 2015 Oct 15, Andrea Messori commented:

Producing evidence in support of disinvestment: the experience of the Tuscany region in Italy

HTA Unit, ESTAV, 50100 Firenze (Italy)

In June 2013, the regional institution (ESTAV) responsible for drug acquisition in Tuscany (Italy) started a project aimed at identifying a series of pharmacological treatments suitable for disinvestment (i.e. suitable to be replaced by an equi-effective and less costly alternative). One criterion for this initiative was to write a full scientific report focused on comparative effectiveness for each therapeutic issue.<br> Table 1 shows the bibliografic details of the main 10 analyses of disinvestment conducted within this project.

Table 1. Information shown in this table: (a) therapeutic issue; (b) more costly treatment; (c) less costly tretament; (d) references

[1] -----------------------------------------------------------------------

(a) First line treatment of previously untreated patients with genotype-1 HCV infection ; (b) Sofosbuvir + ledipasvir (12 weeks) ; (c) Ritonavir-boosted dual therapy (12 weeks) ; (d) Trippoli S, Fadda V, Maratea D, Messori A. Bayesian network meta-analysis to evaluate interferon-free treatments in naive patients with genotype 1 hepatitis C virus infection. Eur J Gastroenterol Hepatol. 2015 Aug;27(8):983-4.

[2] -----------------------------------------------------------------------

(a) First line treatment of previously untreated patients with multiple sclerosis ; (b) Beta-Interferon ; (c) Azathoprine ; (d) Messori A, Fadda V, Maratea D, Trippoli S. Indirect meta-analytical comparison of azathioprine and of beta interferon effectiveness in all forms of multiple sclerosis pooled together. J Neurol Sci. 2014 Dec 15;347(1-2):408-10.

[3] -----------------------------------------------------------------------

(a) Prevention of Venous Thromboembolism in Major Orthopedic Surgery ; (b) Enoxaparin ; (c) Dalteparin ; (d) Messori A, Trippoli S, Maratea D, Fadda V, Marinai C. Prevention of venous thromboembolism in major orthopedic surgery: Bayesian network meta-analysis of 21 randomized trials evaluating unfractionated heparins, low-molecular weight heparins, and new oral anticoagulants. Int Cardiovasc Res J.2015;9(4):238-242

[4]------------------------------------------------------------------------

(a) Targeted Treatments for Pulmonary Arterial Hypertension: ; (b) Various agents of recent approval ; (c) Sildenafil ; (d) Badiani B, Messori A. Targeted Treatments for Pulmonary Arterial Hypertension: Interpreting Outcomes by Network Meta-analysis. Heart Lung Circ. 2015 Jul 6. pii:S1443-9506(15)01248-2. doi: 10.1016/j.hlc.2015.05.020. [Epub ahead of print]

[5]------------------------------------------------------------------------

(a) Thromboprophylaxis in orthopedic surgery ; (b) Rivaroxaban ; (c) Apixaban ; (d) Messori A, Fadda V, Maratea D, Trippoli S, Marinai C. Testing the therapeutic equivalence of novel oral anticoagulants for thromboprophylaxis in orthopaedic surgery and for prevention of stroke in atrial fibrillation. Int J Clin Pharmacol Ther. 2015 Mar;53(3):211-9. doi: 10.5414/CP202183.

[6]------------------------------------------------------------------------

(a) Treatment of Moderate-to-Severe Psoriasis by Subcutaneous Route ; (b) Ustekinumab 45mg ; (c) Adalimumab ; (d) Messori A, Fadda V, Maratea D, Trippoli S, Gatto R, De Rosa M, Marinai C. Biological drugs for the treatment of moderate-to-severe psoriasis by subcutaneous route: determining statistical equivalence according to evidence-based methods. Clin Drug Investig. 2014 Aug;34(8):593-8.

[7]------------------------------------------------------------------------

(a) Anti-reabsorptive treatment in women with osteoporosis ; (b) Risedronate or ibandronate or denosumab ; (c) Alendronate ; (d) Messori A, Fadda V, Maratea D, Trippoli S, Marinai C. Anti-reabsorptive agents in women with osteoporosis: determining statistical equivalence according to evidence-based methods. J Endocrinol Invest. 2014 Aug;37(8):769-73.

[8]------------------------------------------------------------------------

(a) Intravenous proton pump inhibitors for stress ulcer prophylaxis in critically ill patients ; (b) Omeprazole ; (c) Pantoprazole ; (d) Messori A, Fadda V, Maratea D, Gatto R, Trippoli S, De Rosa M, Marinai C. Intravenous proton pump inhibitors for stress ulcer prophylaxis in critically ill patients: determining statistical equivalence according to evidence-based methods. Int J Clin Pharmacol Ther. 2014 Oct;52(10):825-9.

[9]------------------------------------------------------------------------

(a) Stroke prevention in atrial fibrillation: ; (b) Novel oral anticoagulants ; (c) Devices for closure of appendage (Watchman) ; (d) Messori A, Trippoli S. Left atrial appendage occlusion devices vs pharmacological agents for stroke prevention in atrial fibrillation: testing non-inferiority. Journal of the American College of Cardiology 2015 (in press) http://www.osservatorioinnovazione.net/papers/jacc2015.pdf

[10]-----------------------------------------------------------------------

(a) Biological drugs for inducing remission in patients with Crohn’s disease ; (b) Certolizumab ; (c) Adalimumab ; (d) Messori A, Maratea D, Fadda V, Trippoli S, Marinai C. Biological drugs for inducing remission in patients with Crohn's disease: determining statistical equivalence according to evidence-based methods. Arch Med Sci 2014 in press http://www.osservatorioinnovazione.net/papers/arch-med-sci-2014.pdf

On 2015 Oct 15, Andrea Messori commented:

Producing evidence in support of disinvestment: the experience of the Tuscany region in Italy

HTA Unit, ESTAV, 50100 Firenze (Italy)

In June 2013, the regional institution (ESTAV) responsible for drug acquisition in Tuscany (Italy) started a project aimed at identifying a series of pharmacological treatments suitable for disinvestment (i.e. suitable to be replaced by an equi-effective and less costly alternative). One criterion for this initiative was to write a full scientific report focused on comparative effectiveness for each therapeutic issue.<br> Table 1 shows the bibliografic details of the main 10 analyses of disinvestment conducted within this project.

Table 1. Information shown in this table: (a) therapeutic issue; (b) more costly treatment; (c) less costly tretament; (d) references

[1] -----------------------------------------------------------------------

(a) First line treatment of previously untreated patients with genotype-1 HCV infection ; (b) Sofosbuvir + ledipasvir (12 weeks) ; (c) Ritonavir-boosted dual therapy (12 weeks) ; (d) Trippoli S, Fadda V, Maratea D, Messori A. Bayesian network meta-analysis to evaluate interferon-free treatments in naive patients with genotype 1 hepatitis C virus infection. Eur J Gastroenterol Hepatol. 2015 Aug;27(8):983-4.

[2] -----------------------------------------------------------------------

(a) First line treatment of previously untreated patients with multiple sclerosis ; (b) Beta-Interferon ; (c) Azathoprine ; (d) Messori A, Fadda V, Maratea D, Trippoli S. Indirect meta-analytical comparison of azathioprine and of beta interferon effectiveness in all forms of multiple sclerosis pooled together. J Neurol Sci. 2014 Dec 15;347(1-2):408-10.

[3] -----------------------------------------------------------------------

(a) Prevention of Venous Thromboembolism in Major Orthopedic Surgery ; (b) Enoxaparin ; (c) Dalteparin ; (d) Messori A, Trippoli S, Maratea D, Fadda V, Marinai C. Prevention of venous thromboembolism in major orthopedic surgery: Bayesian network meta-analysis of 21 randomized trials evaluating unfractionated heparins, low-molecular weight heparins, and new oral anticoagulants. Int Cardiovasc Res J.2015;9(4):238-242

[4]------------------------------------------------------------------------

(a) Targeted Treatments for Pulmonary Arterial Hypertension: ; (b) Various agents of recent approval ; (c) Sildenafil ; (d) Badiani B, Messori A. Targeted Treatments for Pulmonary Arterial Hypertension: Interpreting Outcomes by Network Meta-analysis. Heart Lung Circ. 2015 Jul 6. pii:S1443-9506(15)01248-2. doi: 10.1016/j.hlc.2015.05.020. [Epub ahead of print]

[5]------------------------------------------------------------------------

(a) Thromboprophylaxis in orthopedic surgery ; (b) Rivaroxaban ; (c) Apixaban ; (d) Messori A, Fadda V, Maratea D, Trippoli S, Marinai C. Testing the therapeutic equivalence of novel oral anticoagulants for thromboprophylaxis in orthopaedic surgery and for prevention of stroke in atrial fibrillation. Int J Clin Pharmacol Ther. 2015 Mar;53(3):211-9. doi: 10.5414/CP202183.

[6]------------------------------------------------------------------------

(a) Treatment of Moderate-to-Severe Psoriasis by Subcutaneous Route ; (b) Ustekinumab 45mg ; (c) Adalimumab ; (d) Messori A, Fadda V, Maratea D, Trippoli S, Gatto R, De Rosa M, Marinai C. Biological drugs for the treatment of moderate-to-severe psoriasis by subcutaneous route: determining statistical equivalence according to evidence-based methods. Clin Drug Investig. 2014 Aug;34(8):593-8.

[7]------------------------------------------------------------------------

(a) Anti-reabsorptive treatment in women with osteoporosis ; (b) Risedronate or ibandronate or denosumab ; (c) Alendronate ; (d) Messori A, Fadda V, Maratea D, Trippoli S, Marinai C. Anti-reabsorptive agents in women with osteoporosis: determining statistical equivalence according to evidence-based methods. J Endocrinol Invest. 2014 Aug;37(8):769-73.

[8]------------------------------------------------------------------------

(a) Intravenous proton pump inhibitors for stress ulcer prophylaxis in critically ill patients ; (b) Omeprazole ; (c) Pantoprazole ; (d) Messori A, Fadda V, Maratea D, Gatto R, Trippoli S, De Rosa M, Marinai C. Intravenous proton pump inhibitors for stress ulcer prophylaxis in critically ill patients: determining statistical equivalence according to evidence-based methods. Int J Clin Pharmacol Ther. 2014 Oct;52(10):825-9.

[9]------------------------------------------------------------------------

(a) Stroke prevention in atrial fibrillation: ; (b) Novel oral anticoagulants ; (c) Devices for closure of appendage (Watchman) ; (d) Messori A, Trippoli S. Left atrial appendage occlusion devices vs pharmacological agents for stroke prevention in atrial fibrillation: testing non-inferiority. Journal of the American College of Cardiology 2015 (in press) http://www.osservatorioinnovazione.net/papers/jacc2015.pdf

[10]-----------------------------------------------------------------------

(a) Biological drugs for inducing remission in patients with Crohn’s disease ; (b) Certolizumab ; (c) Adalimumab ; (d) Messori A, Maratea D, Fadda V, Trippoli S, Marinai C. Biological drugs for inducing remission in patients with Crohn's disease: determining statistical equivalence according to evidence-based methods. Arch Med Sci 2014 in press http://www.osservatorioinnovazione.net/papers/arch-med-sci-2014.pdf