Background: Prolactinoma, the most common pituitary adenoma, is usually treated with dopamine agonist (DA) therapy like cabergoline. Surgery is second-line therapy, and radiotherapy is used if surgical treatment fails or in relapsing macroprolactinoma. Objective: This study aimed to provide economic evidence for the management of prolactinoma in Italy, using a cost-of-illness and cost-utility analysis that considered various treatment options, including cabergoline, bromocriptine, temozolomide, radiation therapy, and surgical strategies. Methods: The researchers conducted a systematic literature review for each research question on scientific databases and surveyed a panel of experts for each therapeutic procedure’s specific drivers that contributed to its total cost. Results: The average cost of the first year of treatment was €2,558.91 and €3,287.40 for subjects with microprolactinoma and macroprolactinoma, respectively. Follow-up costs from the second to the fifth year after initial treatment were €798.13 and €1,084.59 per year in both groups. Cabergoline had an adequate cost-utility profile, with an incremental cost-effectiveness ratio (ICER) of €3,201.15 compared to bromocriptine, based on a willingness-to-pay of €40,000 per quality-adjusted life year (QALY) in the reference economy. Endoscopic surgery was more cost-effective than cabergoline, with an ICER of €44,846.64. Considering a willingness-to-pay of €40,000/QALY, the baseline findings show cabergoline to have high cost utility and endoscopic surgery just a tad above that. Conclusions: Due to the favorable cost-utility profile and safety of surgical treatment, pituitary surgery should be considered more frequently as the initial therapeutic approach. This management choice could lead to better outcomes and an appropriate allocation of healthcare resources.

Acquired brain injuries (ABI), resulting from stroke or traumatic brain injury, cause a range of neuropsychological impairments and many patients continue to experience neuropsychological deficits years after onset. The increasing average age of the population highlights the importance of effective management strategies for the consequences of ABI. Despite the well‐documented impact of rehabilitation interventions, the cost‐effectiveness of neuropsychological rehabilitation remains largely unknown. This study conducted a scoping review to update the findings of Stolwyk et al. ( Neuropsychological Rehabilitation , 2021, 31, 316), focusing on the economic evaluations of neuropsychological rehabilitation for individuals with ABI. Following the PIO framework, PRISMA ScR guidelines, and systematic review reporting checklist, the review screened 1027 articles and included eight studies published between 2019 and 2024. The studies encompassed either language rehabilitation or general neuropsychological programs, including neuropsychological interventions. The economic analyses, including two cost‐effectiveness, five cost‐utility, and one cost–benefit study, mostly adhered to CHEERS guidelines, enhancing the transparency and methodological rigour of their reporting. These studies demonstrated varying degrees of cost‐effectiveness for interventions targeting post‐stroke language disorders and neuropsychological rehabilitation for ABI, with significant cost savings and health benefits observed, particularly for home‐based rehabilitation interventions. The included studies suffered from a short time horizon, limiting the ability to capture the long‐term economic impacts and effectiveness of the interventions. Future research should focus on longer‐term follow‐up data and include broader search strategies to enhance understanding and optimise health care interventions. A comprehensive implementation of these economic analyses is crucial for informing policymakers, enabling them to introduce rehabilitative interventions based on solid evidence.

Aim: The present guideline (GL) is aimed to improve and standardize the treatment of primary hypothyroidism in non-pregnant adults and to offer all the patients the best possible care across the Italian country. Target population: Non-pregnant adults with hypothyroidism. Excluded population: This GL does not cover the treatment of hypothyroidism in children and adolescents under 18 years of age, in women who are pregnant or breastfeeding, nor in subjects with central hypothyroidism. Also patients who require suppressive therapy with levothyroxine after thyroidectomy for thyroid cancer and those with transient iatrogenic hypothyroidism were not considered in this GL. Methods: The direct costs and the utilization of resources over time were evaluated for the implementation of the appropriate management within the National Health Service. Recommendations were based on the analysis, according to the GRADE methodology, of the evidence from literature. Patients preferences were collected and verified by means of specific bibliographic research and the active participation of two patients’ representatives in the GL development group. Results: The present GL provides 4 formal graded recommendations and 16 ungraded indications for good clinical practice. An elevated agreement was consistently obtained among the panel members. Conclusions: The present GL provides operative recommendations—based on the best available evidence and cost-effectiveness analysis—for the treatment of adult patients with primary hypothyroidism. The expected benefits from the dissemination, application and implementation of this GL are the improvement of the quality of care, its homogenization across the national territory and the rationalization of health expenditure in the respect of patient preferences.

Objective We assessed the cost effectiveness of onasemnogene abeparvovec (OA) for presymptomatic infants with two or three copies of the survival motor neuron 2 (SMN2) gene (diagnosed/treated ≤ 6 weeks old) who lack functional SMN1 gene (biallelic SMN1 mutations). This cost-utility model compared three disease-modifying treatments and best supportive care (BSC) (scenario analysis) in an Italian setting. Methods For a cohort of 1000 children, a Markov model simulated costs and benefits of OA (a one-time treatment), nusinersen and risdiplam (continuous lifelong treatments), and BSC. A lifetime time horizon (up to age 100 years) was applied, and the perspective of the Italian National Health Service was considered. Results are reported as incremental cost-effectiveness ratios (ICERs). Deterministic and probabilistic sensitivity analyses were conducted to assess the robustness of the model and validity of results. Results In the full cohort, OA was dominant (less costly, more effective) compared with nusinersen or risdiplam (ICERs,–€4,562,815 and–€718,640), and cost effective (more costly, more effective) compared with BSC (ICER, €65,894). Similar results were found for patients with two SMN2 copies. For patients with three SMN2 copies, OA was less costly, with a similar efficacy profile compared with nusinersen, dominant versus risdiplam, and cost effective compared with BSC. Probabilistic sensitivity analysis demonstrated the robustness of the model and validated deterministic sensitivity analysis results for the full cohort. Conclusions OA for the treatment of presymptomatic newborns was dominant or cost effective compared with other treatments or BSC in the full patient cohort within the Italian context.

Background/Objectives: A successful implementation of VBHC requires significant transformations, spanning from structural adjustments to a fundamental shift in organizational culture. However, organizations often adopt VBHC principles piecemeal, while managers overlook diverse staff reactions and their leadership role. To address these challenges, we developed and validated a multi-source assessment tool for use by organizations during their transition to VBHC to determine whether they are progressing effectively in both the dimensions. Method: To develop the first version of the tool, a multidisciplinary group translated strategies identified in a previous scoping review into questionnaire items through structured sessions. To validate it, a two round Delphi analysis was conducted. Experts in VBHC, management, health economy and clinical/researcher were contacted to ask for their participation. Consensus was established based on the following criteria: a median (Mdn) score of ≥4, an interquartile range (IQR) of ≤1.5 or ≤2, and a frequency of ratings in the range [4–5] ≥ 70%. Results: A total of 54 experts were invited to participate in the Delphi survey. The first round received 25 responses, while the second round had 23 responses. The final version of the assessment tool consists of 30 questions divided into two macro-areas: the Value Agenda Section and the Change Management Section. All items achieved a minimum frequency of ratings > 80% during both the rounds. Conclusion: By comparing the perspectives of managers and clinicians, the resulting tool enables organizations to assess the adoption of the Value Agenda component, as well as the change management strategies supporting its implementation.

Since the 1990s, healthcare systems in many Western countries, including Italy, have undergone significant reforms, transforming organizational models and structures to meet the growing demand for healthcare services efficiently. This transformation has introduced new managerial roles for doctors-managers, particularly at the midlevel, creating “doctor-manager” positions that involve both clinical and managerial responsibilities. However, doctor-managers often struggle to balance these dual roles due to a lack of formal managerial training and the inherent conflict between clinical and economic objectives. This study aims to define new evaluation dimensions that can enhance the existing scale and develop a new tool to assess the necessary components of the managerial attitude dimension required by doctor-managers in the current Italian healthcare system. This study updated Cicchetti’s 2005 scale to reflect the changes that have occurred in healthcare organizations over the past 20 years, focusing on the evolving roles and challenges of middle healthcare managers. A scoping review was conducted to explore the existing literature, resulting in the identification and analysis of 24 key articles. Thematic analysis, facilitated by NVivo software, identified 171 items related to managerial attitude. These items were further refined, resulting in a 61-item Health Middle Manager Competencies Scale. The scale was evaluated by a Delphi panel through an e-survey, and Cronbach’s alpha was used to assess reliability. The final Competencies Scale for Middle Managers of Health consists of 61 items, validated by the Delphi panel of experts. The panel reached consensus on the relevance and significance of each item, confirming the scale’s reliability with an acceptable Cronbach alpha. The new scale captures various dimensions of the competencies essential for middle managers in healthcare settings. The study provides insights into the dimensions of doctor managerial attitude and contributes to the update of Cicchetti’s Scale to develop a new tool that assesses all the necessary components now required within the managerial attitude dimension.