Cost effectiveness of a new combined immunosuppressive and antiviral regimen on the one-year follow-up of kidney transplant patients.

Background: Medical prescription after organ transplant must prevent both rejection and infectious complications. We assessed the 1-year effectiveness and cost of introducing a new combined regimen in kidney transplantation. Methods: Patients transplanted from January 2000 to March 2003 (Period 1) were compared to patients transplanted from April 2003 to July 2005 (Period 2). In period 1, patients were treated with Basiliximab, Cyclosporin, steroids and Mycophenolate (MMF) or Azathioprine. Prophylaxis with Valacyclovir was prescribed only in CMV D+/R- patients. In period 2, immunosuppressive drugs were Basiliximab, Tacrolimus, steroids and MMF. A 3-month universal CMV prophylaxis with Valganciclovir was used. Medical charts of outpatient visits allowed identifying drug, laboratory and radiological tests use, and hospital information system causes of hospitalisation and length of stay (LOS) over the first year after transplant. Patients with incomplete costs data were excluded. Results: 53 patients were analysed in period 1, and 60 in period 2. CMV serostatus patterns were not significantly different between the 2 periods. Over 12 months, acute rejection decreased from 22 patients (42%) in period 1 to 4 patients (7%) in period 2 (p<0.001), and CMV infection from 25 patients (47%) to 9 patients (15%, p<0.001). Average total rehospitalisation LOS decreased from 28±19 to 20±11 days (p<0.007). Average outpatient visits decreased from 49±10 to 39±8 (p<0.001). Average immunosuppression and CMV prophylaxis costs increased from US$ 18,362±6,546 to 24,637±5,457 (p<0.001), while average graft rejection costs decreased form US$ 4,135±9,164 to 585±2,850 (p=0.005), and average CMV treatment costs from US$ 2,043±5,545 to 91±293 (p=0.008). Average outpatient visits costs decreased from US$ 7,619±1,549 to 6,074±1,043 (p<0.001), and other hospital costs from US$ 3,801±6,519 to 1,196±3,146 (p=0.007). Altogether, average 1-year treatment costs decreased from US$ 35,961±14,916 to 32,584±6,211 (p=0.115). Cost-effectiveness ratios to avoid graft rejection and CMV infection decreased from US$ 61,482±9,292 to 34,911± 1,639 (p=0.006) and US$ 68,070±11,122 to 39,899±2,650 (p=0.015), respectively. Conclusion: The new combined regimen administered in period 2 was significantly more effective. Its additional cost was more than offset by savings linked with complications avoidance.

"Vedo il male e non lo posso schivare" : le rime di Antonio Brocardo tra classicismi e polemiche

Antonio Brocardo è ricordato per essere entrato in polemica con Pietro Bembo, suscitando clamore e indignazione. Le fonti antiche sulla vita del Bembo lo descrivono come un folle intento a distruggere qualcosa che non riusciva bene a comprendere Vitaliani lo definisce, nel titolo della sua monografia del 1902 (l'unica fino ad ora dedicata al poeta), «vittima del bembismo», probabilmente risentendo dei pesanti giudizi sul cardinale già presenti in Leopardi e poi nel De Sanctis. Eppure, già a partire da Croce, si cerca di ricostruire in maniera meno pregiudizievole la figura del poeta veneziano, considerando più da vicino i testi pervenuti. Ci si trova, però, di fronte ad uno scarto imponente: la tradizione lo vuole opposto al bembismo, mentre la lirica brocardiana non sembra per molti aspetti differenziarsi così platealmente dal canone bembesco, a giudizio di molte storie letterarie. Questa nuova edizione mira: a ricostruire scrupolosamente la biografia del poeta, l'ambiente frequentato ed i rapporti con altri poeti/intellettuali del suo tempo; a fare finalmente chiarezza sulle polemiche che videro il giovane veneziano come protagonista, a partire dalle fonti contemporanee (correggendo quanto riportato dalle biografìe del Bembo o dalle storie letterarie); a fornire un adeguato commento alle sue rime, dopo aver ristabilito un sicuro testo critico; a fare maggior chiarezza sul rapporto tra Brocardo ed il furbesco letterario; a collocare il poeta in una ben determinata fase del petrarchismo.