{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T11:42:21Z","timestamp":1770291741560,"version":"3.49.0"},"reference-count":16,"publisher":"Aboutscience Srl","issue":"1","license":[{"start":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T00:00:00Z","timestamp":1768176000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Grhta"],"abstract":"<jats:p>Introduction: The clinical management of ostomy and urinary incontinence poses a substantial challenge forhealthcare systems and patients, as it necessitates the provision of specialized medical devices. In Italy, thesedevices are distributed through multiple distribution modalities.Methods: This study aims to update a previous Budget Impact analysis on home distribution, using real-worlddata collected via surveys and applying an ABC approach. Structured questionnaires were administered to theASL of four Italian regions, collecting data on staff involvement, operational times, and resource utilization. TheBIM analysis compared two scenarios: the current distribution scenario and a hypothetical scenario with incremental adoption of home delivery.Results: The estimated average annual personnel costs per patient were \u20ac 153 for direct distribution, \u20ac 107 forhome delivery, and \u20ac 80 for indirect distribution. The revised scenario resulted in an increased resource consumption of \u20ac 214,475,929 over three years. This increase was offset by significant cost reductions in direct(-\u20ac 165,195,792) and indirect distribution (-\u20ac 52,704,435), yielding a cumulative saving of \u20ac 3,424,299 over theanalysis period. Sensitivity analysis confirmed the robustness of the results with respect to the main parameters.Conclusion: The integration of real-world data significantly improves the accuracy and robustness of the BIManalysis. The results support home distribution as a cost-efficient choice for the Italian National Health Service(SSN). The evidence generated provides valuable insights for policymakers to optimize resource allocation anddistribution strategies for stoma and urinary incontinence devices.<\/jats:p>","DOI":"10.33393\/grhta.2026.3606","type":"journal-article","created":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T14:00:29Z","timestamp":1768226429000},"page":"7-14","source":"Crossref","is-referenced-by-count":1,"title":["Economic evaluation of distribution modalities for ostomy and incontinence medical devices within the italian healthcare context"],"prefix":"10.33393","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-8199-068X","authenticated-orcid":false,"given":"Agostino","family":"Fortunato","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michele","family":"Basile","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9294-1241","authenticated-orcid":false,"given":"Debora","family":"Antonini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7964-3348","authenticated-orcid":false,"given":"Eugenio","family":"Di Brino","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vincenzo","family":"Falabella","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pier","family":"Vincenzo Spena","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Filippo","family":"Rumi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"18642","published-online":{"date-parts":[[2026,1,12]]},"reference":[{"key":"18594","doi-asserted-by":"crossref","unstructured":"Recalla S., English K., Nazarali R., et al. Ostomy Care and Management: A Systematic Review. Journal of Wound, Ostomy and Continence Nursing. 2013;40(5):p 489-500, https:\/\/doi.org\/10.1097\/WON.0b013e3182a219a1","DOI":"10.1097\/WON.0b013e3182a219a1"},{"key":"18595","unstructured":"Bernardi FF, Delrio P, Eto L, et al. Il percorso di cura dei pazienti con stomia: stato dell\u2019arte e prospettive future. Boll SIFO. 2023;69(2):68-78. https:\/\/doi.org\/10.1704\/4038.40134"},{"key":"18596","unstructured":"Associazione Tenico-Scientifica di stomaterapia e riabilitazione del pavimento pelvico. Percorso di cura per la persona con Stomia. Online https:\/\/bit.ly\/41iG8LR (Accessed July 2025)"},{"key":"18597","unstructured":"Gazzetta Ufficiale della Repubblica Italiana. Decreto del Presidente del Consiglio dei Ministri 12 gennaio 2017. Definizione e aggiornamento dei Livelli Essenziali di Assistenza (LEA). Serie Generale, n. 65. Online https:\/\/www.gazzettaufficiale.it\/eli\/id\/2017\/03\/18\/17A02015\/sg (Accessed July 2025)"},{"key":"18598","doi-asserted-by":"crossref","unstructured":"Irwin GM. Urinary Incontinence. Prim Care. 2019 Jun;46(2):233-242. doi: 10.1016\/j.pop.2019.02.004. PMID: 31030824.","DOI":"10.1016\/j.pop.2019.02.004"},{"key":"18599","doi-asserted-by":"crossref","unstructured":"Rivet EB. Ostomy management: a model of interdisciplinary care. Surg Clin North Am. 2019;99(5):885-898. https:\/\/doi.org\/10.1016\/j.suc.2019.06.007 PMID:31446916","DOI":"10.1016\/j.suc.2019.06.007"},{"key":"18600","unstructured":"Hu JS, Pierre EF. Urinary incontinence in women: evaluation and management. Am Fam Physician. 2019;100(6):339-348. PMID:31524367"},{"key":"18601","doi-asserted-by":"crossref","unstructured":"Rumi F, Orsini F, Falabella V, Spena PR, Cicchetti A. Le modalit\u00e0 distributive dei presidi per stomia e incontinenza nel setting sanitario italiano: un questionario di valutazione e il burden sociale della distribuzione diretta. Glob Reg Health Technol Assess. 2022;9:36-44. https:\/\/doi.org\/10.33393\/grhta.2022.2292. PMID: 36628302.","DOI":"10.33393\/grhta.2022.2292"},{"key":"18602","unstructured":"Di Filippo A, Cangini A, Trotta F. Distribuzione dei medicinali diretta e per conto: opportunit\u00e0 e criticit\u00e0. Agenzia Italiana del Farmaco; 2022."},{"key":"18603","unstructured":"Federfarma, la nuova remunerazione delle farmacie. Online https:\/\/www.federfarma.it\/Farmaci-e-farmacie\/Farmacie-e-farmacisti-in-Italia\/La-nuova-remunerazione-delle-farmacie.aspx (Accessed July 2025)"},{"key":"18604","unstructured":"Cicchetti A, Rumi F, Fiore A, et al. Valutazione multidimensionale e multidisciplinare del servizio di consegna domiciliare dei presidi medici per stomia e incontinenza. ALTEMS, Universit\u00e0 Cattolica del Sacro Cuore. 2020. Online https:\/\/www.galm.it\/wp-content\/uploads\/2020\/12\/HTA-Direct-HD-DEF-1.pdf (Accessed July 2025)"},{"key":"18605","unstructured":"Fondazione CREF. Analisi della spesa farmaceutica e della distribuzione diretta in Italia. 2012. Online https:\/\/www.federfarma.it\/Documenti\/Indagini\/ricercaCREF2012.aspx (Accessed July 2025)"},{"key":"18606","doi-asserted-by":"crossref","unstructured":"da Silva Etges APB, Cruz LN, Notti RK, et al. An 8-step framework for implementing time-driven activity-based costing in healthcare studies. Eur J Health Econ. 2019;20(8):1133-1145. https:\/\/doi.org\/10.1007\/s10198-019-01085-8 PMID:31286291","DOI":"10.1007\/s10198-019-01085-8"},{"key":"18607","unstructured":"Dati ISTAT. Popolazione residente al primo gennaio in Italia. 2024. Online http:\/\/dati.istat.it\/Index.aspx?DataSetCode=DCIS_POPRES1 (Accessed July 2025)"},{"key":"18608","unstructured":"Salutequit\u00e0, & FAIS. 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