Fabio Barbone

Background: Vestibular tests are critical for an early detection of balance disorders, thereby reducing the risk of falls, particularly in older adults. The present is an ecologic study where the units of observation are the Italian Regions. Regional scores of access to essential levels of care (LEAs) were employed as predictors to investigate the hypothesis that vestibular examinations supplied by the Italian National Health Service (NHS) were insufficient to meet the needs of the Italian population. Methods: The number of first-level (clinical evaluations of vestibular function) and second-level (recorded spontaneous nystagmus, induced nystagmus, or rotary stimulation) vestibular tests per 100 K population was estimated by Italian region and calendar year during the 2021–2023 period. The odds (i.e., number of any second-level vestibular tests divided by difference between number of first- and second-level tests) by region and calendar year were investigated as a proxy for regional propensity to refer patients to a second-level test following a first-level vestibular assessment. A logistic regression investigated the odds by region and calendar year. Lastly, the regional number × 100 K population (prevalence) of vestibular examinations underwent linear regression analysis, using LEAs as predictors. Results: Descriptive analysis showed that first-level assessments were the most common vestibular tests in Italy during the 2021–2023 period. Prevalence of first-level vestibular examinations was not associated with any indicator of access to healthcare in linear regression. By contrast, the prevalence of second-level vestibular tests decreased with social inequality yet increased with the indicator of higher access to hospital care. In logistic regression, referral propensity to second-level vestibular tests progressively decreased from 2021 to 2023 and exhibited considerable regional variability, being lower than in Lombardy (reference) in all other Italian regions but Veneto (aOR = 4.826; 95%CI: 4.445; 5.329) and Trento autonomous province (aOR = 1.488; 1.363; 1.624). Conclusions: The number of vestibular function tests supplied by the National Health Service in Italy during the 2021–2023 period was probably insufficient to meet the care needs of the general population, forcing more than 66.8% of patients to forgo vestibular evaluation or turn to private audiological services with out-of-pocket payments. The shortfall was greater for more costly instrumental (second-level) vestibular tests, whose supply was influenced by social inequalities and barriers to accessing audiology care at the regional level. The National Recovery and Resiliency Plan has allocated EUR 20.23 billion for healthcare services in Italy, with the aim of addressing patient care requirements in every area of the country.

Background: Past workplace exposure to asbestos in combination with tobacco smoking has increased the risk of lung cancer for some residents in an area within the Friuli Venezia Giulia region, Northeast Italy. In light of studies showing that lung cancer screening (LCS) with low-dose computed tomography (LDCT) can reduce mortality, local stakeholders and decision-makers decided to assess the potential benefits, harms and cost-effectiveness of a single round of LCS with LDCT versus standard care among people aged 55 to 80 who were formerly exposed to asbestos and with at least 10 pack-years of smoking. Methods: An economic model was developed using a decision tree connected to a Markov cohort model. The primary outcome was the incremental cost per additional quality-adjusted life year (QALY). Other outcomes included the number of life years saved, the number of deaths averted and overdiagnosis. Results: Per 10,000 people screened, the intervention led to 395 additional QALYs (95% credible interval: 129 to 831) and incremental total costs of EUR 1,086,345 (95% credible interval: −852,607 to 2,155,826). The incremental cost per QALY gained was EUR 2750. There was a probability of cost-effectiveness of 99.5% relative to a threshold of EUR 25,000. Conclusions: The model estimated that the intervention was cost-effective. The model’s simplifications and limitations should be considered when interpreting the findings in relation to policy-making decisions. Further research could include the costs and benefits of incidental findings and could assess the cost-effectiveness of repeated rounds of screening for the same population.