Fresenius (fre) xetra

  • Ecco la 60° Edizione del settimanale "Le opportunità di Borsa" dedicato ai consulenti finanziari ed esperti di borsa.

    Questa settimana abbiamo assistito a nuovi record assoluti in Europa e a Wall Street. Il tutto, dopo una ottava che ha visto il susseguirsi di riunioni di banche centrali. Lunedì la Bank of Japan (BoJ) ha alzato i tassi per la prima volta dal 2007, mettendo fine all’era del costo del denaro negativo e al controllo della curva dei rendimenti. Mercoledì la Federal Reserve (Fed) ha confermato i tassi nel range 5,25%-5,50%, mentre i “dots”, le proiezioni dei funzionari sul costo del denaro, indicano sempre tre tagli nel corso del 2024. Il Fomc ha anche discusso in merito ad un possibile rallentamento del ritmo di riduzione del portafoglio titoli. Ieri la Bank of England (BoE) ha lasciato i tassi di interesse invariati al 5,25%. Per continuare a leggere visita il link

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ecco un altro farma di peso. Tra le prime società dello XETRA (è svedese) i suoi prodotti sono estremamente usati in alcuni settori specifici quali la nefrologia (dialisi). produce macchine per dialisi emo e peritoneale oltre che composti chimici per l'uso. Reni artificiali. Un settore in continua crescita

Fresenius is a global health care company with products and services for dialysis, the hospital and the medical care of patients at home.

The Fresenius Group consists of four business segments, each of which is responsible for its own business operations worldwide: Fresenius Medical Care, Fresenius Kabi, Fresenius Helios and Fresenius Vamed.

Around the world, Fresenius has more than 122,000 employees, the majority in the United States.

La società è svedesed ma è maggioritariamente presente negli usa
http://www.fresenius.se/internet/fag/com/faginpub.nsf/Content/Fresenius+Kabi+(Products+and+Services)
specializzata nella gestione e nell'organizzazione di reparti per terapie intensive
http://www.fresenius.se/internet/fa...ntent/Fresenius+VAMED+(Products+and+Services)
ha un settore di biotech
si occupa della preservazione e del mantenimento degli organi trapiantati
Immunosuppressive agent ATG-Fresenius S
Fluids and disposables for organ perfusion and preservation
Cell products for research and clinical application
Vector production gene therapy

Fatturati e risultati in crescita
http://www.fresenius.se/internet/fag/com/faginpub.nsf/AttachmentsByTitle/At+a+glance+FSE+07_08/$FILE/AeB+2007_08_englisch.pdf
http://www.fresenius.se/internet/fa...700e00405e26?OpenDocument#Peritoneal dialysis
 
alla faccina della crisi ecco il primo trimestre
Q1 2009: Successful start into 2009
(for additional tables please see pdf-file)
April 30, 2009
Bad Homburg v.d.H.



Sales € 3.4 billion, +21 % at actual rates, +15 % in constant currency
EBIT € 477 million, +27 % at actual rates, +20 % in constant currency
Adjusted net income1 € 110 million, +10 % at actual rates, +6 % in constant currency
Strong sales and earnings growth
Positive impact of currency translation
All business segments fully on track − guidance for 2009 confirmed

Group outlook for 2009 confirmed
Based on the Group’s strong first quarter financial results Fresenius fully confirms its positive outlook for 2009. Group sales are expected to grow by more than 10 % in constant currency. Organic growth is projected to be in a 6 to 8 % range. Adjusted net income1 is expected to increase by approximately 10 % in constant currency.

Fresenius plans to invest € 700 to 750 million in property, plant and equipment (2008: € 764 million).

Strong sales growth across all business segments
Group sales increased by 15 % in constant currency and by 21 % at actual rates to € 3,373 million (Q1 2008: € 2,798 million). Organic sales growth was 8 %. Acquisitions contributed a further 7 %. Currency translation had a positive impact of 6 %. This is mainly attributable to the average US dollar rate improving 13 % against the euro.

Sales growth in the business segments was as follows:



In Europe sales grew by 12 % in constant currency with organic sales growth contributing 8 %. In North America sales grew by 18 % in constant currency. Organic growth was 7 %. The strong increase in constant currency sales is mainly due to the consolidation of APP Pharmaceuticals from September 2008. Acquisitions contributed 11 %. Strong organic growth rates were achieved in the emerging markets, reaching 16 % in Asia-Pacific and 14 % in Latin America.




Strong earnings growth
Group EBITDA increased by 21 % in constant currency and by 27 % at actual rates to € 613 million (Q1 2008: € 483 million). Group operating income (EBIT) grew by 20 % in constant currency and by 27 % at actual rates to € 477 million (Q1 2008: € 377 million). The Group’s EBIT margin was 14.1 % (Q1 2008: 13.5 %).

Group net interest was € -145 million (Q1 2008: € -84 million). Lower average interest rates on liabilities of Fresenius Medical Care were more than offset by incremental debt relating to the acquisitions of APP Pharmaceuticals and Dabur Pharma and currency translation effects.

The other financial result was € 77 million and includes valuation changes of the fair redemption value of both the Mandatory Exchangeable Bonds (MEB) and the Contingent Value Rights (CVR).

The Group tax rate was 33.4 % (Q1 2008: 35.2 %).

Noncontrolling interest increased to € 111 million (Q1 2008: € 90 million), of which 93 % was attributable to the noncontrolling interest in Fresenius Medical Care.

Adjusted net income1 grew by 6 % in constant currency and by 10 % at actual rates to € 110 million (Q1 2008: € 100 million). Both adjusted earnings per ordinary share and adjusted earnings per preference share increased to € 0.68 (Q1 2008: ordinary share € 0.64, preference share € 0.64). This represents an increase of 3 % for both share classes in constant currency.

Reconciliation to net income according to US GAAP
The Group’s US GAAP quarterly financial results as of March 31, 2009 include the effects of mark-to-market accounting of the Mandatory Exchangeable Bonds (MEB) and the Contingent Value Rights (CVR) relating to the acquisition of APP Pharmaceuticals. Those special items are recognized in the financial result of the “Corporate/Other” segment. Adjusted earnings represent the Group’s business operations in the reporting period.

The table reconciles adjusted net income to net income according to US GAAP in the first quarter of 2009:



Both the Mandatory Exchangeable Bonds and the Contingent Value Rights are viewed as liabilities and therefore recognized with their fair redemption value. Valuation changes will lead to gains or expenses on a quarterly basis until maturity of the instruments.

Net income2 (including special items) was € 164 million or € 1.02 both per ordinary share and per preference share.

Continued investments in growth
Fresenius Group spent € 128 million for property, plant and equipment (Q1 2008: € 154 million). Acquisition spending was € 112 million (Q1 2008: € 216 million).

Cash flow development
Operating cash flow of € 182 million was below previous year’s € 278 million mainly due to an increase of inventories. Net capital expenditure was € 147 million (Q1 2008: € 161 million). Cash flow before acquisitions and dividends was € 35 million (Q1 2008: € 117 million).

Balance sheet
Fresenius Group’s total assets increased by 2 % in constant currency and by 5 % at actual rates to € 21,537 million (December 31, 2008: € 20,544 million). Current assets increased by 5 % in constant currency and by 7 % at actual rates to € 5,436 million (December 31, 2008: € 5,078 million). Non-current assets grew by 1 % in constant currency and by 4 % at actual rates to € 16,101 million (December 31, 2008: € 15,466 million).

Total shareholders’ equity increased by 3 % in constant currency and by 6 % at actual rates to € 7,372 million (December 31, 2008: € 6,943 million). The equity ratio (including noncontrolling interest) improved to 34.2 % (December 31, 2008: 33.8 %).

Group debt increased by 2 % in constant currency and by 5 % at actual rates to € 9,199 million (December 31, 2008: € 8,787 million). The acquisition financing of APP Pharmaceuticals was successfully completed in January 2009. As of March 31, 2009, the net debt/EBITDA ratio (pro forma the acquisition of APP Pharmaceuticals and excluding special items) was 3.6 (December 31, 2008: 3.6).

Number of employees increased
As of March 31, 2009, Fresenius increased the number of its employees by 4 % to 126,849 (December 31, 2008: 122,217).

Fresenius Biotech
Fresenius Biotech develops innovative therapies with trifunctional antibodies for the treatment of cancer. In the field of polyclonal antibodies, Fresenius Biotech has successfully marketed ATG-Fresenius S for many years. ATG-Fresenius S is an immunosuppressive agent used to prevent and treat graft rejection following organ transplantation.

On April 22, 2009, the European Commission granted Fresenius Biotech the approval for Removab (catumaxomab) for the treatment of malignant ascites with immediate effect. It is the first drug worldwide with a regulatory label for the treatment of malignant ascites and provides an important new therapy approach. The European Commission’s decision will apply to all EU member states. Removab will initially be launched in Germany within the next few weeks and will subsequently be introduced in other European countries.

Fresenius Biotech’s EBIT was € -10 million in the first quarter of 2009 (Q1 2008: € -9 million). For 2009, Fresenius Biotech confirms its guidance of an EBIT of € -40 million to € -50 million.


1 Net income attributable to Fresenius SE; adjusted for the effects of mark-to-market accounting of the Mandatory Exchangeable Bonds (MEB) and the Contingent Value Rights (CVR) relating to the acquisition of APP Pharmaceuticals.
2 Net income attributable to Fresenius SE.


The Business Segments

Fresenius Medical Care
Fresenius Medical Care is the world’s leading provider of services and products for patients with chronic kidney failure. As of March 31, 2009, Fresenius Medical Care was treating 187,476 patients in 2,448 dialysis clinics.




Strong organic sales growth of 8 % achieved
Outlook 2009 fully confirmed
Fresenius Medical Care achieved sales growth of 2 % to US$ 2,560 million (Q1 2008: US$ 2,512 million). Organic growth was 8 %. Currency translation effects had a negative impact of 6 %. Sales in dialysis services revenue increased by 4 % to US$ 1,923 million (Q1 2008: US$ 1,844 million). In dialysis products sales were US$ 637 million (Q1 2008: US$ 667 million). In constant currency, dialysis products sales increased by 8 %.

In North America sales increased by 6 % to US$ 1,774 million (Q1 2008: US$ 1,668 million). Dialysis services revenue grew by 5 % to US$ 1,577 million. Average revenue per treatment for the U.S. clinics was at US$ 338 in the first quarter of 2009 compared to US$ 326 for the first quarter of 2008 and 335 US$ for the fourth quarter of 2008. This development was based on an increase in underlying reimbursement rates and stable EPO utilization. Sales outside North America (“International” segment) were US$ 786 million (Q1 2008: US$ 844 million). In constant currency, sales growth was 11 %.

EBIT increased by 2 % to US$ 396 million (Q1 2008: US$ 389 million) resulting in an EBIT margin of 15.5 % (Q1 2008: 15.5 %). The margin development mainly reflects higher personnel expenses, increased pharmaceutical costs and the impact of one less dialysis day in the first quarter of 2009 compared to the first quarter of 2008. These effects were partially offset by increased dialysis treatment rates and sales of the newly licensed iron products. Net income* increased by 7 % to US$ 198 million (Q1 2008: US$ 186 million).

Fresenius Medical Care fully confirms its outlook for 2009: the company expects to achieve revenue of more than US$ 11.1 billion, which is more than 8 % growth in constant currency. Net income* is expected to be between US$ 850 million and US$ 890 million in 2009.

For further information, please see Fresenius Medical Care’s Investor News at www.fmc-ag.com.

* Net income attributable to Fresenius Medical Care AG & Co. KGaA


Fresenius Kabi
Fresenius Kabi offers infusion therapies, intravenously administered generic drugs and clinical nutrition for seriously and chronically ill patients in the hospital and out-patient environments. The company is also a leading provider of medical devices and transfusion technology products.





Strong sales and EBIT growth
Outlook 2009 fully confirmed
Fresenius Kabi increased sales by 32 % to € 722 million (Q1 2008: € 545 million). Organic sales growth was 7 %. Net acquisitions contributed 28 % to sales. Currency translation had a net negative impact of 3 %. This was mainly due to the depreciation of currencies in Great Britain, Brazil and South Africa against the euro, whereas positive translation effects resulted from the strengthening of the Chinese yuan.

In Europe, sales reached € 376 million, driven by 5 % organic growth. In North America, sales increased from € 30 million in the first quarter of 2008 to € 168 million in the first quarter of 2009 due to the acquisition of APP Pharmaceuticals. Organic sales growth was 3 %. In the Asia-Pacific region Fresenius Kabi achieved organic sales growth of 10 % to € 111 million. Sales in Latin America and Africa increased to € 67 million, driven by 20 % organic growth.

EBIT grew by 59 % to € 138 million (Q1 2008: € 87 million). EBIT includes a € 7 million non-cash charge related to the amortization of APP intangible assets. The EBIT margin increased to 19.1 % (Q1 2008: 16.0 %). Net interest increased to € 79 million (Q1 2008: € 17 million) due to the acquisition financing. Net income* was € 38 million (Q1 2008: € 46 million).

Sales at APP Pharmaceuticals were US$ 192 million in the first quarter of 2009. Adjusted EBITDA** was US$ 81 million and EBIT was US$ 61 million.

Fresenius Kabi fully confirms its outlook for 2009: the company targets sales growth in constant currency of 25 to 30 %. Further, Fresenius Kabi forecasts an EBIT margin in the range of 19.5 to 20.5 %. Currency translation effects may impact Fresenius Kabi's margin as APP provides a significant earnings contribution from the US$ area. This guidance is based on the US$/€ exchange rate from the beginning of 2009.

Special items relating to the acquisition of APP Pharmaceuticals are included in the segment “Corporate/Other”.

* Net income attributable to Fresenius Kabi AG
** Non-GAAP financial measures − Adjusted EBITDA is a defined term in the indenture governing the Contingent Value Rights (CVRs), however it is not a recognized term under GAAP.


Fresenius Helios
Fresenius Helios is one of the largest private hospital operators in Germany. The HELIOS Kliniken Group owns 62 hospitals, including five maximum care hospitals in Berlin-Buch, Erfurt, Krefeld, Schwerin and Wuppertal. HELIOS treats about 600,000 in-patients per year at its clinics and operates a total of more than 18,000 beds.




Excellent sales and earnings growth
Outlook 2009 fully confirmed
Fresenius Helios increased sales by 13 % to € 577 million (Q1 2008: € 509 million). Net acquisitions contributed 8 % to overall sales growth. Strong organic growth of 5 % on a like-for-like basis was again driven by a significant increase in patient numbers.

EBIT grew by 16 % to € 44 million (Q1 2008: € 38 million) due to the excellent business operations of the established clinics. The EBIT margin was 7.6 % (Q1 2008: 7.5 %). Net income* improved by 33 % to € 20 million (Q1 2008: € 15 million).

At HELIOS’ established clinics, sales rose by 5 % on a like-for-like basis to € 536 million. EBIT improved by 16 % to € 44 million. The EBIT margin increased to 8.2 % (Q1 2008: 7.5 %). The acquired clinics (consolidation <1 year) achieved sales of € 41 million and a marginally negative EBIT.

Fresenius Helios fully confirms its outlook for 2009: the company expects to achieve sales of more than € 2.3 billion. EBIT is projected to increase to € 180 to 200 million.

* Net income attributable to HELIOS Kliniken GmbH

Fresenius Vamed
Fresenius Vamed offers engineering and services for hospitals and other health care facilities.




Strong order backlog ensures further growth
Outlook 2009 fully confirmed
Fresenius Vamed achieved strong sales growth of 57 % to € 116 million (Q1 2008: € 74 million). The clinics in the Czech Republic acquired from Fresenius Helios contributed 8 %. Organic sales growth was 49 %. Sales in the project business rose by 94 % to € 68 million (Q1 2008: € 35 million). Sales in the service business increased by 23 % to € 48 million (Q1 2008: € 39 million).

EBIT was € 4 million, unchanged from previous year. Significant sales growth driven by a strong project business in the first quarter of 2009 diluted the EBIT margin to 3.4 %
(Q1 2008: 5.4 %). Net income* of € 4 million was also at previous year’s level.

Fresenius Vamed reported an order intake of € 88 million (Q1 2008: € 125 million).

Order backlog increased by 4 % to € 592 million, close to its all-time high of € 595 million in the first quarter of 2008 (December 31, 2008: € 571 million).

Fresenius Vamed fully confirms the outlook for 2009 and expects to achieve both sales and EBIT growth of 5 to 10 %.

** Net income attributable to VAMED AG


Analyst Conference Call and Audio Webcast
As part of the publication of the results for first quarter of 2009 a conference call will be held on April 30, 2009 at 2.00 p.m. CEDT (8.00 a.m. EDT). All investors are cordially invited to follow the conference call in a live broadcast over the Internet at www.fresenius.com see Investor Relations / Presentations. Following the call, a recording will be available.

Quarterly financial report
The report for the first quarter 2009 will be published on May 12, 2009 (US GAAP) and on May 15, 2009 (IFRS) on our website www.fresenius.com see Investor Relations / Financial Reports.


# # #

This release contains forward-looking statements that are subject to various risks and uncertainties. Future results could differ materially from those described in these forward-looking statements due to certain factors, e.g. changes in business, economic and competitive conditions, regulatory reforms, results of clinical trials, foreign exchange rate fluctuations, uncertainties in litigation or investigative proceedings, and the availability of financing. Fresenius does not undertake any responsibility to update the forward-looking statements in this release.

--------------------------------------------------------------------------------
© 30.04.2009 - Fresenius SE
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For further information please send an
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Home > Investor Relations > News > Investor News > 2009
 
società leader nella nutrizione via flebo... campo questo importantissimo
http://www.fresenius-kabi.com/
WELCOME
Fresenius Kabi is the leader in infusion therapy and clinical nutrition in Europe and in its most important countries of Latin America and Asia Pacific. Within I.V. generic drugs, Fresenius Kabi counts among the leading suppliers in the U.S. market.

All over the world more than 20,000 employees are committed to improving the quality of life of critically and chronically ill patients with innovative products for patients in hospitals and outpatients
 
catena di cliniche
http://www.fresenius.se/internet/fag/com/faginpub.nsf/Content/Fresenius+HELIOS+(Caring+for+health)
HELIOS
The HELIOS Kliniken Group is one of the largest and most medically-advanced operators of both in- and outpatient care in Europe, offering expertise in all areas of clinical care. Based in Berlin, the Group owns and operates 62 clinics, including five maximum care hospitals in Erfurt, Berlin-Buch, Wuppertal, Schwerin and Krefeld. HELIOS hospitals provide inpatient care to some 600,000 patients annually.

Expertise in medicine

The HELIOS Kiliniken Group boasts first-class quality medical care, and its hospitals exceed the industry’s highest standards. In addition to providing the best available treatment for its own patients, HELIOS’ top priority is to further raise the standard of patient care throughout the industry.

For more information, please visit the homepage of the HELIOS Kliniken Group

For further information in English, please visit HELIOS healthcare international, a special web site for international patients
 
farmaci per combattere il rigetto da trapianto
http://www.fresenius.se/internet/fag/com/faginpub.nsf/Content/Transplantation
e per curare il cancro attraverso farmaci che potenziano le capacità dell'organismo di distruggere le cellule malate
Fresenius Biotech GmbH is a company of the Fresenius health care group, focused on the development and marketing of biopharmaceuticals in the fields of oncology and immunology/transplantation medicine.

The main business activities of Fresenius Biotech are:



Immunosuppression in organ transplantation
Development of trifunctional antibodies for cancer treatment

Immunosuppression in organ transplantation

Fresenius Biotech is manufacturing and commercializing an immunosuppressive agent, a polyclonal antibody that is used in organ transplantation. This medicinal product has been proven to be effective in suppressing the rejection of organs by the immune system. Currently, the efficacy and safety of this immunosuppressant are being assessed in clinical trials for bone marrow transplantation and stem cell transplantation.

Development of trifunctional antibodies for cancer treatment

This innovative therapy with trifunctional antibodies activates the immune system to destroy tumor cells. Currently, clinical studies are investigating the antibodies for use against various tumors. Possible therapeutic options for future applications of the antibodies could be an adjuvant setting (after surgical resection of a tumor) or as additional immune therapy after previous chemo- or radiation therapy. Fresenius Biotech has successfully completed several clinical studies. The European Commission has approved the trifunctional antibody Removab (catumaxomab) for the treatment of malignant ascites. Trifunctional antibodies are a development of our partner TRION Pharma.
http://www.fresenius.se/internet/fag/com/faginpub.nsf/AttachmentsByTitle/Biotech+Company+Profile/$FILE/Company+Profile_E_Final_05_2008.pdf
 
struttura del capitale
http://www.fresenius.se/internet/fag/com/faginpub.nsf/Content/Key+Data
e storia alquanto complicata
http://www.fresenius.se/internet/fag/com/faginpub.nsf/Content/Shareholder+Structure

At the beginning of 2009, we conducted a shareholder survey covering 90 % of our subscribed capital. 98 % of the ordinary shares and 82 % of the preference shares were identified.

According to this survey, 289 institutional investors held about 86.8 million shares. This was split into 24.0 million ordinary shares and 62.8 million preference shares. 2.0 million ordinary shares and 3.5 million preference shares were identified as retail holdings. The top ten investors hold approximately 16 % of the ordinary share capital and approximately 27 % of the preference share capital.

The geographical distribution of the Fresenius shares became more international in 2008. Approximately 20 % of the preference shares and approximately 11 % of the ordinary shares are held by US investors (2007: 13 % and 9 %, respectively). Investors in Great Britain hold about 26 % of the preference shares and about 8 % of the ordinary shares (2007: 24 % and 9 %, respectively). The relative weight of German investors declined: approximately 15 % of the preference shares are held by German investors (2007: 17 %). The figure for the ordinary shares is about 4 % (2007: 4 %).
Return
In 2008, the prices of both our ordinary shares and preference shares were affected by the repercussions of the global financial market crisis. At the end of the year, the ordinary share had lost 35 %, while the preference share was down 27 % from its price at the beginning of the year. Despite excellent financial results and a positive company outlook, Fresenius shares were unable to escape the general market trend. Both share classes exceeded the DAX and the MDAX but underperformed the Dow Jones Stoxx European Healthcare sector index (-18 %) and the German DAXsector Pharma & Healthcare index (-22 %).

On December 22, 2008, at € 31.93, the ordinary share reached its low for the year, recovering only slightly to close the year at € 36.23. Its high for the year, € 60.87, was reached on May 19, 2008. The preference share registered its low for the year, € 37.23, on December 11, 2008 and its high, € 59.25, as early as January 9, 2008.

It closed the year at € 41.59. Out of the 110 companies listed in the Deutsche Börse index HDAX, Fresenius was ranked 24th, at the end of 2008. Fresenius SE’s market capitalization as of December 31, 2008 was € 6.3 billion. As the following table shows, the average daily trading volume in Fresenius shares on Xetra has continued to rise.


andamento del titolo sotto 40€
http://www.fresenius.se/internet/fag/com/faginpub.nsf/Content/Share+Price
le ordinarie
http://www.fresenius.se/internet/fag/com/faginpub.nsf/Content/Ordinary+Shares
 
gli stocastici l'RSI la bollinger inferiore danno segnale di acquisto. Anche il macd è in zona acquisto anche se incerto
 

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bello schizzo da ieri: supera i 33 di slancio
 
sopra i 34, molto bene. I volumi dovrebbero superare la media. Ottimo titolo
 
ritornata a 31. bene per eventuale rimbalzo
 
Fresenius Medical Care: Exane BNP Paribas alza rating a outperform da neutral

Finanzaonline.com - 24.7.09/10:20

Gli analisti della banca francese, Exane BNP Paribas, hanno migliorato la loro valutazione su Fresenius Medical Care. Il broker ha alzato la raccomandazione sulla società, portandola da neutral ad outperform con target price individuato a 41 euro.
 
Girovagando nel dax spesso si trovano configurazioni interessanti :D questa nn ha tutte le div al posto giusto ma forse un giretto short si potrebbe fare alla rotture della 1-3-5 :rolleyes:
 

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occhio..
***Fresenius Medical Care: espande attività dialisi in Russia***

Finanzaonline.com - 30.6.10/08:38

Fresenius Medical Care: espande attività dialisi in Russia
 
sopra 44. Bel titolo da tenere in portafoglio
 
occhio..
***Fresenius Medical Care: espande attività dialisi in Russia***

Finanzaonline.com - 30.6.10/08:38

Fresenius Medical Care: espande attività dialisi in Russia

credo che la dialisi peritoneale conoscerà una grande espansione nei prox anni. Quindi i titoli forti in questo settore vanno seguiti con grrandde attenzione. Rispetto all'emodialisi costa circa 1\3 . Ogni paziente trattato con la peritoneale costa circa 30.000 € all'anno. Si può facilmente capire le potenzialità del settore se pensiamo all'espansione del trattamento nei paesi dell'est asiatico, oltre che nei nostri. Qui anche se con una certa riluttanza da parte dei reparti ospedalieri, che hanno interesse a finanziare le attività ospedaliere conoscerà, per motivi di budget una buona espansione..
 
in italia i margini di incremento per la peritoneale, osteggiata dai centri sopedalieri sono elevatissimi
L'indagine del Censis sui costi e l'efficacia dei principali trattamenti dialitici rivela che il costo totale, come somma di costo economico e costo sociale, facente capo ai circa 39 mila pazienti presenti in Italia risulta pari a quasi 2 mila e settecento miliardi di lire, di cui circa 700 miliardi rappresentano il costo sociale (pari a oltre un quarto del costo totale) in gran parte ad esclusivo carico delle famiglie.

Il 90% circa dei pazienti (34.919 pari all'89,6%) utilizza i trattamenti extracorporei, mentre il rimanente 10% ricorre alle diverse metodiche di dialisi peritoneale. Tuttavia, si riscontra una distribuzione non omogenea delle tipologie di trattamento a livello territoriale, con il prevalere dei trattamenti extracorporei soprattutto al Sud (il 94,7% dei pazienti è attualmente in emodialisi) e la diffusione della peritoneale soprattutto nel Nord del paese dove i pazienti che utilizzano questa metodica rappresentano il 15,3% (a fronte del 5,3% del Sud e delle Isole). Tale distribuzione dei pazienti per metodica si spiega anche sulla base della diversa localizzazione dei centri pubblici e privati di dialisi; infatti, i pazienti dializzati in centri privati sono solo il 2% al Nord, il 26% al Centro e il 49% al Sud. La situazione italiana differisce da quella europea ove la diffusione media della peritoneale è intorno al 13%, con una media di circa il 25% nei paesi del Nord-Europa ed una percentuale pari al 37,5% nel Regno Unito.

Sotto il profilo dei costi, i dati dell'indagine di campo condotta in tre diverse regioni italiane (Piemonte, Emilia Romagna e Sicilia) dimostrano che i diversi trattamenti di dialisi peritoneale hanno costi medi più bassi rispetto a tutti i trattamenti di dialisi extracorporea svolti in ospedale e nei Cal (tabb. 1,2,3).

Il vantaggio competitivo dei trattamenti peritoneali è ancora maggiore se si focalizza l'attenzione sul costo sociale (che include alcuni costi, soprattutto indiretti, a carico del paziente e del caregiver); infatti, le due metodiche di dialisi peritoneale automatizzata (CCPD e APD) che vengono svolte di notte e lasciano ai pazienti maggiori possibilità di lavorare e avere una vita sociale, azzerano i costi sociali, che invece risultano particolarmente pesanti per i trattamenti di emodialisi in ospedale, in Cal e, soprattutto, a domicilio.

Per tenere conto della periodicità dei trattamenti, si è calcolato anche il costo annuale per paziente, dal quale emerge che la CCPD è la modalità di trattamento meno onerosa, immediatamente seguita dall'APD.

Perché dunque in Italia il trattamento tendenzialmente più conveniente e meno oneroso per le famiglie risulta meno diffuso? Dall'analisi qualitativa effettuata a partire dai pareri di medici e personale amministrativo delle regioni analizzate è emerso il prevalere delle logiche dell'organizzazione sanitaria e dell'offerta sulle esigenze degli utenti.

Inoltre, i risultati evidenziano la necessità di un approccio più flessibile, che contempli intercambiabilità e integrazione dei trattamenti adattandoli al mutare delle condizioni cliniche, sociali e psicologiche del paziente e della sua storia di malattia.


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