Cost-effectiveness of HCV screening: a systematic review of the literature from 2007 to 2012

Background: currently, 123-170 million people in the world are infected with Hepatitis C Virus (HCV) and 75% of them remain undiagnosed. HCV-positive individuals will develop Chronic Hepatitis C (CHC) or hepatocellular carcinoma (HCC) within 25 years in 20-30% of cases. Early detection of HCV has been demonstrated to increase quality-adjusted life years (QALY) and to improve the behaviour of the infected population. Current national policies usually recommend regular screenings only for at-risk populations. A systematic review of the recent evidence on long-term cost-effectiveness of HCV screening in different populations was performed. Methods: resources were searched on publicly available databases (PubMed, ScienceDirect, NHS EED, Cochrane Library) and Google®. Studies were considered eligible if published between 2007 and 2012 and if providing measures of incremental cost-effectiveness ratio (ICER) or incremental cost utility ratio (ICUR ) of HCV screening in terms of cost/life years gained (LYG) and cost/QALY. All the costs were converted into Euro (€) for 2011. A weighted version of the Drummond checklist was used to further assess the quality of the included studies. Results: six articles were selected and analysed. Three U.S. and one Japanese studies suggested a positive cost-effectiveness profile of broad birth-cohort and population screening. Other studies conducted in Italy and the UK demonstrated high variability in the cost-effectiveness in different study populations. All the studies were judged of medium-high quality. Conclusions: cost-effectiveness of HCV screening significantly varies among countries and study populations. Prevalence in the population should be one of the criteria for policy-makers for future decisions and recommendations. New Direct-Acting Antiviral agents might increase the costeffectiveness of early HCV screening. Future studies should also focus on migrants and men who have sex with men (MSM) populations

A systematic review of the cost-effectiveness of lifestyle modification as primary prevention intervention for type 2 diabetes mellitus

Background: diabetes is one of the leading causes of death, and has a huge economic impact on the burden of society. Lifestyle interventions such as diet, physical activity and weight reducing are proven to be effective in the prevention of diabetes. To encourage policy actions, data on the costeffectiveness of such strategies of prevention programmes are needed. Methods: a systematic review of the literature on the cost-effectiveness of prevention strategies focusing on lifestyle interventions for diabetes type 2 patients. A weighted version of Drummond checklist was used to further assess the quality of the included studies. Results: six studies met the inclusion criteria and were therefore considered in this paper. Intensive lifestyle intervention to prevent diabetes type 2 is cost-effective in comparison to other interventions. All studies were judged of medium-to-high quality. Conclusions: policy makers should consider the adoption of a prevention strategy focusing on intensive lifestyle changes because they are proven to be either cost-saving or cost-effective

Capturing the chance for pneumococcal vaccination in the hospital setting

Introduction: Because of the relevant burden of pneumococcal diseases, people at risk and elderly are recommended vaccination but coverage is still low because of problems in catching them. This study evaluates the proportion of eligible patients in the hospital in the view of assessing its potential role in vaccination campaigns.Methods: this is a retrospective analysis of discharge data from all patients over 49 years of age admitted between 2011 and 2013 to ‘A. Gemelli’ teaching hospital. Eligibility for pneumococcal vaccination was evaluated based on ICD-9 codes.Results: among 65,047 unique patients, 53.2% were eligible for pneumococcal vaccination. Most common eligibility criteria were chronic heart diseases, cancer and diabetes. Considering also age ≥ 65 as an indication to vaccination, the proportion of eligible patients reached 76.8%. In absolute terms the most of eligible patients were seen in medical sciences, general surgery, cardiovascular medicine and neurosciences departments.Conclusions: the proportion of patients eligible to vaccination is high in the hospital and the latter may play an important role in catching them

Cost-effectiveness of HCV screening: A systematic review of the literature from 2007 to 2012

Background: currently, 123-170 million people in the world are infected with Hepatitis C Virus (HCV) and 75% of them remain undiagnosed. HCV-positive individuals will develop Chronic Hepatitis C (CHC) or hepatocellular carcinoma (HCC) within 25 years in 20-30% of cases. Early detection of HCV has been demonstrated to increase quality-adjusted life years (QALY) and to improve the behaviour of the infected population. Current national policies usually recommend regular screenings only for at-risk populations. A systematic review of the recent evidence on long-term cost-effectiveness of HCV screening in different populations was performed. Methods: resources were searched on publicly available databases (PubMed, ScienceDirect, NHS EED, Cochrane Library) and Google\uae. Studies were considered eligible if published between 2007 and 2012 and if providing measures of incremental cost-effectiveness ratio (ICER) or incremental cost utility ratio (ICUR) of HCV screening in terms of cost/life years gained (LYG) and cost/QALY. All the costs were converted into Euro (\u20ac) for 2011. A weighted version of the Drummond checklist was used to further assess the quality of the included studies. Results: six articles were selected and analysed. Three U.S. and one Japanese studies suggested a positive cost-effectiveness profile of broad birth-cohort and population screening. Other studies conducted in Italy and the UK demonstrated high variability in the cost-effectiveness in different study populations. All the studies were judged of medium-high quality. ConclusionS: cost-effectiveness of HCV screening significantly varies among countries and study populations. Prevalence in the population should be one of the criteria for policy-makers for future decisions and recommendations. New Direct-Acting Antiviral agents might increase the costeffectiveness of early HCV screening. Future studies should also focus on migrants and men who have sex with men (MSM) populations

A systematic review of the cost-effectiveness of lifestyle modification as primary prevention intervention for diabetes mellitus type 2

Background: diabetes is one of the leading causes of death, and has a huge economic impact on the burden of society. Lifestyle interventions such as diet, physical activity and weight reducing are proven to be effective in the prevention of diabetes. To encourage policy actions, data on the costeffectiveness of such strategies of prevention programmes are needed. Methods: a systematic review of the literature on the cost-effectiveness of prevention strategies focusing on lifestyle interventions for diabetes type 2 patients. A weighted version of Drummond checklist was used to further assess the quality of the included studies. Results: six studies met the inclusion criteria and were therefore considered in this paper. Intensive lifestyle intervention to prevent diabetes type 2 is cost-effective in comparison to other interventions. All studies were judged of medium-to-high quality. ConclusionS: policy makers should consider the adoption of a prevention strategy focusing on intensive lifestyle changes because they are proven to be either cost-saving or cost-effective

[Molecular epidemiology in healthcare-associated infections: guidelines of the Italian Society of Hygiene, Preventive Medicine and Public Health (SItI)]

Healthcare-associated infections (HAI) are the most frequent and severe complication acquired in healthcare settings and have a significant impact in terms of morbidity, mortality and costs. This document is aimed at different health professionals and focuses on the role of molecular epidemiology in the prevention and management of these infections. It describes the role of molecular characterization and of bioinformatics archives, the organizational levels of laboratories, the evidence regarding cost-effectiveness, ethical aspects related to HAI, and highlights some specific peculiarities of Italy. Molecular epidemiology is an indispensable tool and should be part of a multidisciplinary approach in the proper management of HAI

Direct-to-Consumer Genetic Testing: A Systematic Review of European Guidelines, Recommendations, and Position Statements

Background: Personalized healthcare is expected to yield promising results, with a paradigm shift toward more personalization in the practice of medicine. This emerging field has wide-ranging implications for all the stakeholders. Commercial tests in the form of multiplex genetic profiles are currently being provided to consumers, without the physicians' consultation, through the Internet, referred to as direct-to-consumer genetic tests (DTC GT). Objectives: The objective was to review all the existing European guidelines on DTC GT, and its associated interventions, to list all the supposed benefits and harms, issues and concerns, and recommendations. Methods: We conducted a systematic review of position statements, policies, guidelines, and recommendations, produced by professional organizations or other relevant bodies for use of DTC GT in Europe. Results: Seventeen documents met the inclusion criteria, which were subjected to thematic analysis, and the texts were coded for statements related to use of DTC GT. Discussion and Conclusions: Professional societies and associations are currently more suggestive of potential disadvantages of DTC GT, recommending improved genetic literacy of both populations and health professionals, and implementation research on the genetic tests to integrate public health genomics into healthcare systems

Public Health Genomics education in post-graduate schools of hygiene and preventive medicine: a cross-sectional survey

BACKGROUND: The relevance of Public Health Genomics (PHG) education among public health specialists has been recently acknowledged by the Association of Schools of Public Health in the European Region. The aim of this cross-sectional survey was to assess the prevalence of post-graduate public health schools for medical doctors which offer PHG training in Italy. METHODS: The directors of the 33 Italian public health schools were interviewed for the presence of a PHG course in place. We stratified by geographical area (North, Centre and South) of the schools. We performed comparisons of categorical data using the chi-squared test. RESULTS: The response rate was 73% (24/33 schools). Among respondents, 15 schools (63%) reported to have at least one dedicated course in place, while nine (38%) did not, with a significant geographic difference. CONCLUSIONS: Results showed a good implementation of courses in PHG discipline in Italian post-graduate public health schools. However further harmonization of the training programs of schools in public health at EU level is needed

Economic impact of schizophrenia on health systems [Pitch presentation]

Background Schizophrenia represents an important public health issue. An assessment of its costs would be useful to provide recommendations for policy and decision-making strategies. The aims of our study were to carry out a systematic review to assess the economic burden of schizophrenia in terms of direct and indirect costs and to perform a quality appraisal of the analysed studies. Methods A literature search was carried out on PubMed, Scopus and Cochrane Library to retrieve cost-of-illness (COI) analyses focused on schizophrenia and published up to December 2015. COI analyses that considered direct and indirect costs were included. Each included manuscript was independently appraised by three researchers on the basis of the British Medical Journal Drummond\u2019s checklist. Results 2724 articles were initially retrieved, and 84 were included in the current review. The included studies showed a medium\u2013 high-quality level. The available studies seemed to be heterogeneous both in terms of methodology and results reporting. Extrapyramidal symptoms in patients with schizophrenia seemed to be associated with increased healthcare resource utilization and higher medical costs. Indirect costs were evaluated in 32 studies from a societal perspective and, in almost all these studies, their estimation exceed those provided for direct costs. High social costs of schizophrenia were also described for caregivers of schizophrenia patients. Conclusions The review confirmed that schizophrenia absorbs a huge amount of health-care resources. Further research is therefore needed to better understand the economic impact and to identify and promote public health strategies to tackle obesit