Economic consequences of investing in anti-HCV antiviral treatment from the Italian NHS perspective : a real-world-based analysis of PITER data

OBJECTIVE: We estimated the cost consequence of Italian National Health System (NHS) investment in direct-acting antiviral (DAA) therapy according to hepatitis C virus (HCV) treatment access policies in Italy. METHODS: A multistate, 20-year time horizon Markov model of HCV liver disease progression was developed. Fibrosis stage, age and genotype distributions were derived from the Italian Platform for the Study of Viral Hepatitis Therapies (PITER) cohort. The treatment efficacy, disease progression probabilities and direct costs in each health state were obtained from the literature. The break-even point in time (BPT) was defined as the period of time required for the cumulative costs saved to recover the Italian NHS investment in DAA treatment. Three different PITER enrolment periods, which covered the full DAA access evolution in Italy, were considered. RESULTS: The disease stages of 2657 patients who consecutively underwent DAA therapy from January 2015 to December 2017 at 30 PITER clinical centres were standardized for 1000 patients. The investment in DAAs was considered to equal €25 million, €15 million, and €9 million in 2015, 2016, and 2017, respectively. For patients treated in 2015, the BPT was not achieved, because of the disease severity of the treated patients and high DAA prices. For 2016 and 2017, the estimated BPTs were 6.6 and 6.2 years, respectively. The total cost savings after 20 years were €50.13 and €55.50 million for 1000 patients treated in 2016 and 2017, respectively. CONCLUSIONS: This study may be a useful tool for public decision makers to understand how HCV clinical and epidemiological profiles influence the economic burden of HCV

Genetic bases of barley resistance to the leaf stripe agent Pyrenophora graminea

Leaf stripe, caused by Pyrenophora graminea, is a serious disease of barley in many production areas. Genetic mapping of major genes and quantitative trait loci (QTLs) for this disease has revealed resistance loci on chromosomes 1 (7H), 2 (2H) and 3 (3H). QTLs for partial resistance have been identified in segregating populations derived from the crosses between Proctor and Nudinka, L94 and Vada, L94 and C123, and Steptoe and Morex. Major genes conferring a useful range of activity have been identified in the barley cultivars Vada and Thibaut. The Thibaut resistance gene, Rdg2a, has been subjected to high resolution mapping and a syntenic relationship of the resistance gene locus with rice chromosome 6 has been established. In the course of mapping major and quantitative disease resistance loci, molecular markers for resistance breeding for disease control using gene technology have been identified and validated for utilization in marker-assisted selection of disease resistance

Weight loss and clinical characteristics of young adults patients seeking treatment at medical centers: Data from the QUOVADIS Study

Objective: To compare the clinical characteristics, attrition, weight loss, and psychological changes of young adults and adults treated at Italian medical centers. Research Methods and Procedures: 1530 individuals seeking treatment in 18 Italian medical centers (1194 females and 336 males; age, 44.6\ub111.0 years; BMI, 37.9\ub16.2 kg/m2) were evaluated. Three hundred eighty two cases (25%) were classified as young adults (age 64 35 years), and 1148 (75%) as adults (>35 years). Measurements were obtained at baseline and after a 12-month weight-loss program in patients compliant to follow-up. Psychological distress, binge eating, body uneasiness, and attitude towards eating were evaluated by self-administered questionnaires together with BMI changes. Weight-loss expectations and primary motivation for seeking treatment (health or improving appearance) were also recorded. Results. At baseline, young adults showed significantly higher BMI at age 20, higher weight loss expectations and body uneasiness score than adults. A significantly higher percentage of young adults than adults also reported improving appearance as the primary reason for seeking treatment. Attrition rate was significant higher in young adults (73.6% vs. 65.2% in adults, respectively; Chi-Square=9.01, p=0.003). Among completers, the mean percentage of weight loss after 12 months was significantly higher in young adults (10.9%, SD=9.8) than in adults (7.2%, SD=7.7, t=3.46; p=0.001). Young adults also had a larger improvement of psychosocial variables, compared to adults. By intention to treat, no significant difference emerged between young adults and adults on BMI change. Discussion: Obese young adults have larger weight loss and improvement of psychological distress, but higher attrition rate after 12-month of continuous care in a real world medical setting

Aminotransferase and gamma-glutamyltranspeptidase levels in obesity are associated with insulin resistance and the metabolic syndrome

ABSTRACT Fatty liver at ultrasounds, with/without raised plasma levels of hepatic enzymes, is common in obesity. In most cases, it is the hallmark of nonalcoholic fatty liver disease (NAFLD), a potentially progressive disease associated with insulin resistance and the metabolic syndrome. We tested the hypothesis that insulin resistance per se might be associated with hepatocellular necrosis. Alanine and aspartate aminotransferases (ALT and AST; n = 799) and gamma-glutamyltranspeptidase (GGT; n =459) were analyzed in a group of treatment-seeking obese patients recruited in 12 Italian medical centers. Insulin resistance was calculated by the homeostasis model assessment method (HOMA-IR)(n =522). Median ALT and AST increased with increasing obesity class (P =0.001 and P =0.005) and exceeded normal limits in 21.0% of cases. Also HOMA-IR increased with the obesity class (P <0.0001), and was higher in subjects with elevated ALT (median, 4.93 vs. 2.89; P <0.0001). A significant correlation was observed between HOMA-IR and ALT (r2 =0.208; P <0.0001), as well as between HOMA-IR and AST or GGT (r2 =0.112 and r2 =0.080; P <0.0001). The correlation was maintained when cases with elevated enzyme levels were omitted from analysis. Diabetes and hypertriglyceridemia were the features of the metabolic syndrome most commonly associated with raised liver enzymes. In logistic regression, after correction for age, gender, BMI and features of the metabolic syndrome, HOMA-IR maintained a highly predictive value for raised ALT, AST and GGT. We conclude that in obesity insulin resistance is a risk factor for raised liver enzyme levels, possibly related to NAFLD

Influence of dietary fat and carbohydrates proportions on plasma lipids, glucose control and low-grade inflammation in patients with type 2 diabetes\u2014The TOSCA.IT Study

The optimal macronutrient composition of the diet for the management of type 2 diabetes is debated, particularly with regard to the ideal proportion of fat and carbohydrates. The aim of the study was to explore the association of different proportions of fat and carbohydrates of the diet-within the ranges recommended by different guidelines-with metabolic risk factors