A cost-consequence analysis of hepatitis B screening in an immigrant population

Introduction. Prevalence of infection with HIV-1 non-B subtypes in Italy has been reported to raise, due to increased migration flows and travels. HIV-1 variants show different biological and immunological properties that impact on disease progression rate, response to antiretroviral therapy (ART) and sensitivity of diagnostic tests with important implications for public health. Therefore, a constant surveillance of the dynamics of HIV variants in Italy should be a high public health priority. Organization of surveillance studies requires building up a platform constituted of a network of clinical centers, laboratories and institutional agencies, able to properly collect samples for the investigation of HIV subtypes heterogeneity and to provide a database with reliable demographic, clinical, immunological and virological data. Aim. We here report our experience in building up such a platform, co-ordinated by the National AIDS Center of the Istituto Superiore di Sanità, taking advantage of a pilot study aimed at evaluating HIV subtypes diversity in populations of HIV-infected migrant people in Italy. Materials and methods. Four hundred and thirty four HIV-infected migrants were enrolled in 9 Italian clinical centers located throughout the Italian territory. Standard Operating Procedures (SOPs) for sample collection were provided by the National AIDS Center to each clinical center. In addition, clinical centers were required to fill up a case report form (crf) for each patient, which included demographic, clinical, immunological and virological information. Results. All centers properly collected and stored samples from each enrolled individual. Overall, the required information was correctly provided for more than 90% of the patients. However, some fields of the crf, particularly those including information on the last HIV-negative antibody test and presence of co-infections, were properly filled up in less than 80% of the enrolled migrants. Centers from Northern and Central Italy showed a better tendency to report correct information in the crf than centers from the South. These results provide evidence that procedures for establishing a platform for the surveillance of HIV subtype heterogeneity are affordable by all the components of the network and lay the ground for the organization of a broader HIV subtypes surveillance in Italy

A cost-consequence analysis of hepatitis B screening in an immigrant population

none9Screening for HBV among groups at risk, such as migrant populations, has proved to be a cost-effective strategy. With a view to advising local policy-makers, the cost-consequences of HBV screening was assessed using a modeling approach.noneBuja, Alessandra; Martines, Diego; Lobello, Salvatore; Vinelli, Angela; Bardelle, Giorgia; Lopatriello, Stefania; De Lazzari, Franca; Perrier, Lionel; Baldo, VincenzoBuja, Alessandra; Martines, Diego; Lobello, Salvatore; Vinelli, Angela; Bardelle, Giorgia; Lopatriello, Stefania; DE LAZZARI, Franca; Perrier, Lionel; Baldo, Vincenz

A cost-consequence analysis of screening and treatment for chronic hepatitis B (CHB) virus infection in resident immigrants of an Italian North-East

Introduction: The epidemiology of hepatitis B in Europe is changing, with migration causing significant increases in prevalence rates. It is of paramount importance to identify the most effective ways to contain the disease. Systematic screening and treatment of migrants for CHB virus infection is likely to be costeffective, but it is crucial to take into account the significant associated costs and the considerable net investment by governments. Aim: The objective of this study is to estimate the health and economic effects of screening strategy for CHB screening among immigrants. Materials and methods: We used the Markow model to examine the cost-consequence of screening and treatment vs a no screening strategy in a cohort of 348,991 adult migrants resident in the Veneto Region. The rate of adherence to the HBV screening program was judged to be 40%. The prevalence of HBV infection (6.03%) and the chance of having active CHB (30%) were based on our recent screening campaign in Padua involving 465 migrants. Likelihood of HBV-related events was obtained from literature. Results: The screening-treatment strategy prevented 273 cases of cirrhosis, 18 decompensated cirrhosis, 28 HCC, and 54 CHB related deaths, over a period of 5 years. The incremental cost of the screening strategy totaled 51,597,980 D in five years (0.1% of the Veneto annual health budget). Conclusions: This study provides information useful mainly to policy makers, who need to establish whether the cost generated by a screening strategy is affordable when set against the better health outcomes for resident immigrants

Need and disparities in primary care management of patients with diabetes.

BACKGROUND: An aging population means that chronic illnesses, such as diabetes, are becoming more prevalent and demands for care are rising. Members of primary care teams should organize and coordinate patient care with a view to improving quality of care and impartial adherence to evidence-based practices for all patients. The aims of the present study were: to ascertain the prevalence of diabetes in an Italian population, stratified by age, gender and citizenship; and to identify the rate of compliance with recommended guidelines for monitoring diabetes, to see whether disparities exist in the quality of diabetes patient management. METHODS: A population-based analysis was performed on a dataset obtained by processing public health administration databases. The presence of diabetes and compliance with standards of care were estimated using appropriate algorithms. A multilevel logistic regression analysis was applied to assess factors affecting compliance with standards of care. RESULTS: 1,948,622 Italians aged 16+ were included in the study. In this population, 105,987 subjects were identified as having diabetes on January 1st, 2009. The prevalence of diabetes was 5.43% (95% CI 5.33-5.54) overall, 5.87% (95% CI 5.82-5.92) among males, and 5.05% (95% CI 5.00-5.09) among females. HbA1c levels had been tested in 60.50% of our diabetic subjects, LDL cholesterol levels in 57.50%, and creatinine levels in 63.27%, but only 44.19% of the diabetic individuals had undergone a comprehensive assessment during one year of care. Statistical differences in diabetes care management emerged relating to gender, age, diagnostic latency period, comorbidity and citizenship. CONCLUSIONS: Process management indicators need to be used not only for the overall assessment of health care processes, but also to monitor disparities in the provision of health care