Post on 30-Dec-2016
POSTERS
P1281
GENERATION AND PERFORMANCE OF VALUE-BASED
OUTCOME INDICATORS IN LIVER DISEASE: THE MULTICENTER
V.B.M.H. STUDY
M. Rota1, S. Okolicsanyi2, A. Ciaccio2, M. Gemma2, M. Gentiluomo3,
A. Grisolia4, P.A. Cortesi5, L. Scalone5, L. Mantovani6, G. Cesana7,
M.G. Valsecchi1, P. Pontisso8, M.U. Mondelli9, G. Marchesini10,
L. Fabris11, V. Mazzaferro12, P. Burra13, M. Colledan14, S. Fagiuoli4,
L.S. Belli3, M. Strazzabosco2,15. 1Department of Health Sciences,
Centre of Biostatistics for Clinical Epidemiology, 2Department of
Surgical and Interdisciplinary Medicine, University of Milan-Bicocca,
Monza, 3Department of Hepatology and Liver Unit, Niguarda Hospital,
Milan, 4Department of Gastroenterology and Transplant Hepatology,
Papa Giovanni XXIII Hospital, Bergamo, 5Research Centre for Public
Health (CESP), University of Milan-Bicocca, Milan, 6Department
of Clinical Medicine and Surgery, University Federico II of Naples,
Naples, 7Research Centre for Public Health (CESP), University
of Milan-Bicocca, Monza, 8Department of Medicine – DIMED,
University of Padua, Padua, 9Research Laboratories, Department
of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo
and University of Pavia, Pavia, 10Department of Medicine, Unit of
Metabolic Disease & Clinical Dietetics, University of Bologna, Bologna,11Department of Surgical and Gastroenterological Sciences, University
of Padua, Padua, 12Gastro-Intestinal Surgery, Liver Transplantation
and Hepatology Unit, Fondazione IRCCS Istituto Nazionale Tumori,
Milan, 13Department of Surgery, Oncology and Gastroenterology,
University of Padua, Padua, 14Department of Surgery, Papa Giovanni
XXIII Hospital, Bergamo, Italy; 15Liver Center & Section of Digestive
Diseases, Department of Internal Medicine, Yale University School of
Medicine, New Haven, CT, United States
E-mail: matteo.rota@unimib.it
Background and Aims: Liver disease (LD) is a major cause of
morbidity and mortality worldwide. Development of outcome
indicators (OIs) provides health care policy makers with objective
criteria that can be used to generate a virtuous competition to
improve value of care. Aim of our study was to generate and test a
set of health care OIs for the major LDs.
Methods: Using a modified Delphi method, 7 expert panels
identified a set of OIs according to experience and scientific
evidence (as of 2010). Each OI was rated in a two-step process using
the RAND 9-point agreement scale. Median scores were computed
for each OI. After the second rating, a disagreement index (DI) was
calculated to identify and accept (if DI≤1) OIs with median rating
≥7. The final set of selected OIs was tested through an ongoing
prospective multicenter observational study involving three tertiary
centers in Lombardy, Italy.
Results: A total of 51 OIs were identified by the focus groups. We
recruited 3213 consecutive liver patients, of whom 91% had at least
one follow-up visit after a median follow-up time of 15 months.
Among these patients, 1752 were cirrhotic and 711 were affected by
HCC. During observation time, 156 patients were transplanted and
210 patients died. All the identified OIs were successfully tested in
the clinical setting showing excellent performance and correlation
with natural history information.
Conclusions: This study provides a set of validated outcomes
indicators that can be used to monitor the performance of referral
centers and improve the value and sustainability of care.
P1282
A COST–CONSEQUENCE ANALYSIS OF SCREENING AND
TREATMENT FOR CHRONIC HEPATITIS B (CHB) VIRUS INFECTION
IN RESIDENT IMMIGRANTS OF AN ITALIAN NORTH-EAST REGION
E. Rosa-Rizzotto1, A. Buja2, D. Martines1, A. Vinelli2, G. Bardelle2,
S. Lopatriello2, L. Peraro1, L. Scribano3, D. Caroli4, F. De Lazzari1,
S. Lobello1, V. Baldo2. 1Gastroenterology Unit, St Anthony Hospital,2Department of Molecular Medicine, Laboratory of Public Health and
Population Studies, Padua University, 3Gastroenterology Unit, Azienda
Ospedaliera Padova, Padua, 4Chioggia Hospital, Venice, Italy
E-mail: erik.rosarizzotto@gmail.com
Background and Aims: 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 cost-effective, but it
is crucial to take into account the significant associated costs and
the considerable net investment by governments. The objective
of this study is to estimate the health and economic effects of
screening for CHB screening among immigrants.
Methods: We used the Markov 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 and the chance of having
active CHB was based on our recent screening campaign in Padua
involving 465 migrants (table). Likelihood of HBV-related events
were obtained from literature.
Population 465,322Age group >20y 348,991HBsAg+, n (%) 21,048 (6)Active CHB, n (%) 6,314 (30)Rate of adherence to screening program, n (%) 2,525 (40)
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€ 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 are affordable when set against the better
health outcomes for resident immigrants.
P1283
PREVALENCE OF LIVER DISEASES IN RUSSIAN MEGALOPOLIS
A. Komova, M. Maevskaya, V. Ivashkin. First Moscow State Medical
University n.a. I.M. Sechenov, Moscow, Russian Federation
E-mail: annakomova@inbox.ru
Background and Aims: Difficulties in accessing data from
individual countries, especially Russia, hinder global evaluation of
liver disease in Europe. The goal of this study was to estimate the
prevalence of liver diseases in the Russian megalopolis.
Methods: 5000 random Moscow residents were screened for liver
diseases from October 2012 till November 2012. Socio-demographic,
health and lifestyle information was obtained via the questionnaire,
alcohol screening was done by CAGE and AUDIT tools; BMI, liver
tests (ALT, AST, GGTP, bilirubin, ALP, ALT/AST), anti-HCV, HBsAg,
g-globulins were investigated.
Results: Socio-demographic data: male 1671 (33.42%), female
3329 (66.58%), average age 45yr (from 18 to 72), average BMI
25.68 kg/m2. 1209 subjects (24.18%, m:f = 1:1) of 5000 participants
had any abnormalities in liver functional tests. According to
occupation BMI >25kg/m2 was observed in retired, disabled,
businessmen, military. Health care workers and students (24.75%
and 21.8% respectively) belonged to the “slimmest” group.
Journal of Hepatology 2014 vol. 60 | S361–S522 S517