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