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INTRODUZIONE L’introduzione dei farmaci biologici ha rivoluzionato l’approccio terapeutico nell’Artrite Idiopatica Giovanile a esordio Sistemico (SoJIA), modificando la storia naturale di questa malattia e migliorandone l’outcome globale. METODI Obiettivo principale dello studio era analizzare il tasso di persistenza in terapia (DRR) degli inibitori dell’Interleuchina (IL)-1 nei pazienti affetti da SoJIA. Obiettivi secondari dello studio erano: (1) esplorare l’influenza della linea biologica di trattamento, degli eventi avversi, dello specifico agente anti-IL-1 e del cotrattamento con disease modifying anti-rheumatic drugs (cDMARDs) sul DRR; (2) identificare eventuali fattori predittivi associati all’abbandono della terapia. Dati demografici, clinici e terapeutici relativi ai pazienti affetti da SoJIA trattati con anakinra e canakinumab in 15 centri italiani sono stati raccolti retrospettivamente ed analizzati. RISULTATI Sono stati arruolati 77 pazienti, corrispondenti a 86 regimi di trattamento. Il DRR cumulativo degli inibitori dell’IL-1 è risultato essere a 12-, 24-, 48- e 60- mesi di follow-up rispettivamente 79.9, 59.5, 53.5 e 53.5%. Non è stata riscontrata alcuna differenza statisticamente significativa stratificando per anakinra e canakinumab (p=0.056) e tra i pazienti trattati in monoterapia e quelli in cotrattamento con cDMARDs (p=0.058). Al contrario, differenze significative sono state individuate tra il gruppo dei pazienti biologic-naive e quello dei pazienti precedentemente trattati con altre terapie biologiche (p=0.038) e in relazione all’occorrenza di eventi avversi (AE) in corso di terapia (p=0.04). Nell’analisi di regressione, i pazienti precedentemente trattati con altre terapie biologiche (HR = 3.357 [CI: 1.341–8.406], p = 0.01) e quelli che presentavano AE (HR = 2.970 [CI: 1.186–7.435], p = 0.020) erano associati ad un hazard ratio maggiore relativamente al rischio di abbandono della terapia. Il treatment delay è risultato essere significativamente più elevato tra i pazienti che hanno abbandonato la terapia (p = 0.0002). CONCLUSIONI I risultati dello studio suggeriscono un eccellente DRR per anakinra e canakinumab, che può essere ulteriormente aumentato attraverso una più attenta gestione degli AE ed impiegando questi farmaci in prima linea in una fase precoce della malattia.

Objectives: Rotavirus (RV) is the most common etiological agent of gastroenteritis in children. The oral vaccine Rix4414 was recently commercialized in Italy for prevention of RV infections. The health outcomes and the economic impact of a national RV immunization program were assessed. Design: A Markov model simulated the flow of a birth cohort on RV disease burden and costs up to age 5, comparing a RV vaccination programme with no vaccination. Lifetime cost-effectiveness for the national healthcare system (NHS) and the society (S) with a benchmark of 50,000 €/QALY was analysed. Main results: Disease’s medical direct costs exceeded 30 million €/year, while indirect costs approached 112 million €/year. A routine, universal RV immunization program, for a birth cohort of 550,000 children, would prevent 80% of RV diarrhoea, 97% of severe RV cases, 87% of medical consultations and 98% of hospitalizations. In the NHS perspective, the incremental cost/QALY would be € 14,829 and it would decrease to € −17,030 (cost-saving) in the S perspective. In the private market scenario, the incremental cost/QALY (€ 24,687) would remain far below the threshold. Conclusion: A national immunization program with Rix44141 in Italy would be cost-effective both from the S and the NHS perspective.

http://www.francoangeli.it/ricerca/scheda_codice_volume.asp?CodiceLibro=1792.78

Objectives: To evaluate the cost-benefit ratio of measles-mumps-rubella vaccination in two Italian areas with different immunisation coverages. Design: On the basis of the epidemiologic patterns of the three diseases and vaccination were estimated. A hypothetical 5-years vaccination program for children between 2 and 6 years of age was designed for the two regions. Setting: Piemonte and Puglia regions from 1995 to 1999, with a MMR immunization coverage of 60% and 40%, respectively. Main outcome measures and results: The variation of the cost-benefit ratio of vaccination was related to immunization coverage (and residual morbidity), cost of the disease (especially indirect costs), efficacy of the vaccine. The ratio was >1 when coverage was moderate (40%) with high morbidity and low costs of the disease; with a 60% coverage a ratio of 0.70-0.90 was achieved. Conclusions: The analysis showed that the cost-benefit ratio is affected by several factors that can vary within the regional situations. While the cost of a prevented case can be low, public health strategies should also consider the cost of residual cases, which can be high when immunisation coverage or vaccine efficacy is low.

Influenza is an important public problem in relation to the considerable epidemiological impact in terms of morbidity and mortality. Surveillance is therefore central to monitor the spread of this infection in the population of a specific area. For these reasons, virological, clinical and epidemiological surveillance were conducted during the 2000/2001 influenza season in the area of Lecce. The surveillance activities were part of a national influenza surveillance programme. A team of sentinel physicians, voluntary general practitioners and pediatricians, monitored a sample of 1% of the total population. These doctors reported weekly the number of patients with influenza-like illness (ILI) or acute respiratory illness (ARI), indicating if these patients had or had not received influenza vaccine. In parallel with the clinical and epidemiological surveillance, virological surveillance was also carried out in a group of patients meeting the ILI criteria. Samples of nasal and pharyngeal secretions were collected from these patients in order to isolate and identify any influenza viruses. The epidemiological surveillance showed that most of the patients affected by influenza were young subjects aged up to 14 years and adults aged 15-64 years. They were mostly non-vaccinated subjects. The average rate of incidence for the 2000/2001 season was 3.03/1,000 inhabitants. Virological surveillance evidenced that during the 2000/2001 influenza season all cases were associated to the A/H1N1 virus.

Influenza is an important public health problem in relation to the considerable epidemiological impact in terms of morbidity and mortality. Surveillance is therefore central to monitor the spread of this infection in the population of a specific area. For these reasons, virological, clinical and epidemiological surveillance were conducted during the 2000/2001 influenza season in the area of Lecce. The surveillance activities were part of a national influenza surveillance programme. A team of sentinel physicians, voluntary general practitioners and paediatricians, monitored a sample of 1% of the total population. These doctors reported weekly the number of patients with influenza-like illness (ILI) or acute respiratory illness (ARI), indicating if these patients had or had not received influenza vaccine. In parallel with the clinical and epidemiological surveillance, virological surveillance was also carried out in a group of patients meeting the ILI criteria. Samples of nasal and pharyngeal secretions were collected from these patients in order to isolate and identify any influenza viruses. The epidemiological surveillance showed that most of the patients affected by influenza were young subjects aged up to 14 years and adults aged 15-64 years. They were mostly non-vaccinated subjects. The average rate of incidence for the 2000/2001 season was 3.03/1000 inhabitants. Virological surveillance evidenced that during the 2000/2001 influenza season all cases were associated to the A/H I N 1 virus.

Cataracts are a common condition and represent a frequent cause of visual disability. Nevertheless, data regarding the incidence of cataracts and the progression of and loss of vision due to cataracts is scarce. In this study, hospital discharge abstract data was evaluated to estimate the frequency and type of hospitalisations for cataract surgery that occurred in the Puglia region in the years 2000-2002. The results of this study confirm that cataract surgery accounts for a relevant amount of regional healthcare system costs. In fact, every year, over 25,000 lens surgery procedures, most of which age-related, are performed in the Puglia region. Approximately 90% of such procedures involve cataract surgery; age-specific hospitalisation rates show very high rates in the50 year old population. Only 25% of total cataract extractions were performed as a day-surgery procedure and the mean length of hospital stay was found to be 2.5 days. This confirms that inappropriate hospitalisations, with respect to both type and duration, do occur. Cataract surgery is performed in over 30 hospitals in Puglia; the availability of health facilities in the region, therefore, seems to be satisfactory. In fact, on average, in the three-year period, only 7.5% of cases underwent the procedure outside the Puglia region.

Public health passive surveillance systems are often affected by low sensitivity level. Enhancement of the reporting by general practitioners is important to improve the sensitivity of notification system. The aim of this work was to evaluate the mandatory notification activities of communicable diseases by general practitioners (GPs) and family pediatricians (FPs) in the Local Health Unit Bari/4, during the years 1999-2000. This study shows that GPs and FPs notified only 39% and 28% of notifiable diseases respectively in 1999 and 2000, although some of these diseases have a very low hospitalization rate. The majority of doctors never notified any case of infectious disease during the period. The study shows also that the doctors who was older and who had larger list of patients had a greater compliance regarding notification. Therefore, a specific training of family doctors and a better facility in the notification procedures (for example, by phone or e-mail) should be very important to improve the sensitivity of surveillance system.

Objectives: To evaluate the cost-benefit ratio of measles-mumps-rubella vaccination in two Italian areas with different immunisation coverages. Design: On the basis of the epidemiologic patterns of the three diseases in Piemonte and Puglia, the direct and indirect costs of the diseases and vaccination were estimated. A hypothetical 5-year vaccination program for children between 2 and 6 years of age was designed for the two regions. Setting: Piemonte and Puglia regions from 1995 to 1999, with a MMR immunization coverage of 60% and 40%, respectively. Main outcome measures and results: The variation of the cost-benefit ratio of vaccination was related to immunization coverage (and residual morbidity), cost of the disease (especially indirect costs), efficacy of the vaccine. The ratio was > 1 when coverage was moderate (40%) with high morbidity and low costs of the disease; with a 60% coverage a ratio of 0.70–0.90 was achieved. Conclusions: The analysis showed that the cost-benefit ratio is affected by several factors that can vary within the regional situations. While the cost of a prevented case can be low, public health strategies should also consider the cost of residual cases, which can be high when immunisation coverage or vaccine efficacy is low.