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4 results on '"Ciaccio, Antonio"'

1. Health related quality of life in chronic liver diseases.

Author

Cortesi, Paolo A., Conti, Sara, Scalone, Luciana, Jaffe, Ariel, Ciaccio, Antonio, Okolicsanyi, Stefano, Rota, Matteo, Fabris, Luca, Colledan, Michele, Fagiuoli, Stefano, Belli, Luca S., Cesana, Giancarlo, Strazzabosco, Mario, and Mantovani, Lorenzo G.

Subjects
LIVER diseases, CHRONIC diseases, QUALITY of life, ANXIETY, PATIENT care
Abstract

Background & Aims: The impact of chronic liver diseases (CLDs) on health‐related quality of life (HRQoL) is relevant to understand the burden of these conditions and inform decision‐making processes related to their care. Studies simultaneously comparing the HRQoL of patients affected by the major CLDs to that of the general population are still lacking and are the subject of this study. Methods: Using the EQ‐5D‐3L questionnaire, we analysed and compared HRQoL data from 2962 Italian patients affected by CLDs and forming a representative sample of the general Italian population (6800 individuals). Exploratory analyses were conducted to investigate the effects of each CLD on HRQoL, using the general population as reference and adjusting for possible confounders. Results: Patients with CLDs (HBV, HCV, PSC, PBC, AIH, NAFLD/NASH) in the chronic hepatitis stage and with compensated cirrhosis (CC) showed HRQoL similar to the general population. However, AIH were more likely to report problems in self‐care and lower EQ‐5D VAS score, while NAFLD/NASH and HCV showed an increased risk of anxiety/depression. On the other hand, with progression to more advanced stages of liver disease (DC or HCC), HRQoL decreased significantly with higher risk of reporting problems in the physical domains, and significant reductions in the VAS and utility index scores. Conclusions: Different subtypes of CLD affected different QoL domains. This study therefore provides a real estimate of the impact of CLDs on patients' HRQoL, and represents a much needed tool to inform decision‐making while assessing the effectiveness and cost‐effectiveness of the care of these patients. [ABSTRACT FROM AUTHOR]

Published
2020
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2. Clinical outcome indicators in chronic hepatitis B and C: A primer for value‐based medicine in hepatology.

Author

Strazzabosco, Mario, Cortesi, Paolo A., Conti, Sara, Okolicsanyi, Stefano, Rota, Matteo, Ciaccio, Antonio, Cozzolino, Paolo, Fornari, Carla, Gemma, Marta, Scalone, Luciana, Cesana, Giancarlo, Fabris, Luca, Colledan, Michele, Fagiuoli, Stefano, Ideo, Gaetano, Zavaglia, Claudio, Perricone, Giovanni, Munari, Luca M., Mantovani, Lorenzo G., and Belli, Luca S.

Subjects
CHRONIC hepatitis B, DELPHI method, LIVER diseases
Abstract

Background & Aims: Chronic liver diseases (CLDs) are major health problems that require complex and costly treatments. Liver‐specific clinical outcome indicators (COIs) able to assist both clinicians and administrators in improving the value of care are presently lacking. The Value‐Based Medicine in Hepatology (VBMH) study aims to fill this gap, devising and testing a set of COIs for CLD, that could be easily collected during clinical practice. Here we report the COIs generated and recorded for patients with HBV or HCV infection at different stages of the disease. Methods / Results: In the first phase of VBMH study, COIs were identified, based on current international guidelines and literature, using a modified Delphi method and a RAND 9‐point appropriateness scale. In the second phase, COIs were tested in an observational, longitudinal, prospective, multicentre study based in Lombardy, Italy. Eighteen COIs were identified for HBV and HCV patients. Patients with CLD secondary to HBV (547) or HCV (1391) were enrolled over an 18‐month period and followed for a median of 4 years. The estimation of the proposed COIs was feasible in the real‐word clinical practice and COI values compared well with literature data. Further, the COIs were able to capture the impact of new effective treatments like direct‐acting antivirals (DAAs) in the clinical practice. Conclusions: The COIs efficiently measured clinical outcomes at different stages of CLDs. While specific clinical practice settings and related healthcare systems may modify their implementation, these indicators will represent an important component of the tools for a value‐based approach in hepatology and will positively affect care delivery. [ABSTRACT FROM AUTHOR]

Published
2020
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3. Generation and performance of value-based outcome indicators in liver disease: The multicenter V.B.M.H. study

Author

ROTA, MATTEO, OKOLICSANYI, STEFANO, CIACCIO, ANTONIO, GEMMA, MARTA, GENTILUOMO, MARIA, CORTESI, PAOLO ANGELO, SCALONE, LUCIANA, CESANA, GIANCARLO, VALSECCHI, MARIA GRAZIA, STRAZZABOSCO, MARIO, Grisolia, A, MANTOVANI, LORENZO GIOVANNI, Pontisso, P, Mondelli, M, Marchesini, G, Fabris, L, Mazzaferro, V, Burra, P, Colledan, M, Fagiuoli, S, Belli, L, Rota, M, Okolicsanyi, S, Ciaccio, A, Gemma, M, Gentiluomo, M, Grisolia, A, Cortesi, P, Scalone, L, Mantovani, L, Cesana, G, Valsecchi, M, Pontisso, P, Mondelli, M, Marchesini, G, Fabris, L, Mazzaferro, V, Burra, P, Colledan, M, Fagiuoli, S, Belli, L, and Strazzabosco, M

Subjects
Health care indicators, Liver diseases, Delphi method, Prospective study, Value based Medicine in Hepatology, MED/12 - GASTROENTEROLOGIA, MED/42 - IGIENE GENERALE E APPLICATA, Liver disease, Health care indicator, MED/01 - STATISTICA MEDICA
Abstract

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.

Published
2014

4. Health Related Quality of Life in the Major Liver Conditions

Author

CORTESI, PAOLO ANGELO, SCALONE, LUCIANA, CESANA, GIANCARLO, MANTOVANI, LORENZO GIOVANNI, OKOLICSANYI, STEFANO, CIACCIO, ANTONIO, ROTA, MATTEO, GEMMA, MARTA, VALSECCHI, MARIA GRAZIA, STRAZZABOSCO, MARIO, Ciampichini, R, Cozzolino, P, Gentiluomo, M, Grisolia, A, Pontisso, P, Burra, P, Mondelli, M, Fabris, L, Colledan, M, Fagiuoli, S, Belli, L, Cortesi, P, Scalone, L, Ciampichini, R, Cozzolino, P, Cesana, G, Mantovani, L, Okolicsanyi, S, Ciaccio, A, Rota, M, Gentiluomo, M, Gemma, M, Grisolia, A, Pontisso, P, Burra, P, Mondelli, M, Fabris, L, Colledan, M, Fagiuoli, S, Valsecchi, M, Belli, L, and Strazzabosco, M

Subjects
Health care indicators, Liver diseases, Quality of care, MED/12 - GASTROENTEROLOGIA, MED/42 - IGIENE GENERALE E APPLICATA, Liver disease, Health care indicator, MED/01 - STATISTICA MEDICA
Abstract

Liver diseases (LDs) have a high impact on morbidity, mortality and health-related quality of life (HRQoL). Different LDs may have different effects on patients’ HRQoL. The aim of our study was to assess the reliability and benefit of using a generic HRQoL questionnaire to evaluate the health status of patients with the major liver conditions: hepatitis B (HBV), hepatitis C (HCV), cirrhosis, hepatocellular carcinoma (HCC), autoimmune hepatitis (AIH), primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC), NAFLD/NASH and patients in the liver transplant list. A naturalistic, prospective, multicenter study has been conducted to generate and validate a set of health care outcomes indicators for the major liver conditions. LDs patients (age>18 years) were enrolled in 3 major Italian medical centers and are still being followed up (median f-up: 13 months). Within this study, socio-demographic, clinical and HRQoL were collected using the EQ-5D-3L, a generic instrument that enables HRQoL to compared within and between clinical conditions and with the general population. It generates a health profile made up of 5 domains (mobility, self care, anxiety/depression, usual activities and pain/discomfort), each one with three levels of severity. It also consists of a visual analogue scale (EQ-5D VAS) which measures overall HRQoL in a range from 0 (worst imaginable health state) to 100 (best imaginable health state). The baseline HRQoL data was analyzed dividing the patients in sub-groups according to the most recently diagnosed and most severe condition. The results reported below focus on the mean VAS. We enrolled 3,217 patients, 64.8% male, aged 19-91 (median=61) years; 95.0% of them filled in the EQ-5D at baseline. Patients in the HCC group were 22.6%, those with compensated cirrhosis were 21.2%, HCV 20.9%, decompensated cirrhosis 10.3%, HBV 9.5%. The HBV group reported the best HRQoL with a mean EQ-5D VAS of 77.8. NAFLD/NASH, HCV and PSC patients had a similar HRQoL with a mean EQ-5D VAS between 76.5 and 75.1. While, compensated cirrhosis and PBC had a slightly worsen values (74.5 and 74.0, respectively). HCC and decompensated cirrhosis showed a mean EQ-5D VAS of about 69.0. At least, AIH and listed for liver transplant patients reported the worst HRQoL levels than the other sub-groups (67.7 and 67.0, respectively). In conclusion, EQ-5D is well accepted by the patients and accurately reflects the changes in HRQoL related to the clinical severity of LDs. Understanding the different impact of LDs on the patients’ HRQoL could help physicians and decision makers to better estimate the burden of these conditions and to improve the quality of care

Published
2013

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