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Private or public developers, including local authorities and government agencies, have limited operational guidance to include case-relevant health information in environmental reports. In Italy, the absence of technical indications prompted the Ministry of Health to construct a new model of Health Impact Assessment (HIA) for health integration in Environmental Assessment (EA) processes. A coordinating committee set within an inter-institutional working group was assisted by public and private key stakeholders to deliver guidance on HIA. The three research stages of framing, production and delivery were carried out to: (1) frame the context for HIA guidance implementation; (2) produce the operational guideline and tools; (3) train and disclose the guideline to final users. The guideline and the operational procedures were informed by core criteria to achieve a health standard in environmental reporting. The procedures guide the user to carry out a comprehensive assessment of the population health based on the broad determinants. The environmental reporting integrates health through functional components, divided into levels and supported by related flowcharts and checklists. HIA knowledge and skills were provided to facilitate the guideline utilization within the health departments. The guideline embedded the existing EA national legacy, normative and technical. The entire decisional cycle, from strategic planning to project development was covered in the guideline including the screen of proposals. The experience triggered the definition of an environmental health collaborative platform under the Ministry of Health coordination to fill gaps in competence building, sector operational tools development, methodologies harmonization on the national territory.

Objective: Poor information on long-term outcomes and costs on tumour necrosis factor (TNF) inhibitors in psoriatic arthritis (PsA) are available. Our aim was to evaluate long-term costs and benefits of TNF- inhibitors in PsA patients with inadequate response to conventional treatment with traditional disease-modifying anti-rheumatic drugs (tDMARDs). Methods: Fifty-five out of 107 enrolled patients included in the study at one year, completed the 5-year follow-up period. These patients were enrolled in 8 of 9 centres included in the study at one year. Patients aged older than 18 years, with different forms of PsA and failure or intolerance to tDMARDs therapy were treated with anti-TNF agents. Information on resource use, health-related quality of life (HRQoL), disease activity, function and laboratory values were collected at baseline and through the 5 years of therapy. Costs (expressed in Euro 2011) and utility (measured by EQ-5D instrument) before TNF inhibitor therapy and after 1 and 5 years were compared. Results: The majority of patients (46 out of 55; 83.6%) had a predominant or exclusive peripheral arthritis and 16.4% had predominant or exclusive axial involvement. There was a statistically significant improvement of the most important clinical variables after 1 year of follow-up. These improvements were maintained also after 5 years. The direct costs increased by approximately €800 per patient-month after 1 year, the indirect costs decreased by €100 and the overall costs increased by more than €700 per patient-month due to the cost of TNF inhibitor therapy. Costs at 5 year were similar to the costs at 1 year. The HRQoL parameters showed the same trends of the clinical variables. EQ-5D VAS, EQ-5D utility and SF-36 PCS score showed a significant improvement after 1 year, maintained at 5 years. SF-36 MCS showed an improvement only at 5 years. Conclusion: The results of our study suggest that TNF blockers have long-term efficacy. The higher cost of TNF inhibitor therapy was balanced by a significant improvement of HRQoL, stable at 5 years of follow-up. Our results need to be confirmed in larger samples of patients. © Copyright Clinical and Experimental Rheumatology 2016.

Background: Many studies have been conducted in Italy to assess Health-Related Quality-of-Life (HRQoL) in subjects with different diseases. However, no recent HRQoL population norm data were available to make comparisons with diseased populations. We assessed HRQoL norm data using the generic instrument EQ-5D in its standard version (EQ-5D-3L) and with the recently introduced version (EQ-5D-5L). Methods: A survey was conducted on 6,800 individuals, representative of the Lombardy general adult population for age, gender and geographical distribution. Each participant underwent a telephone interview with questions using the EQ-5D-3L and the EQ-5D-5L descriptive systems, the visual analogue scale (EQ-VAS) and socio-demographic data. Results: participants were 48% male, aged on average 51.9 years. With the 3L version, men and women aged 18-35 years reporting a full health state were 71.3% and 56.5%, respectively, those aged ≥ 76 years decreased to 29.5% and 13.5%, respectively. The proportion of respondents reporting no problems decreased with the 5L version. The mean (standard deviation) of the EQ-VAS was 87.7(12.1) and 85.0(15.2) among men and women aged 18-35 years, and 68.0(20.6) and 64.4(23.2) in men and women aged ≥ 76 years. The mean (standard deviation) utility obtained from the 3L version ranged from 0.965(0.068) and 0.944(0.086) among men and women aged 18-35 years, to 0.880(0.123) and 0.829(0.137) in men and women aged ≥ 76 years. Similar results were obtained with the 5L version. Conclusion: HRQoL norm data are now available for the general adult population in Italy, to be used as a reference in clinical sector, economic evaluations and in policy settings.

We analysed 1.6 million population-based EUROCARE-4 cancer cases (26 cancer sites, excluding sex-specific sites, and breast) from 23 countries to investigate the role of sex in cancer survival according to age at diagnosis, site, and European region. For 15 sites (salivary glands, head and neck, oesophagus, stomach, colon and rectum, pancreas, lung, pleura, bone, melanoma of skin, kidney, brain, thyroid, Hodgkin disease and non-Hodgkin's lymphoma) age- and region-adjusted relative survival was significantly higher in women than men. By multivariable analysis, women had significantly lower relative excess risk (RER) of death for the sites listed above plus multiple myeloma. Women significantly had higher RER of death for biliary tract, bladder and leukaemia. For all cancers combined women had a significant 5% lower RER of death. Age at diagnosis was the main determinant of the women's advantage, which, however, decreased with increasing age, becoming negligible in the elderly, suggesting that sex hormone patterns may have a role in women's superior ability to cope with cancer. (C) 2008 Elsevier Ltd. All rights reserved.

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

OBJECTIVES. The assessment of individuals’ demand and related costs can guide to allocate healthcare resources and improve access to healthcare. We created a segmentation demand model and we estimated healthcare costs and their determinants within specific and distinguished groups of general population. METHODS. The target population included subjects living in an area of northern Italy registered at one Local Healthcare Unit in 2005 (1,031,684 subjects). On the basis of clinical judgments and literature, we identified eight different segments: subjects unknown to HS, maternity and infancy, elderly, people with one chronic disease (CD), people with more CDs, people with probable or not severe CDs, subjects with acute event, healthy people. To describe these groups and their health demand, we used demographic and healthcare demand data (hospital admissions, drug’s prescriptions, medical specialist visits, diagnostic tests) from administrative databases available at the Lombardy Health System (HS). These were merged adopting probabilistic record linkage (DENALI Data Warehouse) to optimize correct matching of data. RESULTS. Overall, healthcare cost €834 million in 2005 (€809 per-capita). Healthy people were 53% of the sample and cost €180 per-capita. Next more frequent subjects were those with one CD (14%) and cost €916 per-capita, then those with more CDs (13%) who cost €3,457 per-capita. Hospitalizations were the cost driver in five segments (maternity and infancy, elderly, one CD, more CDs, acute event), accounting for 42-89% of total costs. Diagnostic tests and medical visits contributed to 42-45% of total costs among healthy subjects and those with probable CD. Overall, drugs accounted for 24% of costs of sample. CONCLUSIONS. This pioneer demand segmentation model shows an example of how merging different administrative databases makes possible understanding effects of their characteristics on healthcare demand and costs. Research is encouraged to improve the model and study specific variants that can be applied in different healthcare contexts.

Aims and background In Veneto a regional cancer registry has been operating since 1987 which provides incidence and survival data for the region. It currently covers 48% of the regional population. The aim of this paper is to provide estimates of the incidence, mortality and prevalence of the major cancers for the whole Veneto region in the period 1970—2015. Methods The estimates were obtained by applying the MIAMOD method, a statistical back-calculation approach to derive incidence and prevalence figures starting from mortality and relative survival data. Survival was modeled on the basis of published data from the Italian cancer registries. Results In 2012 the most frequent cancer sites were colon-rectum, prostate and breast with 4,677, 3,760 and 3,729 new diagnosed cases, respectively. The incidence rates were estimated to increase constantly for female lung cancer, prostate cancer, colorectal cancer and melanoma, while they were decreasing for cervical cancer and stomach cancer. For male lung cancer and female breast cancer the rates increased, reaching a peak, and then decreased. In the last years of the period of analysis, mortality declined for all cancers: the highest number of deaths (2,390 in both sexes) was estimated for lung cancer in 2012. Prevalence was increasing for all the considered cancer sites with the exception of lung cancer in men, for which the prevalence was estimated to increase until 2007 and then stabilize. By contrast, the cervical cancer decreased during the whole period. In 2012 breast cancer had the highest prevalence, with about 52,000 cases. Conclusion This paper provides a description of the burden of the major cancers in Veneto until 2015. The estimates highlight the continuing reduction of cancer mortality. This decline can be related to the improvement of clinical treatments and to multidisciplinary treatment approaches. In order for this positive trend to continue, implementation and reinforcement of the screening programs is needed, especially for breast and colorectal cancer.

Few studies have addressed longer-term survival for breast cancer in European women. We have made predictions of 10-year survival for European women diagnosed with breast cancer in 2000-2002. Data for 114,312 adult women (15-99 years) diagnosed with a first primary malignant cancer of the breast during 2000-2002 were collected in the EUROCARE-4 study from 24 population-based cancer registries in 14 European countries. We estimated relative survival at 1, 5, and 10 years after diagnosis for women who were alive at some point during 2000-2002, using the period approach. We also estimated 10-year survival conditional on survival to 1 and 5 years after diagnosis. Ten-year survival exceeded 70% in most regions, but was only 54% in Eastern Europe, with the highest value in Northern Europe (about 75%). Ten-year survival conditional on survival for 1 year was 2-6% higher than 10-year survival in all European regions, and geographic differences were smaller. Ten-year survival for women who survived at least 5 years was 88% overall, with the lowest figure in Eastern Europe (79%) and the highest in the UK (91%). Women aged 50-69 years had higher overall survival than older and younger women (79%). Six cancer registries had adequate information on stage at diagnosis; in these jurisdictions, 10-year survival was 89% for local, 62% for regional and 10% for metastatic disease. Data on stage are not collected routinely or consistently, yet these data are essential for meaningful comparison of population-based survival, which provides vital information for improving breast cancer control. What's new? Policy-makers and health-care planners need accurate data on long-term survival to improve cancer control. This Europe-wide study of 10-year survival identified low survival in Eastern Europe for women with breast cancer in 2000-2002, and wide variation by age at diagnosis. Data on stage at diagnosis are crucial for meaningful comparison of population-based survival, and fundamental for improving breast cancer control, but our analyses confirmed that stage data are not collected routinely or consistently

We present estimates of population-based 5-year relative survival for adult Europeans diagnosed with central nervous system tumors, by morphology (14 categories based on cell lineage and malignancy grade), sex, age at diagnosis and region (UK and Ireland, Northern, Central, Eastern and Southern Europe) for the most recent period with available data (2000-2002). Sources were 39 EUROCARE cancer registries with continuous data from 1996 to 2002. Survival time trends (1988 to 2002) were estimated from 24 cancer registries with continuous data from 1988. Overall 5-year relative survival was 85.0% for benign, 19.9% for malignant tumors. Benign tumor survival ranged from 90.6% (Northern Europe) to 77.4% (UK and Ireland); for malignant tumors the range was 25.1% (Northern Europe) to 15.6% (UK and Ireland). Survival decreased with age at diagnosis and was slightly better for women (malignant tumors only). For glial tumors, survival varied from 83.5% (ependymoma and choroid plexus) to 2.7% (glioblastoma); and for non-glioma tumors from 96.5% (neurinoma) to 44.9% (primitive neuroectoderm tumor/medulloblastoma). Survival differences between regions narrowed after adjustment for morphology and age, and were mainly attributable to differences in morphology mix; however UK and Ireland and Eastern Europe patients still had 40% and 30% higher excess risk of death, respectively, than Northern Europe patients (reference). Survival for benign tumors increased from 69.3% (1988-1990) to 77.1% (2000-2002); but survival for malignant tumors did not improve indicating no useful advances in treatment over the 14-year study period, notwithstanding major improvement in the diagnosis and treatment of other solid cancers.