1
|
Cabibbo G, Daniele B, Borzio M, Casadei-Gardini A, Cillo U, Colli A, Conforti M, Dadduzio V, Dionisi F, Farinati F, Gardini I, Giannini EG, Golfieri R, Guido M, Mega A, Cinquini M, Piscaglia F, Rimassa L, Romanini L, Pecorelli A, Sacco R, Scorsetti M, Viganò L, Vitale A, Trevisani F. Multidisciplinary treatment of hepatocellular carcinoma in 2023: Italian practice Treatment Guidelines of the Italian Association for the Study of the Liver (AISF), Italian Association of Medical Oncology (AIOM), Italian Association of Hepato-Bilio-Pancreatic Surgery (AICEP), Italian Association of Hospital Gastroenterologists (AIGO), Italian Association of Radiology and Clinical Oncology (AIRO), Italian Society of Pathological Anatomy and Diagnostic Cytology (SIAPeC-IAP), Italian Society of Surgery (SIC), Italian Society of Gastroenterology (SIGE), Italian Society of Medical and Interventional Radiology (SIRM), Italian Organ Transplant Society (SITO), and Association of Patients with Hepatitis and Liver Disease (EpaC) - Part II - Non-surgical treatments. Dig Liver Dis 2024; 56:394-405. [PMID: 38052656 DOI: 10.1016/j.dld.2023.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/13/2023] [Accepted: 10/30/2023] [Indexed: 12/07/2023]
Abstract
Worldwide, hepatocellular carcinoma (HCC) is the third most common cause of cancer-related death. The remarkable improvements in treating HCC achieved in the last years have increased the complexity of its management. Following the need to have updated guidelines on the multidisciplinary treatment management of HCC, the Italian Scientific Societies involved in the management of this cancer have promoted the drafting of a new dedicated document. This document was drawn up according to the GRADE methodology needed to produce guidelines based on evidence. Here is presented the second part of guidelines, focused on the multidisciplinary tumor board of experts and non-surgical treatments of HCC.
Collapse
Affiliation(s)
- Giuseppe Cabibbo
- Section of Gastroenterology and Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties PROMISE, University of Palermo, Gastroenterology Unit, Azienda Ospedaliera Universitaria Policlinico "Paolo Giaccone", Palermo, Italy.
| | - Bruno Daniele
- Oncology Unit, Ospedale del Mare, ASL Napoli 1 Centro, Napoli, Italy
| | - Mauro Borzio
- Centro Diagnostico Italiano (CDI), Milano, Italy
| | - Andrea Casadei-Gardini
- Department of Oncology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute Hospital, Milan, Italy
| | - Umberto Cillo
- General Surgery 2-Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, Padua University Hospital, 35128 Padua, Italy
| | - Agostino Colli
- Dipartimento di Medicina Trasfusionale ed Ematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | | | - Vincenzo Dadduzio
- Medical Oncology Unit, "Mons. A.R.Dimiccoli" Hospital, Barletta, ASL BT, Italy
| | - Francesco Dionisi
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute - Rome, Italy
| | - Fabio Farinati
- Department of Surgery, Oncology and Gastroenterology, University of Padova, 35128 Padova, Italy; Gastroenterology Unit, Azienda Ospedale-Università di Padova, 35128 Padova, Italy
| | - Ivan Gardini
- EpaC Onlus, Italian Liver Patient Association, Turin, Italy
| | - Edoardo Giovanni Giannini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Rita Golfieri
- Alma Mater Studiorum" Bologna University, Bologna, Italy; Radiology Unit Madre Fortunata Toniolo Private Hospital, coordinator of Radiology centers Medipass Bologna, Bologna, Italy
| | - Maria Guido
- Department of Medicine, University of Padova, Padova - Italy
| | - Andrea Mega
- Department of Gastronterology, Regional Hospital Bolzano, Italy
| | - Michela Cinquini
- Oncology Department, Istituto di Ricerche Farmacologiche Mario Negri, IRCCS, Milano, Italy
| | - Fabio Piscaglia
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Lorenza Rimassa
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan, Italy; Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Laura Romanini
- Radiology Unit, Ospedale di Cremona, ASST Cremona, Cremona, Italy
| | - Anna Pecorelli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Rodolfo Sacco
- Gastroenterology and Endoscopy Unit, Department of Surgical and Medical Sciences, University of Foggia, 71100 Foggia, Italy
| | - Marta Scorsetti
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, Italy; Department of Radiotherapy and Radiosurgery, Humanitas Research Hospital IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Luca Viganò
- Hepatobiliary Unit, Department of Minimally Invasive General & Oncologic Surgery, Humanitas Gavazzeni University Hospital, Viale M. Gavazzeni 21, 24125 Bergamo, Italy; Department of Biomedical Sciences, Humanitas University, Viale Rita Levi Montalcini 4, 20090 Milan, Italy
| | - Alessandro Vitale
- General Surgery 2-Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, Padua University Hospital, 35128 Padua, Italy
| | - Franco Trevisani
- Department of Medical and Surgical Sciences, University of Bologna, Italy; Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy.
| |
Collapse
|
2
|
Cabibbo G, Daniele B, Borzio M, Casadei-Gardini A, Cillo U, Colli A, Conforti M, Dadduzio V, Dionisi F, Farinati F, Gardini I, Giannini EG, Golfieri R, Guido M, Mega A, Minozzi S, Piscaglia F, Rimassa L, Romanini L, Pecorelli A, Sacco R, Scorsetti M, Viganò L, Vitale A, Trevisani F. Multidisciplinary Treatment of Hepatocellular Carcinoma in 2023: Italian practice Treatment Guidelines of the Italian Association for the Study of the Liver (AISF), Italian Association of Medical Oncology (AIOM), Italian Association of Hepato-Bilio-Pancreatic Surgery (AICEP), Italian Association of Hospital Gastroenterologists (AIGO), Italian Association of Radiology and Clinical Oncology (AIRO), Italian Society of Pathological Anatomy and Diagnostic Cytology (SIAPeC-IAP), Italian Society of Surgery (SIC), Italian Society of Gastroenterology (SIGE), Italian Society of Medical and Interventional Radiology (SIRM), Italian Organ Transplant Society (SITO), and Association of Patients with Hepatitis and Liver Disease (EpaC) - Part I - Surgical treatments. Dig Liver Dis 2024; 56:223-234. [PMID: 38030455 DOI: 10.1016/j.dld.2023.10.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 10/07/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023]
Abstract
Worldwide, hepatocellular carcinoma (HCC) is the third most common cause of cancer-related death. The remarkable improvements in treating HCC achieved in the last years have increased the complexity of HCC management. Following the need to have updated guidelines on the multidisciplinary treatment management of HCC, the Italian Scientific Societies involved in the management of this cancer have promoted the drafting of a new dedicated document. This document was drawn up according to the GRADE methodology needed to produce guidelines based on evidence. Here is presented the first part of guidelines, focused on the multidisciplinary tumor board of experts and surgical treatments of HCC.
Collapse
Affiliation(s)
- Giuseppe Cabibbo
- Section of Gastroenterology and Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties PROMISE, University of Palermo, Italy; Gastroenterology Unit, Azienda Ospedaliera Universitaria Policlinico "Paolo Giaccone", Palermo, Italy.
| | - Bruno Daniele
- Oncology Unit, Ospedale del Mare, ASL Napoli 1 Centro, Napoli, Italy
| | - Mauro Borzio
- Centro Diagnostico Italiano (CDI), Milano, Italy
| | - Andrea Casadei-Gardini
- Department of Oncology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute Hospital, Milan, Italy
| | - Umberto Cillo
- General Surgery 2-Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, Padua University Hospital, 35128 Padua, Italy
| | - Agostino Colli
- Dipartimento di Medicina Trasfusionale ed Ematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | | | - Vincenzo Dadduzio
- Medical Oncology Unit, "Mons. A.R.Dimiccoli" Hospital, Barletta, ASL BT, Italy
| | - Francesco Dionisi
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute - Rome, Italy
| | - Fabio Farinati
- Department of Surgery, Oncology and Gastroenterology, University of Padova, 35128 Padova, Italy; Gastroenterology Unit, Azienda Ospedale-Università di Padova, 35128 Padova, Italy
| | - Ivan Gardini
- EpaC Onlus, Italian Liver Patient Association, Turin, Italy
| | - Edoardo Giovanni Giannini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Rita Golfieri
- Alma Mater Studiorum" Bologna University, Bologna, Italy; Radiology Unit Madre Fortunata Toniolo Private Hospital, coordinator of Radiology centers Medipass Bologna, Bologna, Italy
| | - Maria Guido
- Department of Medicine, University of Padova, Padova- Italy
| | - Andrea Mega
- Department of Gastronterology, Regional Hospital Bolzano, Italy
| | - Silvia Minozzi
- Oncology Department, Istituto di Ricerche Farmacologiche Mario Negri, IRCCS, Milano, Italy
| | - Fabio Piscaglia
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Lorenza Rimassa
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan, Italy; Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Laura Romanini
- Radiology Unit, Ospedale di Cremona, ASST Cremona, Cremona, Italy
| | - Anna Pecorelli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Rodolfo Sacco
- Gastroenterology and Endoscopy Unit, Department of Surgical and Medical Sciences, University of Foggia, 71100 Foggia, Italy
| | - Marta Scorsetti
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, Italy; Department of Radiotherapy and Radiosurgery, Humanitas Research Hospital IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Luca Viganò
- Hepatobiliary Unit, Department of Minimally Invasive General & Oncologic Surgery, Humanitas Gavazzeni University Hospital, Viale M. Gavazzeni 21, 24125 Bergamo, Italy; Department of Biomedical Sciences, Humanitas University, Viale Rita Levi Montalcini 4, 20090 Milan, Italy
| | - Alessandro Vitale
- General Surgery 2-Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, Padua University Hospital, 35128 Padua, Italy
| | - Franco Trevisani
- Department of Medical and Surgical Sciences, University of Bologna, Italy; Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy.
| |
Collapse
|
3
|
Coppola C, Masarone M, Bartoli M, Staiano L, Coppola R, Torre P, Conforti M, Amoruso D, Gardini I, Persico M. Associated screening for HCV and SARS-Cov2 infection in an urban area of Southern Italy: A cohort study. J Viral Hepat 2022; 29:171-173. [PMID: 34585821 PMCID: PMC8662270 DOI: 10.1111/jvh.13623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/10/2021] [Accepted: 09/06/2021] [Indexed: 12/09/2022]
Affiliation(s)
- Carmine Coppola
- Department of Internal Medicine ‐ Unit of Hepatology and Interventional UltrasonographyOORR Area StabiesePlesso Nuovo GragnanoGragnanoItaly
| | - Mario Masarone
- Internal Medicine and Hepatology DivisionDepartment of Medicine and SurgeryScuola Medica Salernitana”University of SalernoBaronissiItaly
| | - Marco Bartoli
- EpaC OnlusItalian Liver Patient AssociationTurinItaly
| | - Laura Staiano
- Department of Internal Medicine ‐ Unit of Hepatology and Interventional UltrasonographyOORR Area StabiesePlesso Nuovo GragnanoGragnanoItaly
| | - Roberta Coppola
- Internal Medicine and Hepatology DivisionDepartment of Medicine and SurgeryScuola Medica Salernitana”University of SalernoBaronissiItaly
| | - Pietro Torre
- Internal Medicine and Hepatology DivisionDepartment of Medicine and SurgeryScuola Medica Salernitana”University of SalernoBaronissiItaly
| | | | - Daniela Amoruso
- Department of Internal Medicine ‐ Unit of Hepatology and Interventional UltrasonographyOORR Area StabiesePlesso Nuovo GragnanoGragnanoItaly
| | - Ivan Gardini
- EpaC OnlusItalian Liver Patient AssociationTurinItaly
| | - Marcello Persico
- Internal Medicine and Hepatology DivisionDepartment of Medicine and SurgeryScuola Medica Salernitana”University of SalernoBaronissiItaly
| |
Collapse
|
4
|
Andreoni M, Coppola N, Craxì A, Fagiuoli S, Gardini I, Mangia A, Nava FA, Pasqualetti P. Meet-Test-Treat for HCV management: patients' and clinicians' preferences in hospital and drug addiction services in Italy. BMC Infect Dis 2022; 22:3. [PMID: 34983405 PMCID: PMC8725306 DOI: 10.1186/s12879-021-06983-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 12/09/2021] [Indexed: 02/08/2023] Open
Abstract
Background It has been estimated that the incidence of chronic hepatitis C virus (HCV) will not decline over the next 10 years despite the improved efficacy of antiviral therapy because most patients remain undiagnosed and/or untreated. This study aimed to investigate the opinion of relevant target populations on the practicability, effectiveness and best modalities of the test-and-treat approach in the fight against HCV in Italy. Methods A survey was delivered to patients with HCV from the general population, patients from drug addiction services, hospital physicians and healthcare providers for drug addiction services. Results For both hospital clinicians and SerD HCPs, tolerability is shown as the most important feature of a suitable treatment. Time to treatment (the time from first contact to initiation of treatment) is deemed important to the success of the strategy by all actors. While a tolerable treatment was the main characteristic in a preferred care pathway for general patients, subjects from drug addiction services indicated that a complete Meet–Test–Treat pathway is delivered within the habitual care center as a main preference. This is also important for SerD HCPs who are a strong reference for their patients; hospital clinicians were less aware of the importance of the patient-HCP relationship in this process. Conclusion The health system is bound to implement suitable pathways to facilitate HCV eradication. A Meet–Test–Treat program within the drug addiction services may provide good compliance from subjects mainly concerned with virus transmission. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06983-y.
Collapse
Affiliation(s)
- Massimo Andreoni
- Infectious Diseases, Polyclinic of Rome Tor Vergata, Rome, Italy
| | - Nicola Coppola
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Antonio Craxì
- Department of Gastroenterology, University of Palermo, Palermo, Italy
| | - Stefano Fagiuoli
- Gastroenterology Hepatology and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Ivan Gardini
- EpaC Onlus, Italian Liver Patient Association, Monza (MB), Italy
| | - Alessandra Mangia
- Liver Unit, Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, FG, Italy
| | - Felice Alfonso Nava
- Penitentiary Medicine and Drug Abuse Unit, Public Health Service, Padua, Italy
| | - Patrizio Pasqualetti
- Section of Medical Statistics, Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy.
| |
Collapse
|
5
|
Coppola C, Masarone M, Bartoli M, Staiano L, Torre P, Conforti M, Amoruso D, Gardini I, Persico M. Associated screening for HCV and SARS-Cov2 infection in an urban area of Southern Italy: the “Casola di Napoli” cohort study. Dig Liver Dis 2021. [PMCID: PMC7901280 DOI: 10.1016/j.dld.2020.12.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- C. Coppola
- Department of Hepatology, Gragnano Hospital, Naples, Italy
| | - M. Masarone
- Internal Medicine and Hepatology Division, Department of Medicine and Surgery,” Scuola Medica Salernitana”, University of Salerno, Italy
| | - M. Bartoli
- EpaC Onlus, Italian Liver Patient Association, Rome, Italy
| | - L. Staiano
- Department of Hepatology, Gragnano Hospital, Naples, Italy
| | - P. Torre
- Internal Medicine and Hepatology Division, Department of Medicine and Surgery,” Scuola Medica Salernitana”, University of Salerno, Italy
| | - M. Conforti
- EpaC Onlus, Italian Liver Patient Association, Rome, Italy
| | - D. Amoruso
- Department of Hepatology, Gragnano Hospital, Naples, Italy
| | - I. Gardini
- EpaC Onlus, Italian Liver Patient Association, Rome, Italy
| | - M. Persico
- Internal Medicine and Hepatology Division, Department of Medicine and Surgery,” Scuola Medica Salernitana”, University of Salerno, Italy
| |
Collapse
|
6
|
Gardini I, Bartoli M, Conforti M, Mennini FS, Marcellusi A. Estimation of the number of HCV-positive patients in Italy. PLoS One 2019; 14:e0223668. [PMID: 31671120 PMCID: PMC6822946 DOI: 10.1371/journal.pone.0223668] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 09/25/2019] [Indexed: 12/17/2022] Open
Abstract
Background HCV is one of the main causes of cirrhosis, hepatocellular carcinoma (HCC) and liver transplantation. Aim The aim of this study was to estimate the number of living individuals diagnosed with hepatitis C in Italy. This study also aimed to stratify these subjects as diagnosed and cured, diagnosed awaiting a cure, and undiagnosed (individuals who were not diagnosed, living or lived with hepatitis C). Methods To quantify the number of ill patients in Italy, an inquiry was conducted based on questionnaires submitted to three nationally representative regions, namely, Campania, Lazio and Piemonte, as representatives of the three main areas of Italy (North, Centre and South regions). The data were collected through a questionnaire to acquire demographic and clinical information on patients in the participating hospitals. The questionnaires contained 6 questions on sex, age, region of residence, disease condition, type of exemption and category. The questionnaires were administered individually to consecutive patients through face-to-face interviews conducted by specialised personnel in each centre. Data were collected between September 2017 and January 2018. Results In total, 2,860 questionnaires were analysed. They were completed by the patients (55% male), who had an average age of 61 years (64 years for women and 59 years for men). In total, 54% of the sample declared that they were still infected with HCV (1,548 patients out of 2,860 respondents), while the remaining subjects declared that they had been cured. The inquiry showed that 46.6% of the sample had at least a 016 exemption (chronic hepatitis), while more than 51% (1,469 interviewed patients out of 2,860 respondents) had a different type of exemption. Only 2% of the respondents declared that they had no exemption. Assuming that the analysed sample is representative of the actual HCV-positive population in Italy and considering the number of 016 exempt patients in the regional data, the model estimates that there are 443,491 cured and HCV-positive living patients and 240,043 ill patients who have yet to be treated. Conclusions Although this study has limitations, it represents a considerable improvement over the previously available studies. This study can help decision-makers implement more effective strategic planning to eliminate hepatitis C.
Collapse
Affiliation(s)
- Ivan Gardini
- EpaC Onlus, Italian Liver Patient Association, Rome, Italy
| | - Marco Bartoli
- EpaC Onlus, Italian Liver Patient Association, Rome, Italy
| | | | - Francesco Saverio Mennini
- Centre for Economic and International Study (CEIS), Faculty of Economics, University of Rome "Tor Vergata", Rome, Italy
| | - Andrea Marcellusi
- Department of Accounting, Finance and Informatics, Kingston Business School, Kingston University London, London, United Kingdom
- * E-mail:
| |
Collapse
|
7
|
Tecco S, Parisi MR, Gastaldi G, Polizzi E, D'Amicantonio T, Zilocchi I, Gardini I, Gherlone EF, Lazzarin A, Capparè P. Point-of-care testing for hepatitis C virus infection at an Italian dental clinic: portrait of the pilot study population. New Microbiol 2019; 42:133-138. [PMID: 31157397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 09/10/2019] [Indexed: 06/09/2023]
Abstract
The dental clinic is an appropriate place to promote the prevention of hepatitis C virus (HCV) infection and fast access for care of HCV-positive subjects with new-generation anti-HCV drugs. This study aimed to determine the socio-demographic profile of subjects screened for HCV virus in a dental clinic to acquire useful information for future campaigns of prevention. An easy, free-of-charge, screen salivary test was offered to patients referred to the dental clinic of San Raffaele Scientific Research Hospital in Milan, Italy for dental procedures. These patients were also asked to complete an anonymous questionnaire on demographics and risk behaviours. A total of 1388 of 2097 (66.19%) questionnaires were evaluable. The demographics of the population responding to this initiative was primarily Italians citizen (96.47%), homogeneous gender distribution (55.55%), age over 50 (609 subjects; 43.88%), with high-level education and stable professional positions. 905 subjects (65.20%) were never tested for HCV before. The test showed positive reactivity in 22 cases (1.05%); of these, 21 subjects were known to be HCV-positive, and the test confirmed their status. One subject was newly diagnosed as HCV-positive. The percentage of subjects who were never tested for HCV infection appears too high (905 subjects, i.e., 65.20%), especially among subjects with high level of education and professions, and among adults over 40 or young people (18-25). The easy screening test in dental clinic can help raise awareness, promote early diagnosis and prevention, and provide a fast link to care for HCV infection.
Collapse
Affiliation(s)
- Simona Tecco
- Department of Dentistry IRCCS San Raffaele Scientific Institute, Milan, Italy and Dental School, Vita-Salute University, Milan, Italy
| | - Maria R Parisi
- Department of Infectious Diseases, Vita-Salute University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giorgio Gastaldi
- Department of Dentistry IRCCS San Raffaele Scientific Institute, Milan, Italy and Dental School, Vita-Salute University, Milan, Italy
| | - Elisabetta Polizzi
- Department of Dentistry IRCCS San Raffaele Scientific Institute, Milan, Italy and Dental School, Vita-Salute University, Milan, Italy
| | - Teresa D'Amicantonio
- Department of Dentistry IRCCS San Raffaele Scientific Institute, Milan, Italy and Dental School, Vita-Salute University, Milan, Italy
| | - Ilaria Zilocchi
- Department of Dentistry IRCCS San Raffaele Scientific Institute, Milan, Italy and Dental School, Vita-Salute University, Milan, Italy
| | | | - Enrico F Gherlone
- Department of Dentistry IRCCS San Raffaele Scientific Institute, Milan, Italy and Dental School, Vita-Salute University, Milan, Italy
| | - Adriano Lazzarin
- Department of Infectious Diseases, Vita-Salute University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Capparè
- Department of Dentistry IRCCS San Raffaele Scientific Institute, Milan, Italy and Dental School, Vita-Salute University, Milan, Italy
| |
Collapse
|
8
|
Parisi MR, Tecco S, Gastaldi G, Polizzi E, D'Amicantonio T, Negri S, Gardini I, Schlusnus K, Gherlone E, Capparè P, Lazzarin A. Point-of-care testing for hepatitis C virus infection at alternative and high-risk sites: an Italian pilot study in a dental clinic. New Microbiol 2017; 40:242-245. [PMID: 28825443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 11/28/2017] [Indexed: 06/07/2023]
Abstract
The Infectious Diseases Department and the Department of Dentistry of San Raffaele Scientific Institute in Milan conducted a screening and prevention program, the "EASY HCV-test Program," at a dental clinic to increase the identification of unrecognized infections. Using a cross-sectional community-based study design, hygienists in the dental clinic offered patients a hepatitis C virus (HCV) rapid salivary test (OraQuick ADVANCE® Rapid HCV Antibody Test) with pre- and post-test counseling prior to initiation of their oral hygiene routine. From April 2015 to November 2015, the EASY HCV test was offered to 2650 patients visiting the Center of Oral Health and Prevention at the Department of Dentistry at San Raffaele Hospital in Milan. Among them, 2077 eligible volunteers were tested. The test showed positive reactivity in 22 cases; of these, 21 subjects were known to suffer from HCV, and the test confirmed their status. One subject was newly diagnosed with HCV infection. The results of this study suggest EASY HCV test screening conducted in dental clinics may constitute an effective strategy for increasing HCV testing among people at risk for infection.
Collapse
Affiliation(s)
- Maria Rita Parisi
- Department of Infectious Diseases, Vita-Salute University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Simona Tecco
- Department of Dentistry IRCCS San Raffaele Scientific Institute, Milan, Italy and Dental School, Vita-Salute University, Milan, Italy
| | - Giorgio Gastaldi
- Department of Dentistry IRCCS San Raffaele Scientific Institute, Milan, Italy and Dental School, Vita-Salute University, Milan, Italy
| | - Elisabetta Polizzi
- Department of Dentistry IRCCS San Raffaele Scientific Institute, Milan, Italy and Dental School, Vita-Salute University, Milan, Italy
| | - Teresa D'Amicantonio
- Department of Dentistry IRCCS San Raffaele Scientific Institute, Milan, Italy and Dental School, Vita-Salute University, Milan, Italy
| | | | | | | | - Enrico Gherlone
- Department of Dentistry IRCCS San Raffaele Scientific Institute, Milan, Italy and Dental School, Vita-Salute University, Milan, Italy
| | - Paolo Capparè
- Department of Dentistry IRCCS San Raffaele Scientific Institute, Milan, Italy and Dental School, Vita-Salute University, Milan, Italy
| | - Adriano Lazzarin
- Department of Infectious Diseases, Vita-Salute University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| |
Collapse
|
9
|
Gardini I, Bartoli M, Conforti M, Mennini FS, Marcellusi A, Lanati E. HCV - Estimation of the number of diagnosed patients eligible to the new anti-HCV therapies in Italy. Eur Rev Med Pharmacol Sci 2017. [PMID: 28083865 DOI: 10.1016/j.jval.2016.09.948] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The present research wants to take a picture of the current epidemiological scenario regarding HCV infection in Italy. Studies used to estimate HCV burden of illness in Italy were so far local and performed a number of years ago, not mirroring the state of the art. EpaC wanted to provide a real number of diagnosed patients, eligible to new anti-HCV therapies. PATIENTS AND METHODS EpaC is the most important Italian NGO for hepatopathic patients. A number of sources were cross-checked. Starting from all regional data regarding HCV-related exemptions, a correction/integration was performed with online questionnaire to associated patients (from which we derived patients cured and also other/no exemptions); survey to all prescribing centers in Italy (from which we derived the percentage of ineligible patients); prevalence of particular subpopulations was also collected (prisoners and HIV/HCV coinfected); calculations of new diagnosed, dead and cured patients in 2015. Excluded patients were illegal immigrants and active drug addicts (subpopulations currently rarely cured). RESULTS A total of 221,549 patients were derived from regional exemptions databases and the mean national prevalence was 0.364%. Adding patients without exemptions/other exemptions, total was 308,624. We deducted the yearly deaths, cured and not eligible patients and, last, integrated with coinfected and prisoner special groups. Prevalence was also estimated at regional level, highlighting a reduction of the typical North-to-South prevalence gradient. Applying the above-mentioned corrections/integrations, total diagnosed and eligible HCV patients in Italy who can be immediately cured are supposed to range 163,148-187,756. CONCLUSIONS This is a research aimed at filling an informative gap able to provide useful actual information in terms of HCV patients real-life management and future resource allocation. These data may be considered the basis for policy- and decision-makers to plan and manage patients ready to be cured. The research does not provide information on patients not yet diagnosed.
Collapse
Affiliation(s)
- I Gardini
- EpaC Onlus, Italian Liver Patient Association, Italy.
| | | | | | | | | | | |
Collapse
|
10
|
Scalone L, Fagiuoli S, Ciampichini R, Gardini I, Bruno R, Pasulo L, Lucà MG, Fusco F, Gaeta L, Del Prete A, Cesana G, Mantovani LG. The societal burden of chronic liver diseases: results from the COME study. BMJ Open Gastroenterol 2015; 2:e000025. [PMID: 26462277 PMCID: PMC4599156 DOI: 10.1136/bmjgast-2014-000025] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 01/21/2015] [Accepted: 02/22/2015] [Indexed: 12/13/2022] Open
Abstract
Objective Chronic liver diseases (CLDs) impose a significant socioeconomic burden on patients and the healthcare system, but to what extent remains underexplored. We estimated costs and health-related-quality-of-life (HRQoL) among patients with CLDs at different stages and with different aetiologies. Design A cost-of-illness study was conducted. Direct costs, productivity loss and HRQoL were estimated in patients with chronic hepatitis, cirrhosis hepatocellular carcinoma (HCC) or where orthotopic liver transplantation (OLT) had been performed, for hepatitis C virus (HCV) infection, hepatitis B virus (HBV) infection, or in those with liver disease from other causes. Patients were retrospectively observed for 6 months. The societal perspective was adopted to calculate costs. Results In total, 1088 valid patients (median age=59.5 years, 60% men) were enrolled. 61% had chronic hepatitis, 20% cirrhosis, 8% HCC and 12% underwent OLT. HCV infection was identified in 52% and HBV infection in 29% of the patients. Adjusted mean direct costs increased from <€200/patient-month in HCV-infected patients with hepatitis to >€3000/patient-month in HBV infected patients with OLT. Antiviral treatment was the cost driver in patients with hepatitis, while hospital costs were the driver in the other subgroups. Absenteeism increased from HBV-infected patients with hepatitis (0.7 day/patient-month) to patients with OLT with other aetiologies (3.7 days/patient-month). HRQoL was on average more compromised in cirrhosis and patients with HCC, than in hepatitis and patients with OLT. HBV-infected patients generated higher direct costs, patients with other aetiologies generated the highest productivity loss and HCV-infected patients reported the worst HRQoL levels. Conclusions The present study can be considered a benchmark for future research and to guide policies aimed at maximising the cost-effective of the interventions.
Collapse
Affiliation(s)
- Luciana Scalone
- Centro di Studio e Ricerca sulla Sanità Pubblica (CESP), Università degli Studi di Milano Bicocca , Monza , Italy ; Fondazione CHARTA , Milano , Italy
| | - Stefano Fagiuoli
- Gastroenterologia , Epatologia e Trapiantologia Ospedale Papa Giovanni XXIII , Bergamo , Italy
| | - Roberta Ciampichini
- Centro di Studio e Ricerca sulla Sanità Pubblica (CESP), Università degli Studi di Milano Bicocca , Monza , Italy ; Fondazione CHARTA , Milano , Italy
| | | | - Raffaele Bruno
- Gastroenterologia , Epatologia e Trapiantologia Ospedale Papa Giovanni XXIII , Bergamo , Italy ; Unità di Malattie Infettive Tropicali e Epatologia Dipartimento di Scienze Clinico-Chirurgiche Diagnostiche e Pediatriche , Università degli Studi di Pavia , Italy ; Dipartimento Malattie Infettive Fondazione IRCCS Policlinico San Matteo, Pavia , Italy
| | - Luisa Pasulo
- Gastroenterologia , Epatologia e Trapiantologia Ospedale Papa Giovanni XXIII , Bergamo , Italy
| | - Maria Grazia Lucà
- Gastroenterologia , Epatologia e Trapiantologia Ospedale Papa Giovanni XXIII , Bergamo , Italy
| | - Francesco Fusco
- Fondazione CHARTA , Milano , Italy ; Istituto di Management-Management e Innovation (MAIN) Scuola Superiore Sant'Anna , Pisa , Italy
| | - Laura Gaeta
- Gastroenterologia. Dipartimento di Medicina Clinica e Chirurgia. Scuola di Medicina , Università degli Studi di Napoli Federico II , Italy
| | - Anna Del Prete
- Gastroenterologia. Dipartimento di Medicina Clinica e Chirurgia. Scuola di Medicina , Università degli Studi di Napoli Federico II , Italy
| | - Giancarlo Cesana
- Centro di Studio e Ricerca sulla Sanità Pubblica (CESP), Università degli Studi di Milano Bicocca , Monza , Italy
| | - Lorenzo Giovanni Mantovani
- Centro di Studio e Ricerca sulla Sanità Pubblica (CESP), Università degli Studi di Milano Bicocca , Monza , Italy ; Fondazione CHARTA , Milano , Italy
| |
Collapse
|
11
|
Scalone L, Ciampichini R, Fagiuoli S, Gardini I, Fusco F, Gaeta L, Del Prete A, Cesana G, Mantovani LG. Comparing the performance of the standard EQ-5D 3L with the new version EQ-5D 5L in patients with chronic hepatic diseases. Qual Life Res 2012. [PMID: 23192232 DOI: 10.1007/s11136-012-0318-0] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
PURPOSE To assess the performance of the EQ-5D-5L version compared with the standard EQ-5D-3L in a clinical setting targeted at patients with chronic hepatic diseases (CHDs). METHODS We introduced the 5L descriptive system into a cost-of-illness study involving patients with different CHDs. The patients completed a questionnaire including the two versions of the EQ-5D, together with other questions related to their condition. We tested the feasibility, the level of inconsistency, the redistribution properties among consistent responses, the ceiling effect, the discriminative power, and the convergent validity of the 5L compared with the 3L system. RESULTS A total of 1,088 valid patients were recruited: 62% male, 19-89 (median = 59) years old. Patients had chronic hepatitis from HCV (31.8%) or HBV infections (29.3%) or other causes (7.8%), 20.4% had cirrhosis, 11.9% underwent liver transplantation, and 7.8% had hepatic carcinoma. Less than 1% of EQ-5D-5L were returned blank, and 1.6% or less of missing values were calculated on the dimensions of the partially completed questionnaires. The proportion and weight of inconsistent responses (i.e., 3L responses that were at least two levels away from the 5L responses) was 2.9% and 1.2 on average, respectively. Regarding redistribution, 57-65% of the patients answering level 2 with the 3L version redistributed their responses to levels 2 or 4 with the 5L version. A relative 7% reduction of the ceiling effect was found. Furthermore, the absolute informativity increased but the relative informativity slightly decreased in every domain, and the convergent validity with the VAS improved. CONCLUSIONS In a clinical setting involving CHD patients, the EQ-5D-5L was shown to be feasible and with promising levels of performance. Our findings suggest that the 5L performs better in at least some of the properties analyzed, and encourage further research to also test other psychometric properties of this new version of the EQ-5D.
Collapse
Affiliation(s)
- Luciana Scalone
- CESP, Research Centre on Public Health, University of Milano Bicocca, Milan, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|