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Lack of hepatitis C transmission among institutionalized psychiatric patients
No full textPrevalence studies have shown low rates of hepatitis C virus (HCV) infection in psychiatric inpatient population [1], [2] and [3]. A recent survey [4] in two psychiatric institutions in northern Italy has shown a 6.7% anti-HCV prevalence rate, which most likely reflects the relatively old median age (55 years) of the subjects studied. In fact there is evidence that anti-HCV prevalence in the Italian general population increases with age, suggesting a cohort effect, i.e. decreased risk of infection along generations as a consequence of improved sanitary and socio-economic conditions over time [5]. In the above-mentioned study [4] logistic regression analysis showed that length of hospitalization was not associated with the likelihood of HCV seropositivity, while a diagnosis of psychosis and a history of trauma both were independent predictors of infection. However, prevalence data, reflecting a cumulative incidence of infection over time, cannot establish exactly the temporal relationship between an exposure and the acquisition of infection. To our knowledge, no prospective study, the best tool to assess directly the risk of infection, has been so far performed on this subject. Therefore, we have conducted in one of these two previously studied institutions a prospective survey to evaluate the risk of acquiring HCV infection. Although the overall clinical features the inpatient population studied was the same, demographics were not exactly identical because three deaths and five new admissions occurred between the period of our study and that of the previous one.
In 1993, 526 subjects (409 with mental retardation, 117 psychotic and three with dementia) were tested for anti-HCV by a commercially available ELISA (Ortho HCV II, Ortho Diagnostic Systems, Raritan, NJ, USA). Anti-HCV positivity was detected in 27 (5.1%) subjects; HCV RNA, examined by reverse transcription–polymerase chain reaction, was present in 24 (88.9%) of these subjects.
The 499 anti-HCV negative subjects (133 females and 366 males) were followed up with anti-HCV test at yearly intervals. No subject seroconverted to anti-HCV during a mean follow-up of 7.4 years. Clearance of anti-HCV was observed in three subjects initially anti-HCV positive, but HCV RNA-negative.
Our findings confirm and extend those of a previous survey [4] which reported low or absent risk of HCV in this setting despite violent behavior, with associated biting and scratching, poor sanitation and presence of not negligible proportion of HCV viremic subjects among the inmates of this institution
PAIR. A preliminary evaluation of cost in Italy
No full textThere is no consensus as to what is the best treatment (surgery, chemotherapy and percutaneous treatments) for hepatic cystic echinococcosis (CE). Retrospective studies have addressed the pros and cons of each option, but costs of treatments, an important issue particularly in developing countries, have never been studied extensively. Aim of this paper is to calculate the cost of PAIR for non-complicated echinococcal cysts of the liver in Italy.
Costs of hospital stay, of disposable items, salaries for health personnel and sonograms, were obtained from the S.Matteo Hospital Administration and pharmacy. The institution is a large tertiary care teaching hospital in Lombardy, a region in Northern Italy. Costs of 1 year follow-up were included. The costs were calculated with respect of a 3-day hospital stay without complications.
The 2006 mean specific cost of a PAIR treatment for a 3 day hospital stay and 1 year follow-up was 2,072 EUR (average exchange rate : 1 EUR = 1.26 USD). Main cost entries were the following:
a) days spent in hospital (net cost of stay): € 1,500 (72.4% of the total cost);
b) disposable items (needles, catheters) € 239 (11.5%);
c) personnel : € 156 (7.5%);
d) drugs (30-days albendazole administration as prophylaxis of secondary echinococcosis): € 72 (3.5%);
e) imaging examinations (paid by patient): € 105 (5.1%).
PAIR is a relatively inexpensive treatment for uncomplicated cysts. The hospital stay accounts for the bulk of the costs. Further research is needed to compare the costs of PAIR with those of surgery (radical and conservative). This would contribute important information to the debate on the best treatment for liver CE
PAIR vs conservative surgery for uncomplicated echinococcal cysts: evaluation of costs in Italy
No full textThere is no consensus about the best treatment (surgery, chemotherapy and percutaneous treatments) for hepatic cystic echinococcosis (CE). Retrospective studies have addressed the pros and cons of each option, but costs of treatments have never been studied extensively. Aim of this paper is to compare the cost of PAIR and conservative surgery for non-complicated echinococcal cysts of the liver in Italy.
Materials and Methods. Costs of hospital stay, operating theatre, disposable items, salaries for health personnel and sonograms, were obtained from the S.Matteo Hospital Administration and pharmacy. The institution is a large tertiary care teaching hospital in Lombardy, a region in Northern Italy. Costs of 1-year follow-up were included. The costs were calculated for a 3-day hospital stay for PAIR procedure and 4-day hospital stay for surgery, both without complications.
Results and Discussion. The 2006 mean specific cost of a PAIR treatment for a 3-day hospital stay and 1 year follow-up was 2,072 EUR (average exchange rate: 1 EUR = 1.26 USD). Main cost entries were the following:
a) hospital stay (net cost): € 1,500 (72.4% of the total cost);
b) disposable items (needles, catheters) € 239 (11.5%);
c) personnel: € 156 (7.5%);
d) drugs (30-days albendazole administration as prophylaxis of secondary echinococcosis): € 72 (3.5%);
e) ultrasound scans (paid by patient): € 105 (5.1%).
In the same year and same hospital, the specific cost of a surgical conservative intervention and 1-year follow-up was 3,267 EUR. Main cost entries were the following:
a) hospital stay (net cost): € 2,000 (61,2% of the total cost);
b) operating theatre (2 hours): € 140 (4,3%);
c) disposable items: e.g. :Fibrin Glue € 500 (15,3%);
d) personnel: € 300 (9,2%);
e) pre-operative tests (Labs, ECG, Chest X-ray, anesthesiological evaluation): € 150 (4,6%);
f) drugs (30-days albendazole administration as prophylaxis of secondary echinococcosis): € 72 (2,2%);
g) ultrasound scans (paid by patient): € 105 (3,2%).
Conclusion
PAIR is significantly less expensive than conservative surgery for uncomplicated echinococcal cysts of the liver.
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