OBJECTIVE: Screening for HBV among groups at risk, such as migrant populations, has proved to be a cost-effective strategy. With a view to advising local policy-makers, the cost-consequences of HBV screening was assessed using a modeling approach. METHODS: This cost-consequence analysis of an HBV screening strategy was conducted in a cohort of adult migrants in the province of Padua, northern Italy. RESULTS: The population targeted for screening consisted of 65405 migrants, among whom the weighted rate for the prevalence of HBV was 0.04972, with 3251 people infected. Over a period of 5 years, the screening strategy prevented 565 cases/year of chronic hepatitis, 141 of compensated cirrhosis, 9 of decompensated cirrhosis, 14 hepatocellular carcinomas and 12 deaths. The above data revealed that the incremental cost of the screening strategy compared to no screening strategy was 7 974 959 over the five year period. The cost per life saved amounted to 676 709. CONCLUSIONS: The present study provides useful information to policy-makers at local and regional levels.

OBJECTIVE: The aim of this research was to characterize hospitalizations associated with discharges against medical advice (DAMA) in a large, population-based data system. MATERIALS AND METHODS: This was a retrospective cohort study on 11 436 500 hospital admissions. The hospital discharge records for residents of the Veneto region (north-east Italy) discharged from 2001 to 2012, from both public and accredited private hospitals, were considered. The DAMA rate was calculated by type of hospital admission, excluding patients who died. The time trend of the DAMA rate was charted from the average annual percent changes. RESULTS: During the period considered, 66 549 DAMA were recorded, amounting to an overall DAMA rate of 6.0‰ admissions. Analyzing the diagnostic categories, admissions for substance abuse (drugs or alcohol) and dependence coincided with the highest DAMA rate (83.5‰), followed by poisoning (40.2‰), psychiatric disorders (24.7 ‰), traumas (21.1‰), HIV-related diseases (19.9‰), burns (10.5‰), and - for women - issues relating to pregnancy, childbirth and the postnatal period (11.2‰). The DAMA rate dropped from 6.72 to 5.55 from 2000 to 2008, then remained stable. CONCLUSION: The DAMA rate dropped slightly over the period considered. Several diagnostic categories are associated with a higher likelihood of patients leaving hospital against their doctor's advice.

OBJECTIVE: To assess elderly individuals' demand for emergency department (ED) care, in terms of the characteristics, processes, outcomes, costs by referral pattern. DATA SOURCE: All ED visits involving patients aged 65 and older, extracted from the 2010 dataset of an Local Health Agency, in North-Eastern Italy (no. = 18 648). STUDY DESIGN: Retrospective cohort study. PRINCIPAL FINDINGS: Patients were referred by primary care professionals (PCPs) in 43.1% of cases, 1.4% came from nursing homes (NH), and 55.5% were self-referred (SR). The SR group had a higher adjusted odds ratio (aOR) for non-urgent conditions (1.98 CI 1.85-2.12), but a lower aOR for conditions amenable to ambulatory care (0.53 CI 0.48-0.59), and a lower consumption of resources. The SR group tend to occur more frequently out of hours, and to coincide with a shorter stay at the ED, lower observation unit activation rates, lower hospitalization rates and a lower consumption of services than other two groups. The average costs for all procedures were lower for the SR patients (mean = 106.04 € ± SD 84.90 €) than for those referred by PCPs (mean = 138.14 € ± SD 101.17 €) or NH (mean = 143.48 € ± SD 95.28 €). CONCLUSION: Elderly patients coming in ED have different characteristics, outcomes and recourses consume by referral pattern.