Maria Martorana

HIV screening in pregnant women: A systematic review of cost‐effectiveness studies

INTRODUCTION Vertical transmission represents the major route of HIV infection for children. However, the preventive interventions available are extremely effective. This review summarizes evidence regarding the cost-effectiveness of mother-to-child-transmission preventive screenings, to help policy makers in choosing the optimal antenatal screening strategy. METHODS A systematic review following PRISMA guidelines was conducted, using 3 databases: PubMed, Scopus, and Cost-Effectiveness Analysis Registry. All articles regarding HIV screening to avoid vertical transmission were included. RESULTS The review included 21 papers. Seven studies assessed the cost-effectiveness of universal antenatal screening during early gestation. Two papers considered the integration of HIV screening with other medical interventions. Eight works estimated the cost-effectiveness of HIV screening in late pregnancy. Finally, 4 papers considered the combination of multiple strategies. The selected papers focused on both developed and developing countries, with a different HIV prevalence. The characteristics and methodology of the studies were heterogeneous. However, all studies agreed about the main findings, outlining the cost-effectiveness of both universal antenatal screening and HIV rescreening in late pregnancy. Cost-effectiveness improved when HIV burden increased. The major findings were proved to be robust across various scenarios when tested in sensitivity analysis. CONCLUSIONS The review confirmed the cost-effectiveness not only of HIV universal antenatal screening but also of rescreening in late gestation in both developed and developing countries. Universal screening is cost-effective even in case of extremely low HIV prevalence. Therefore, to maximize screening, coverage appears as a worldwide priority. In certain settings, a targeted screening towards high-risk groups could be a valuable option.

Cost-effectiveness of HIV screening in high-income countries: A systematic review

INTRODUCTION Over 2 million people in high-income countries live with HIV. Early diagnosis and treatment present benefits for infected subjects and reduce secondary transmissions. Cost-effectiveness analyses are important to effectively inform policy makers and consequently implement the most cost-effective programmes. Therefore, we conducted a systematic review regarding the cost-effectiveness of HIV screening in high-income countries. METHODS We followed PRISMA statements and included all papers evaluating the cost-effectiveness of HIV screening in the general population or in specific subgroups. RESULTS Thirteen studies considered routine HIV testing in the general population. The most cost-effective option appeared to be associating one-time testing of the general population with annual screening of high-risk groups, such as injecting-drug users. Thirteen studies assessed the cost-effectiveness of HIV screening in specific settings, outlining the attractiveness of similar programmes in emergency departments, primary care, sexually transmitted disease clinics and substance abuse treatment programmes. DISCUSSION Evidence regarding the health benefits and cost-effectiveness of HIV screening is growing, even in low-prevalence countries. One-time screenings offered to the adult population appear to be a valuable choice, associated with repeated testing in high-risk populations. The evidence regarding the benefits of using a rapid test, even in terms of cost-effectiveness, is growing. Finally, HIV screening seems useful in specific settings, such as emergency departments and STD clinics.

Trajectories of long-term care in 28 EU countries: evidence from a time series analysis.

Background This study aims to confirm whether an increase in the number of elderly people and a worsening in the auto-evaluation of the general health state and in the limitation of daily activities result in increases in the offered services (beds in residential LTC facilities), in the social and healthcare expenditure and, consequently, in the percentage of LTC users. Methods This study used a pooled, cross-sectional, time series design focusing on 28 European countries from 2004 to 2015. The indicators considered are: population aged 65 years and older; self-perceived health (bad and very bad) and long-standing limitations in usual activities; social protection benefits (cash and kind); LTC beds in institutions; LTC recipients at home and in institutions; healthcare expenditures and were obtained from the Organization for Economic Co-operation and Development and Eurostat. Results The proportion of elderly people increased, and conversely, the percentage of subjects who had a self-perceived bad or very bad health decreased. Moreover, there was an orientation to reduce the share of elderly people who received LTC services and to focus on the most serious cases. Finally, the combination of formal care at home and in institutions resulted in most Member States shifting from institutional care to home care services. Conclusions Demographic, societal, health changes could considerably affect LTC needs and services, resulting in higher LTC related costs. Thus, knowledge of LTC expenditures and the demand for services could be useful for healthcare decision makers.

Medication discrepancies across multiple care transitions: A retrospective longitudinal cohort study in Italy

Purpose Medication discrepancies are defined as unexplained differences among regimens across different sites of care. The problem of medication discrepancies that occur during the entire care pathway from hospital admission to a local care setting discharge (namely all types of settings dedicated to formal care other than hospitals) has received little attention in the medical literature. The present study aims to (1) determine the prevalence of medication discrepancies that occur during the entire care pathway from hospital admission to local care setting discharge, (2) describe the discrepancy and medication type, and (3) identify potential risk factors for experiencing medication discrepancies in patient care transitions. Evidence from an integrated health care system, such as the Italian one, may explain results from other studies in different healthcare systems. Methods A retrospective longitudinal cohort study of patients admitted from July 2015 to July 2016 to the Giovanni Bosco Hospital serving Turin, Italy and its surrounding territory was performed. Discrepancies were recorded at the following four care transitions: T1: Hospital admission; T2: Hospital discharge; T3: Admission into local care settings; T4: Discharge from local care settings. All evaluations were based on documented regimens and were performed by a team (doctor, nurse and pharmacists). Results Of 366 included patients, 25.68% had at least one discrepancy. The most frequent type of discrepancy was from medication omission (N = 74; 71.15%). Only discharge from a long-stay care setting (T4) was significantly associated with the onset of discrepancies (p = 0.045). When considering a lack of adequate documentation, not as missing data but as a discrepancy, 43.72% of patients had at least one discrepancy. Conclusions This study suggests that an integrated health care system, such as Italian system, may influence the prevalence of discrepancies, thus highlighting the need for structured multidisciplinary and, if possible, computerized medication reconciliation to prevent medication discrepancies and improve the quality of medical documentation.