The Cost-effectiveness of Genetic Screening for Familial Hypercholesterolemia: a Systematic Review.

BACKGROUND: Familial hypercholesterolemia (FH) is a genetic disorder that leads to elevated plasma LDL-cholesterol levels and premature coronary heart disease (CHD). An understanding of the mutations responsible for FH and the effectiveness of statins in lowering the risk of CHD in FH patients has increased interest in genetic screening strategies to improve FH diagnosis. In this study, we aimed to evaluate the cost-effectiveness of such strategies. METHODS: We performed a systematic review of full economic evaluations that assessed the cost-effectiveness of FH genetic screening strategies. We used relevant search terms to investigate Medline, Scopus, Web of Science, the Database of Abstracts of Reviews of Effects, the Health Technology Assessment Database, and the National Health Service Economic Evaluation Database. Data extraction and assessment of the quality of the studies were performed independently by two reviewers. The key features of the included studies are summarized in a narrative synthesis. RESULTS: We included seven economic evaluations that assessed the cost-effectiveness of genetic screening for FH, published mainly in Europe between 2002 and 2015. Most studies had a no-screening strategy as a comparator, focused on relatives of index cases with genetic or clinical diagnosis of FH (cascade screening), considered a lifetime horizon and adopted a health care payer viewpoint. Cascade screening, based on genetic testing of relatives of an index case with confirmed clinical or genetic diagnosis of FH, was shown to be cost-effective in most settings. CONCLUSIONS: Our review confirms the cost-effectiveness of cascade genetic screening for the diagnosis of FH. Further research may be needed to assess the cost-effectiveness of cascade screening following the introduction of newly recommended therapeutic regimes and next-generation sequencing.

[Public health strategies in the prevention of induced abortion. An experience of interprofessional education based strategy]. / Strategie di Sanità pubblica nella Prevenzione delle IVG. Una esperienza basata sulla formazione interprofessionale.

In Italy recent statistics show a huge difference between abortion rate among Italian and migrant women: is it an inequity in health? The Italian Ministry of Health / Center for Disease Prevention and Control, which recognized this issue as a specific public health problem, has financed a national Project whose aim was the prevention of abortion among migrant women. The Project was characterized by a multitasking approach: 1) information and health education of migrant women and their communities; 2) education of health and social care professionals; 3) analysis and development of new proposals for the networks of services directed towards the improvement of woman's health. In this article the Authors describe the main characteristics of the realized intervention of inter-professional education. It began with a multidisciplinary process for the identification of educational needs which has allowed the identification of educational goals. A Training of Trainers event was then organized in order to involve and make the ten Italian Regions partners of the Project aware of their responsibilities. A DVD collecting all the material of the course and other useful resources was produced in order to support the educational process. At the moment it is not possible to evaluate the medium- and long-time results of the process (e.g. the efficacy of educational interventions or the health outcomes related to the reduction of abortion among migrant women). Nevertheless all the actors involved have made positive evaluations on the usefulness of the process.