[Covid-19: Thomas Bayes warns and we should listen. False negatives and the probability of encountering them.] / Covid-19: Thomas Bayes ammonisce e noi dovremmo ascoltarlo. I falsi negativi al test e la probabilità d'incontrarli.

We believe that a high percentage of covid-19 infections could be due to the presence of false negative (FN) individuals on rapid swabs. To support this hypothesis and quantify their number, we performed simulations using Bayes' rule and various assumptions about the sensitivity, specificity of swabs and prevalence of infection. Imagining FNs in liberty, we then calculated the probability of encountering them in groups of people with a typical number of habitual sites, such as: bus, supermarket, theatre, etc. The probability of encountering FN from rapid tests was more than 3 times higher (345% change) that reported by the RT-PCR test.

Prevalence of common mental disorders in Italy: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD).

OBJECTIVE: To present 1-month, 12-month and lifetime prevalence estimates of mood, anxiety and alcohol disorders in Italy; and the socio-demographic correlates and comorbidity patterns of these estimated disorders. METHOD: A representative random sample of non-institutionalised citizens of Italy aged 18 or older (N=4,712) was interviewed between January 2001 and July 2003, with a weighted response rate of 71.3%. DSM-IV disorders were assessed by lay interviewers using Version 3.0 of the Composite International Diagnostic Interview (CIDI). RESULTS: A total of 11% of respondents reported a lifetime history of any mood disorder, 10.3% any anxiety disorder and 1.3% any alcohol disorder. About 5% reported having an anxiety disorder in the past 12 months compared to 3.3% for any mood disorder and 0.2% for any alcohol disorder. Major depression and specific phobia were the most common mental disorders. Women were twice as likely as men to report a mood disorder and four times as likely as men to report an anxiety disorder, while men were twice as likely as women to report an alcohol disorder. High comorbidity of mood and anxiety disorders was observed. Prevalence estimates were generally lower than in parallel surveys carried out in other Western European countries. CONCLUSION: A high proportion of adults in Italy have a history of mood, anxiety or alcohol disorders. The lower than expected prevalence estimate of alcohol use disorder may be due to under-reporting or to low social harm from alcohol consumption.

Cost-benefit analysis of influenza vaccination in a public healthcare unit.

OBJECTIVE: Estimate the costs and benefits of influenza vaccination in a group of employees of an Italian District Health Authority, Unità Locale Socio Sanitaria (ULSS), to define a scheme of an economic evaluation to be used for other vaccination strategies. DESIGN: In an observational study conducted from December 2002 to April 2003, 107 ULSS employees, voluntarily vaccinated, were compared with 107 nonvaccinated ULSS employees matched for age, sex, and job category. The outcome of cost-benefit analysis was evaluated by checking personnel department records about absences from work and their causes, including influenza. Costs and benefits of the influenza vaccination from the ULSS point of view were calculated. RESULTS: The influenza vaccination strategy reduced absences from work by 23% and decreased the loss of working days by 30% and related cost. This difference is not significative. The ratio vaccination benefits/cost was euro4.2. The advantage of vaccination is confirmed by sensitivity analysis performed on the mean cost of a working day, which showed that the benefit-cost ratio ranged from euro4.5 to euro11.7. CONCLUSIONS: The results suggest that the influenza vaccination strategy in our sample of people was cost-saving. The economic evaluation used in this study could also be used for other vaccination strategies and in other settings.

[Economic evaluation of the treatment of systemic fungal infections in immunocompromised patients: the role of itraconazole]. / Aspetti farmacoeconomici del trattamento delle micosi sistemiche profonde in pazienti immunocompromessi: il ruolo di itraconazolo.

In recent years, the incidence of HIV infection, the intensity of chemotherapy regimens for cancer and the use of bone marrow transplantation have all increased. This results in an increase in the incidence of systemic fungal infections, which are associated high rates of morbidity and mortality in this immunosuppressed population; the incidence is growing: 50% for neutropenic/transplant bone marrow patients and 5-20% for organ transplant. Fluconazole, itraconazole, amphotericin-B and, in the recent years, caspofungin and voriconazole are the most frequently used antifungal agents. However, the newly developed formulations of itraconazole and lipid-associated formulations of amphotericin-B have provide new treatment options for systemic fungal infection and have prompted a number of comparisons of the treatment costs of empirical therapy. The i.v. formulation of itraconazole may be more cost effective than either conventional or liposomial formulations of amphotericin-B when used as empirical therapy for neutropenic patients with persistent fever despite broad spectrum antibiotic therapy, but further studies are required. The lack of studies, national and international, and the small amount of available data on the cost of systemic fungal infections mean that the costs saving from prophylactic and empirical use of antifungals are difficult to estimate.

[Management of acute pain in Italy. Economic aspects and quality of life]. / La gestione del dolore acuto in Italia: aspetti economici e qualità di vita.

OBJECTIVES: This study aims to measure quality of life and treatment costs of patients with acute pain due to osteoarticular diseases;2 to asses associations between pain, quality of life and treatment costs from NHS' perspective. PATIENTS AND METHODS: Observational, multicentric study; patients of both gender were enrolled sequentially from March to July 2002 and observed for 30 days. Type of pain was assessed by a McGill Pain Questionnaire, while degree of severity was measured by VAS (Visual Analogue Scale) ranging from 0 (no pain) to 10 (very severe pain). Quality of life was assessed by EQ-5D (EuroQol/Quality of Life in Europe-5 Dimensions). RESULTS: 188 patients matched by gender and age in to four group: male < or =65 years (51), female < or =65 years (59), male > 65 years (42), female > 65 years (36). Male's age ranged from 36 to 88 years, while female's ranged from 31 to 87 years. Groups differ for type of pain. Cost after enrollment (48.99 Euro) is due for about 60% to diagnostic examinations, while pharmacological therapies account for only 17.64 Euro. Mean score of EQ-5D shows a low level of utility (0.265) that reflects a rather law quality of life. Patient older than 65 years had lower score than patient of the same gender but younger. Differences are significant in the dimension anxiety/depression that afflicts women and older patients. CONCLUSIONS: This study valued utility of patients with non oncological acute pain in Italy and health cost of diagnostic and therapeutic path faced by patients.

The costs of type 2 diabetes mellitus in Italy: a CODE-2 sub-study.

AIM: To estimate the direct, indirect, and intangible costs associated with type 2 diabetes mellitus in Italy in 1998. To evaluate the economic impact of diabetic complications, and to investigate drug treatment patterns and associated costs in patients with type 2 diabetes. METHODS: The Italian arm of an international study (COsts of Diabetes in Europe--Type 2 [CODE-2], a descriptive, cross-sectional survey) was set up to collect information retrospectively by means of questionnaires from a sample of 1263 patients. Resource use was measured in monetary terms using a set of costs and tariffs. Intangible costs were estimated using the EuroQol questionnaire. RESULTS: The average yearly cost for medical resources for a patient with type 2 diabetes was 2991 Euro, whereas the estimated cost for the whole population with type 2 diabetes was about 5170 million Euro. This corresponds to 6.65% of the total healthcare expenditure (public and private) in Italy. Of direct costs, 29% was spent for the treatment of diabetes and 39% for the treatment of diabetic complications; while the remaining 32% was spent for healthcare not related to diabetes. Quality of life score in patients with type 2 diabetes (EuroQoL overall average score) was 0.68. CONCLUSIONS: Type 2 diabetes has a high cost to society. The major cost component is due to the care of diabetic complications, not to the treatment of the illness itself; in particular, drug costs represent a relatively small proportion of such treatment cost.