A decision-tree model to estimate the impact on cost-effectiveness of a venous thromboembolism prophylaxis guideline.

BACKGROUND AND OBJECTIVE: The impact of clinical guidelines (GL) on venous thromboembolism (VTE) prophylaxis was evaluated in a large Italian hospital with a before/after study. GL were effective in increasing the appropriateness of prophylaxis and in reducing VTE. Following this study, the aim was to estimate the impact of the adopted GL on costs and benefits through a cost-effectiveness analysis. METHODS: A decision-tree model was used to compare prophylaxis costs and effects before and after GL implementation. All patients were classified into four risk profiles (low, moderate, high, very high). Outcomes considered were: no event, asymptomatic VTE, symptomatic VTE, fatal pulmonary embolism and major bleeding. Patient risks and the probability of receiving prophylaxis were defined using data from the previous study. Outcome probabilities were derived from the literature. Regional Drg reimbursements and hospital figures were used for costing the events. RESULTS: Despite a marked increase in the number of patients receiving some form of prophylaxis, it was estimated that the introduction of GL reduced the average cost per patient related to VTE from euro210 to euro181 (-14%), with a parallel absolute decrease in VTE complications (-5%). Results are particularly relevant in the very-high-risk group. Sensitivity analysis confirmed the overall cost savings and gains in effectiveness. CONCLUSIONS: The implementation of locally adapted GL on VTE prophylaxis may lead to a benefit in terms of both costs and effects, especially for the highest-risk patients.

Prevalence and risk factors for Chlamydia trachomatis infection in young women in north-west of Italy.

AIM: The aim of the study was to estimate the prevalence of Chlamydia trachomatis infection, risk factors and best predictors of infection in young sexually active women in north-west of Italy. METHODS: One thousand one hundred and eighty 18-24 years old women of family planning clinics and three STI Clinics over Turin city area underwent vaginal swabs to detect infection and completed a questionnaire. Logistic regression and multivariate analysis identified risk factors and a receiver operating characteristic (ROC) curve was used to assess the model accuracy. RESULTS: Overall prevalence of infection was 10.4% 2.71 times higher (P<0.001) among women afferent to STI clinics than family planning clinics. Higher among women of Eastern European, Asian and South American ethnic origin (P=0.012) compared to Western European or African ethnic origin. Age at first intercourse (P=0.006), absence of a stable partner (P<0.001) partner with urogenital complaints (P<0.001), number of lifetime partners (P<0.001) number of partners in the last 6 months (P<0.001) history of occasional intercourse (P<0.001) and of IST (P<0.007) resulted associated with chlamydial infection. Multivariate analysis showed setting, partner with urogenital complaints and number of lifetime partners as best predictors of infection. ROC curve on variables from multivariate analysis showed an AUC of 0.732. CONCLUSION: The study showed high rates of Chlamydial infection among sexually active women between 18-24 years in north-west area of Italy. Predictors of infection are related to sexual activity and to population sub-groups. Selective screening protocols should be supported by wider and more representative studies in order to increase knowledge and involve public opinion.