BackgroundMany atrial fibrillation patients eligible for oral anticoagulants are unaware of the presence of AF, and improved detection is necessary to facilitate thromboprophylaxis against stroke.ObjectiveTo assess the effectiveness of screening for AF compared to no screening and to compare efficacy outcomes of different screening strategies.Materials and methodsCochrane Central Register of Controlled Trials, EMBASE and MEDLINE from Jan 1, 2000 –Dec 31, 2015 were searched. Studies employing systematic or opportunistic screening and using ECG or pulse palpation in populations age ≥40 years were included. Data describing study and patient characteristics and number of patients with new AF were extracted. The outcome was the incidence of previously undiagnosed AF.ResultsWe identified 25 unique (3 RCTs and 22 observational) studies (n = 88 786) from 14 countries. The incidence of newly detected AF due to screening was 1.5% (95% CI 1.1 to 1.8%). Systematic screening was more effective than opportunistic: 1.8% (95% CI 1.4 to 2.3%) vs. 1.1% (95% CI 0.6 to 1.6%), p<0.05, GP-led screening than community based: 1.9% (95% CI 1.4 to 2.4%) vs. 1.1% (95% CI 0.7 to 1.6%), p<0.05, and repeated heart rhythm measurements than isolated assessments of rhythm: 2.1% (95% CI 1.5–2.8) vs. 1.2% (95% CI 0.8–1.6), p<0.05. Only heart rhythm measurement frequency had statistical significance in a multivariate meta-regression model (p<0.05).ConclusionsActive screening for AF, whether systematic or opportunistic, is effective beginning from 40 years of age. The organisation of screening process may be more important than technical solutions used for heart rhythm assessment.

Colonoscopy is the standard medical procedure to identify inflammatory bowel disease (IBD) in patients with gastrointestinal symptoms. Noninvasive measurement of faecal calprotectin concentration may replace colonoscopy in this indication. The study aimed to assess efficacy of faecal calprotectin as a diagnostic marker of IBD in patients with symptoms suggestive of such diagnosis. Meta-analysis of diagnostic accuracy studies was performed. Cochrane, EMBASE and MEDLINE databases were searched until December 2018. Inclusion criteria comprised experimental and observational studies, adults with gastrointestinal symptoms, calprotectin as index and colonoscopy as reference test, presence of data on/enabling the calculation of diagnostic accuracy parameters. For each study, sensitivity and specificity of faecal calprotectin were analysed as bivariate data. Nineteen studies were identified. The total number of patients was 5032. Calculated pooled sensitivity and specificity were 0.882 [95% confidence interval (CI), 0.827–0.921] and 0.799 (95% CI, 0.693–0.875), respectively. Following faecal calprotectin incorporation in the diagnostic work-up of 100 people with suspected IBD, 18 non-IBD patients will have a colonoscopy performed and one patient with the disease will not be referred for this examination. Faecal calprotectin concentration measurement is a useful screening test to rule out IBD, at the same time reducing the need for colonoscopy by 66.7%.

In the treatment of erosive esophagitis esomeprazole was significantly more effective than other PPIs. Both for 4- and 8-week therapy respective incremental cost-effectiveness ratio values were acceptably low. Differences in effectiveness of non-erosive reflux disease therapy were not significant. The replacement of pantoprazole 20 mg with more effective esomeprazole 20 mg in the 6-month maintenance therapy was associated with a substantially high incremental cost-effectiveness ratio.

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Objectives: To simulate and compare the clinical and economic outcomes of selfmonitoring of blood glucose (SMBG) devices along ranges of accuracy from a German payer perspective. MethOds: We programmed a long-term type 1 diabetes natural history and treatment cost-effectiveness model. In phase one, using past in-silico evidence (UVa/Padova simulator, accepted by the Food and Drug Administration for pre-clinical studies), we associated changes in SMBG error to changes in HbA1c, and separately, changes in severe hypoglycemia and hyperglycemia requiring an inpatient stay. In phase two, using Markov cohort simulations, we estimated the lifetime clinical and economic outcomes based on a German payer perspective. The primary comparison was a SMBG device with strip price € 0.56 Euros and 10% error (exceeding accuracy requirements by International Organization for Standardization (ISO) 15197:2013) versus a SMBG device with the same strip price and 15% error (accuracy meeting ISO 15197:2013). Outputs for the average patient over a 5-year time horizon, discounted at 3% per annum, were severe hypoglycemic and hyperglycemic events requiring an inpatient stay, quality-adjusted life years (QALYs), and cost differences per patient. Results: Assuming the benefits translate into HbA1c improvements only, an SMBG device with 10% versus 15% error was associated with an increase of 0.023 QALYs and a cost savings of € 100 Euros per patient over 5 years. Assuming the benefits translate into reduced severe hypoglycemic and hyperglycemic events requiring an inpatient stay only, an SMBG device with 10% versus 15% error was associated with a combined decrease in severe hypoglycemic and hyperglycemic events of 0.86 and cost savings of € 976 Euros per patient over 5 years. cOnclusiOns: Investing in devices with improved accuracy (less error) appears to be an affordable strategy with improved quality of life for type 1 diabetes patients. PMD67 coSt-effectIVeneSS of a PreVentIVe teStIng Strategy In relatIVeS of PatIentS wIth Brca MutateD oVarIan cancer VerSuS a no teSt StrategyObjectives: According to AIOM estimates, the prevalence rate of ovarian cancer is 1.3%. 8-13% of women diagnosed with epithelial OC have a germline BRCA1 or BRCA2 mutation. Specifically, the lifetime risk for OC in patients with BRCA1 mutations is 39-46% compared with 10-27% in patients with BRCA2 mutation. This study aims to estimate the cost-effectiveness ratio of a preventive testing strategy for relatives of patients with BRCA mutated cancer versus a no test strategy. MethOds: The BRCA testing pathway was elaborated by a panel of experts. Based on this, Cost-effectiveness analysis was carried out from the Italian National Health Service perspective through a decision analytic model, within 5 years times horizon. Two alternatives were considered: 1) Preventive BRCA testing for relatives of ovarian cancer patients with positive mutation BRCA1 and BRCA2; 2) No test . Cost and effectiveness data derived from literature were discounted by 3%. Costs were analyzed from Ital...