on behalf of the WEF Study GroupRandomized controlled trials (RCTs) show that triple therapy (TT) with peginterferon alpha, ribavirin, and boceprevir (BOC) or telaprevir (TVR) is more effective than peginterferon-ribavirin dual therapy (DT) in the treatment of previously untreated patients with genotype 1 (G 1 ) chronic hepatitis C (CHC). We assessed the cost-effectiveness of TT compared to DT in the treatment of untreated patients with G 1 CHC. We created a Markov Decision Model to evaluate, in untreated Caucasian patients age 50 years, weight 70 kg, with G 1 CHC and Metavir F2 liver fibrosis score, for a time horizon of 20 years, the cost-effectiveness of the following five competing strategies: 1) boceprevir response-guided therapy (BOC-RGT); 2) boceprevir IL28B genotype-guided strategy (BOC-IL28B); 3) boceprevir rapid virologic response (RVR)-guided strategy (BOC-RVR); 4) telaprevir response-guided therapy (TVR-RGT); 5) telaprevir IL28B genotype-guided strategy (TVR-IL28B). Outcomes included life-years gained (LYG), costs (in 2011 euros) and incremental cost-effectiveness ratio (ICER). In the base-case analysis BOC-RVR and TVR-IL28B strategies were the most effective and cost-effective of evaluated strategies. LYG was 4.04 with BOC-RVR and 4.42 with TVR-IL28B. ICER compared with DT was €8.304 per LYG for BOC-RVR and €11.455 per LYG for TVR-IL28B. The model was highly sensitive to IL28B CC genotype, likelihood of RVR and sustained virologic response, and BOC/TVR prices. Conclusion: In untreated G 1 CHC patients age 50 years, TT with first-generation protease inhibitors is costeffective compared with DT. Multiple strategies to reduce costs and improve effectiveness include RVR or genotype-guided treatment. (HEPATOLOGY 2012;56:850-860) T he estimated global prevalence of hepatitis C virus (HCV) infection is 2.2%, corresponding to about 130 million HCV-positive persons worldwide, most of whom are chronically infected. 1 A recent revision 2 reported that the estimated prevalence of HCV infection in Europe ranges from 0.6% to 5.6%. This is of increasing interest because HCV is a leading cause of both cirrhosis and hepatocellular carcinoma (HCC) in Western countries. The prevalence of HCV-related cirrhosis and its complications will continue to increase through the next decade, and will mostly affect those above age 60. 3 Considering the burden of HCV-related cirrhosis and its complications, the achievement of a sustained virologic response (SVR) is a very important surrogate outcome in the management of chronic hepatitis C (CHC) patients. In fact, viral eradication prevents the development of cirrhosis 4 and its complications, such as esophageal varices 5 and HCC, 6 and leads to a decrease in liver-related death. 7

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Multi item questionnaires are widely used to collect students' evaluation of teaching at university. This article makes an attempt to analyse students' evaluation on a broad perspective. Its main aim is to adjust the evaluations from a wide range of factors which jointly may influence the teaching process: academic year peculiarities, course characteristics, students' characteristics and item dimensionality. By setting the analysis in a generalised mixed models framework a large flexibility is introduced in the measurement of the quality of university teaching in students' perception. In that way we consider (1) the effects of potential confounding factors which are external to the process under evaluation; (2) the dependency structure across units in the same clusters; (3) the assessment of real improvement in lecturers' performance over time and (4) the uncertainty related to the use of an overall indicator to assess the global level of quality of the teaching as it has been assessed by the students. The implications related to a misuse of the evaluation results in implementing university policies are discussed comparing point versus interval estimates and adjusted versus unadjusted indicators.