ObjectiveThis systematic review aimed to assess the current use and acceptance of real-world data... more ObjectiveThis systematic review aimed to assess the current use and acceptance of real-world data (RWD) and real-world evidence (RWE) in health technology assessment (HTA) process. It additionally aimed to discern stakeholders’ viewpoints concerning RWD and RWE in HTA and illuminate the obstacles, difficulties, prospects, and consequences associated with the incorporation of RWD and RWE into the realm of HTA.MethodsA comprehensive PRISMA-based systematic review was performed in July 2022 in PubMed/Medline, Scopus, IDEAS-RePEc, International HTA database, and Centre for Reviews and Dissemination with ad-hoc supplementary search in Google Scholar and international organization websites. The review included pre-determined inclusion criteria while the selection of eligible studies, the data extraction process and quality assessment were carried out using standardized and transparent methods.ResultsTwenty-nine (n=29) studies were included in the review out of 2.115 studies identified by ...
Three years of adjuvant imatinib therapy for patients at high risk of recurrence was predicted to... more Three years of adjuvant imatinib therapy for patients at high risk of recurrence was predicted to achieve an additional 1.58 QALYS compared with one year of treatment. These health benefits are gained at an estimated incremental cost per QALY of £14,108. These results were robust to changes in key model parameters. Conclusions: The analysis suggests that, for patients at high risk of recurrence following surgical resection of localised GIST, three years of adjuvant imatinib treatment leads to improved long term quality-adjusted survival compared with one year's therapy. Extended adjuvant treatment with imatinib represents good value for money according to currently accepted standards of cost-effectiveness in Scotland.
Objectives: FXS is the most common inherited form of intellectual disability and is associated wi... more Objectives: FXS is the most common inherited form of intellectual disability and is associated with comorbidities that impair functioning and adaptive behavior. This study is aimed at evaluating the incremental direct health care costs and resource utilization associated with FXS using administrative health care claims data. MethOds: Using the Optum Health Reporting and Insights Employer database covering 1999-2012, subjects < 65 years old with ≥ 1 FXS diagnosis (ICD-9-CM: 759.83) and ≥ 6 months of continuous enrollment prior to the first observed FXS diagnosis were matched with up to 5 non-FXS controls using high-dimensional propensity score matching. Individuals were followed until the end of continuous enrollment in the health plan. All-cause and FXS-related costs and resource utilization stratified by hospitalizations, emergency room (ER), outpatient, and home care visits were examined. Results: 590 FXS individuals (mean[median] age: 25.7[27]; female: 54.1%; employee: 32%) and 2,950 non-FXS controls (mean[median] age: 25.7[27]; female: 52.1%; employee: 32%) were identified. Significant differences were observed between FXS and non-FXS in the all-cause per-patient per-year (PPPY) incidence of hospitalizations (0.414 vs. 0.237; incidence rate ratio [IRR] [95%
Objective: Detention conditions during incarceration have not been adequately explored in Greece.... more Objective: Detention conditions during incarceration have not been adequately explored in Greece. The aim of this study was to highlight incarcerated women's views and satisfaction on their detention conditions in the female prison of Attica. Methods: A cross-sectional survey was carried out in 2014. A semi-structured questionnaire was distributed to those who met the inclusion criteria and were enrolled in the study. Inmates who were in solitary confinement, suffered from serious psychiatric problems, or were unable to understand the Greek language were excluded from the study. Participation was voluntary after prisoners' verbal consent. Data were collected via personal interviews and information received was anonymized. Descriptive statistics, bivariate analysis, Spearman correlation coefficient and qualitative content analyses were used. Statistical analysis was performed using SPSS 20. Results: Of a total of 135 incarcerated women, 101 were eligible and accepted to participate in the study. Current mental and health status were rated as poor/ very poor by 55% and 27.7% of the participants, respectively. The vast majority stated their dissatisfaction with the accommodation, the cleanliness, as well as the provided nutrition inside the prison. 65% participated in social reintegration programs and 66% in physical exercise. 73.3% declared that the main reason of their worries was the relationship with their family members and 37.6% stated that there was support in family problems during incarceration. The overall satisfaction on detention conditions regarding prisoner's daily life was also rated as low by 67.3%. In addition, the results confirmed a positive linear relationship between satisfaction on detention conditions and health/mental health status. Conclusion: Incarcerated women in the female prison of Attica appear not to be satisfied with the experienced detentions conditions that are associated with their health status. Our findings should encourage further research in order to introduce more effective interventions aiming at improving prisoner's daily life and future after release.
Background: Corporate social responsibility (CSR) is an evolving business strategy worldwide, foc... more Background: Corporate social responsibility (CSR) is an evolving business strategy worldwide, focusing on the sustainability of the enterprise and the provision of multiple benefits to the societies and economies. Objective: The aim of this paper was to explore the encouraging and deterrent factors for the implementation of CSR actions in companies specializing in pharmaceutical and biomedical products as well as in medical equipment in Greece. Methods: A cross-sectional study was conducted (April to June 2021) in member-companies of the Hellenic Association of Pharmaceutical Companies, the Panhellenic Association of Pharmaceutical Industry and the Association of Health-Research and Biotechnology Industry. Data collection was carried out via an anonymous, self-administered questionnaire. Descriptive and inferential statistical analyses were performed, using SPSS version 25 (IBM Corp., Armonk, NY, USA). The significance level was set at p≤0.05. Results: One hundred twelve questionnaires were distributed, out of which 87 were returned (response rate 77.7%). 81.1% of companies included CSR in their annual strategy, while only 32.4% of them follow the Global Reporting Initiative standards. The majority (62.2%) disposes ≤€100.000 from their annual turnover for CSR actions. The contribution to society and the ethical commitment of the enterprise are stated as the main encouraging factors for CSR, while bureaucracy and the lack of incentives as deterrents. Pharmaceutical companies reported social acceptance as the major CSR enabler compared to other companies (p=0.034), while companies specializing only in medical equipment/biotechnology mentioned industry competition (p=0.003). Bureaucracy has been revealed as the major disincentive for all participating companies. Corporate advertising is found as an important encouraging factor for the adoption of CSR for the international companies compared to the national ones (p=0.023). Moreover, 97.3% stated that the government should reward socially responsible companies by increasing financial incentives. Conclusion: The health technology industry in Greece implements CSR actions. The company's contribution to society and its ethical commitment are important encouraging factors for CSR, while bureaucracy and lack of government incentives are the main deterrents. The reward of socially sensitive companies by the government would provide significant entrepreneurial and societal benefits, supporting the overall Greek economy.
Background: Hospital care expenditure is the most significant cost driver in the health care sect... more Background: Hospital care expenditure is the most significant cost driver in the health care sector. Reductions in public hospitals' expenses are among the principal austerity measures included in the memorandum recommendations. However, health policy decision-making seems to be a political rather than a technical issue. Objective: The aim of this paper is to assess performance by using Data Envelopment Analysis(DEA) among homogeneous specialties in the General Medicine(GM) and surgical clinics, across all hospitals operating in the Regional Health Authority of Thessaly(RHAT), over the period of 2002-2006. Methods: Two output-oriented DEA models have been adapted, separated in homogeneous GM and surgical clinics, for both constant(CRS) and variable returns to scale(VRS). The unit of analysis is the clinic. A total of 175 decision-making units(DMUs) have been composed. The number of inpatients and inpatient days are considered as outputs whereas the number of the personnel employed and beds as labour and capital inputs respectively. Results: Highest efficiency scores overtime were achieved by the GM clinics of the University District Hospital of Larissa. In surgical specialties, the ophthalmology clinic of the general hospital(GH) of Larissa and the urology of GH of Karditsa achieved the highest efficiency scores. Inefficiencies among GM and surgical clinics per year were also found. Both homogeneous groups followed similar trends in the curves. Five GM and ten surgical DMUs under both VRS and CRS remained fully efficient. Conclusions: The economic crisis Greece is facing, necessitates the assessment of National Health System(NHS) hospitals' performance in order to support health policy decision-making and resources allocation.
A487 independent variables on polypharmacy. Data analysis was carried out using SPSS-21. Results:... more A487 independent variables on polypharmacy. Data analysis was carried out using SPSS-21. Results: 644outpatients filled out the questionnaire (RR= 91.7%) witha mean age of 67.8 (SD 13) years and disease duration of11 (SD 8) years. The prevalence of polypharmacy among the sample is 22.5%. Mean number of medications used by each elder was 4.2 (SD 2.5). Approximately 6/10 patients received antidiabetic drug as monotherapy, and 4/10 receivedat least one more medication for other chronic diseases. The majority of the sample suffered from cardiovascular diseases. The findings showed that polypharmacy isaffected significantly by gender (P≤ 0.01; β = 2,093), age (P = 0.005; β = 0,026), presence of ADRs (P = 0.085; β = 0,778), caregiver' help in taking medicines (P = 0.025; β =-0.491), increased drug dosage in order to feel better (P = 0.028; β = 0.403) and self-assessment of health status (P ≤ 0.01; β =-0.451). ConClusions: Change management practices and integrated healthcare networks are needed to be introduced in Greece in order to support health providers to medication decision making as well as to educate elderly about the consequences of polypharmacy. PDB75 AnAlysis of the G-BA Decision-MAkinG criteriA on the Benefit AssessMent of DiABetes treAtMents: is cost An influencinG criterion?
Introduction: The financial crisis in Greece had its strongest impact on unemployment, which led ... more Introduction: The financial crisis in Greece had its strongest impact on unemployment, which led to exacerbation of shrinking incomes and depression symptoms. Aim: To investigate the combined effects of unemployment and economic distress on the Greek population mental health in times of economic crisis. Material and Methods: A crosssectional study was conducted in the Piraeus Manpower Employment Organization (OAED), during September-December 2017, with 21,600 unemployed people records. A random sample was selected among unemployed who attended this entity. A questionnaire was structured including questions on the unemployed' sociodemographic characteristics, the Index of Personal Economic Distress (IPED), and the CES-D (Center for Epidemiological Studies-Depression) scale. Descriptive and inductive statistics were performed in order to find the statistical significance of differences. Binary logistic regression was realized to investigate the associations of unemployment and economic distress as prognostic factors for the experience of symptoms associated with depression. Results: Totally, 130 unemployed participated in the study. 67.7% was female, the mean age was 37.8 years and 47.7% had a secondary educational level. A significant reduction in household monthly income before and after unemployment was observed (p=0.001). The majority of sample was long-term unemployed and 42.3% was short-term. The mean score of IPED was 12, meaning great economic distress. Moreover, based on CES-D score 63.8% of unemployed presented elevated depression and 36.2% no symptoms of depression. Positive correlation was found between the duration of unemployment with IPED (r=0.565) and with CES-D score (r=0.173). The logistic regression showed that the likelihood of expressing depression was influenced by increasing IPED (OR=1.089) and duration of unemployment (OR=1.322). Conclusions: The duration of unemployment and economic hardship led to a higher risk of depressive symptoms, thus policy actions must place greater emphasis on providing additional support through the creation of a more adequate and effective integrated social and health care network.
Introduction Elderly patients are particularly susceptible to polypharmacy issues because of age-... more Introduction Elderly patients are particularly susceptible to polypharmacy issues because of age-related changes in pharmacokinetics and pharmacodynamics as well as to chronic diseases resulting in a continuous increasing demand for drugs. Objective This study captures the prevalence of polypharmacy and adherence in Greece and identifies related risk factors in adult patients with diabetes. Design A cross-sectional study was conducted among patients diagnosed with diabetes mellitus attending public and private outpatients' clinics in the regions of Attica and Western Greece. Results A total of 644 outpatients filled out the questionnaire (relative risk = 91.7%). As far as the medications were concerned, 47.8% of patients had been receiving antidiabetic medication monotherapy, 38.2% combination therapy with two antidiabetic drugs, 11.8% with three drugs, and 2.2% with four drugs. The vast majority of diabetic patients adhered to their medication regimen, and fewer adhered to their physician's diet and physical activity recommendations. Statistically significant differences were found between age group and the existence of polypharmacy (P = 0.005). Additionally, 44.4% of patients with comorbidities exhibited polypharmacy, compared with 4.8% of patients who were diagnosed only with diabetes (P = 0.001). Conclusion The development of new strategies and health policies is necessary for polypharmacy and adherence among diabetic patients to be limited.
Direct medical costs were estimated using tariffs for laboratory tests, diagnostic exams, visits,... more Direct medical costs were estimated using tariffs for laboratory tests, diagnostic exams, visits, and prices for drugs. Procedure and inpatient cost data were collected at Center level. Non medical costs included costs for travel and accommodation, domestic help and informal care. The loss of productivity of patients have been estimated using the human capital approach. The incremental effects of having comorbidities on social costs were estimated by multivariate Generalized Linear Models (log link, Gamma family) adjusting for gender, age, BMI, type of intervention and complications. Costs are expressed in Euro 2013. Results: Among 301 patients enrolled, 108 (36%) had hypertension, 53 (18%) T2DM and 47 (16%) ADD. The raw social cost of intervention were € 8,749 (± € 2,359), € 9,511 (± € 2,292) and € 8,999 (± € 2,275) for patients with hypertension, T2DM and ADD. A significant incremental effect of having T2DM was found on social cost of intervention (€ 751, 95%CI: 242-1,259, p= 0.004). 1 year after intervention reductions of 48%, 81% and 15% were observed for hypertension, T2DM and ADD. The raw social annual costs estimated were € 2,461 (± € 1,490) for hypertension, € 2,424 (± € 951) for T2DM and € 3,582 (± € 2,017) for ADD. Direct non medical costs and indirect costs represent the main component of social cost in patients with hypertension and ADD. ConClusions: Bariatric surgery led to reductions of obesity-related comorbidities. One year after, the economic burden is mainly sustained by patients, their families and the productivity system.
The aim of this paper is to investigate the tourist industry’s satisfaction with medical tourism ... more The aim of this paper is to investigate the tourist industry’s satisfaction with medical tourism in Greece, the factors associated with its performance improvement and the ICT infrastructure underlying it. For this purpose, a nationwide survey was carried out in 2012. According to our findings, satisfaction of tourist company executives with their performance in handling the flow of medical tourists depends on the degree of company staff training on medical tourism. In addition, the important role of state agencies or local government in guaranteeing local infrastructure availability and quality is a fact that influences directly tourism entrepreneurship in the country. Obviously, medical tourism in Greece could constitute an important source of national income and consequently, an alternative for the country to exit the economic crisis, provided care is given to ICT infrastructure and legislation procedures.
care seekers during the second trimester (OR:.82; 95%CI:.68-.99) and third trimester of pregnancy... more care seekers during the second trimester (OR:.82; 95%CI:.68-.99) and third trimester of pregnancy (OR:.50, 95%CI:.39-.64) were less likely to deliver in healthfacilities. ConClusions: Socio-demographic factors: Male headed households, age bracket 20-39 or 40-49, no education, and residence in rural Uganda, was associated with delivering outside health facility. Personal health practices and behaviors: first antenatal visit in second or third trimester of pregnancy was associated with delivering outside health facility.
The objective of this study was to estimate the direct annual cost of treating patients with schi... more The objective of this study was to estimate the direct annual cost of treating patients with schizophrenia in Greece in 2005. Due to the lack of quantitative data, information on the treatment pathway and medical resource utilization of patients were collected from a consensus panel of 9 psychiatrists and 5 health economists. For estimating the costs a bottom up approach from the National Health System perspective was used. The panel of experts defined three patient categories based on the severity of the disease and the medical setting where treatment is received: (a) outpatient setting, (b) ambulatory care, (c) inpatient setting and long-term care. The annual direct cost of treatment per patient was found to be 3,187 € (2,659-4,166 €) in the first category, 10,135 € (7,429-13,972 €) in the second category and 20,782 € (17,482-25,462 €) in the third category. The total cost of treatment increased with the severity of the disease and the use of hospitalization. Systematic data colle...
ObjectiveThis systematic review aimed to assess the current use and acceptance of real-world data... more ObjectiveThis systematic review aimed to assess the current use and acceptance of real-world data (RWD) and real-world evidence (RWE) in health technology assessment (HTA) process. It additionally aimed to discern stakeholders’ viewpoints concerning RWD and RWE in HTA and illuminate the obstacles, difficulties, prospects, and consequences associated with the incorporation of RWD and RWE into the realm of HTA.MethodsA comprehensive PRISMA-based systematic review was performed in July 2022 in PubMed/Medline, Scopus, IDEAS-RePEc, International HTA database, and Centre for Reviews and Dissemination with ad-hoc supplementary search in Google Scholar and international organization websites. The review included pre-determined inclusion criteria while the selection of eligible studies, the data extraction process and quality assessment were carried out using standardized and transparent methods.ResultsTwenty-nine (n=29) studies were included in the review out of 2.115 studies identified by ...
Three years of adjuvant imatinib therapy for patients at high risk of recurrence was predicted to... more Three years of adjuvant imatinib therapy for patients at high risk of recurrence was predicted to achieve an additional 1.58 QALYS compared with one year of treatment. These health benefits are gained at an estimated incremental cost per QALY of £14,108. These results were robust to changes in key model parameters. Conclusions: The analysis suggests that, for patients at high risk of recurrence following surgical resection of localised GIST, three years of adjuvant imatinib treatment leads to improved long term quality-adjusted survival compared with one year's therapy. Extended adjuvant treatment with imatinib represents good value for money according to currently accepted standards of cost-effectiveness in Scotland.
Objectives: FXS is the most common inherited form of intellectual disability and is associated wi... more Objectives: FXS is the most common inherited form of intellectual disability and is associated with comorbidities that impair functioning and adaptive behavior. This study is aimed at evaluating the incremental direct health care costs and resource utilization associated with FXS using administrative health care claims data. MethOds: Using the Optum Health Reporting and Insights Employer database covering 1999-2012, subjects < 65 years old with ≥ 1 FXS diagnosis (ICD-9-CM: 759.83) and ≥ 6 months of continuous enrollment prior to the first observed FXS diagnosis were matched with up to 5 non-FXS controls using high-dimensional propensity score matching. Individuals were followed until the end of continuous enrollment in the health plan. All-cause and FXS-related costs and resource utilization stratified by hospitalizations, emergency room (ER), outpatient, and home care visits were examined. Results: 590 FXS individuals (mean[median] age: 25.7[27]; female: 54.1%; employee: 32%) and 2,950 non-FXS controls (mean[median] age: 25.7[27]; female: 52.1%; employee: 32%) were identified. Significant differences were observed between FXS and non-FXS in the all-cause per-patient per-year (PPPY) incidence of hospitalizations (0.414 vs. 0.237; incidence rate ratio [IRR] [95%
Objective: Detention conditions during incarceration have not been adequately explored in Greece.... more Objective: Detention conditions during incarceration have not been adequately explored in Greece. The aim of this study was to highlight incarcerated women's views and satisfaction on their detention conditions in the female prison of Attica. Methods: A cross-sectional survey was carried out in 2014. A semi-structured questionnaire was distributed to those who met the inclusion criteria and were enrolled in the study. Inmates who were in solitary confinement, suffered from serious psychiatric problems, or were unable to understand the Greek language were excluded from the study. Participation was voluntary after prisoners' verbal consent. Data were collected via personal interviews and information received was anonymized. Descriptive statistics, bivariate analysis, Spearman correlation coefficient and qualitative content analyses were used. Statistical analysis was performed using SPSS 20. Results: Of a total of 135 incarcerated women, 101 were eligible and accepted to participate in the study. Current mental and health status were rated as poor/ very poor by 55% and 27.7% of the participants, respectively. The vast majority stated their dissatisfaction with the accommodation, the cleanliness, as well as the provided nutrition inside the prison. 65% participated in social reintegration programs and 66% in physical exercise. 73.3% declared that the main reason of their worries was the relationship with their family members and 37.6% stated that there was support in family problems during incarceration. The overall satisfaction on detention conditions regarding prisoner's daily life was also rated as low by 67.3%. In addition, the results confirmed a positive linear relationship between satisfaction on detention conditions and health/mental health status. Conclusion: Incarcerated women in the female prison of Attica appear not to be satisfied with the experienced detentions conditions that are associated with their health status. Our findings should encourage further research in order to introduce more effective interventions aiming at improving prisoner's daily life and future after release.
Background: Corporate social responsibility (CSR) is an evolving business strategy worldwide, foc... more Background: Corporate social responsibility (CSR) is an evolving business strategy worldwide, focusing on the sustainability of the enterprise and the provision of multiple benefits to the societies and economies. Objective: The aim of this paper was to explore the encouraging and deterrent factors for the implementation of CSR actions in companies specializing in pharmaceutical and biomedical products as well as in medical equipment in Greece. Methods: A cross-sectional study was conducted (April to June 2021) in member-companies of the Hellenic Association of Pharmaceutical Companies, the Panhellenic Association of Pharmaceutical Industry and the Association of Health-Research and Biotechnology Industry. Data collection was carried out via an anonymous, self-administered questionnaire. Descriptive and inferential statistical analyses were performed, using SPSS version 25 (IBM Corp., Armonk, NY, USA). The significance level was set at p≤0.05. Results: One hundred twelve questionnaires were distributed, out of which 87 were returned (response rate 77.7%). 81.1% of companies included CSR in their annual strategy, while only 32.4% of them follow the Global Reporting Initiative standards. The majority (62.2%) disposes ≤€100.000 from their annual turnover for CSR actions. The contribution to society and the ethical commitment of the enterprise are stated as the main encouraging factors for CSR, while bureaucracy and the lack of incentives as deterrents. Pharmaceutical companies reported social acceptance as the major CSR enabler compared to other companies (p=0.034), while companies specializing only in medical equipment/biotechnology mentioned industry competition (p=0.003). Bureaucracy has been revealed as the major disincentive for all participating companies. Corporate advertising is found as an important encouraging factor for the adoption of CSR for the international companies compared to the national ones (p=0.023). Moreover, 97.3% stated that the government should reward socially responsible companies by increasing financial incentives. Conclusion: The health technology industry in Greece implements CSR actions. The company's contribution to society and its ethical commitment are important encouraging factors for CSR, while bureaucracy and lack of government incentives are the main deterrents. The reward of socially sensitive companies by the government would provide significant entrepreneurial and societal benefits, supporting the overall Greek economy.
Background: Hospital care expenditure is the most significant cost driver in the health care sect... more Background: Hospital care expenditure is the most significant cost driver in the health care sector. Reductions in public hospitals' expenses are among the principal austerity measures included in the memorandum recommendations. However, health policy decision-making seems to be a political rather than a technical issue. Objective: The aim of this paper is to assess performance by using Data Envelopment Analysis(DEA) among homogeneous specialties in the General Medicine(GM) and surgical clinics, across all hospitals operating in the Regional Health Authority of Thessaly(RHAT), over the period of 2002-2006. Methods: Two output-oriented DEA models have been adapted, separated in homogeneous GM and surgical clinics, for both constant(CRS) and variable returns to scale(VRS). The unit of analysis is the clinic. A total of 175 decision-making units(DMUs) have been composed. The number of inpatients and inpatient days are considered as outputs whereas the number of the personnel employed and beds as labour and capital inputs respectively. Results: Highest efficiency scores overtime were achieved by the GM clinics of the University District Hospital of Larissa. In surgical specialties, the ophthalmology clinic of the general hospital(GH) of Larissa and the urology of GH of Karditsa achieved the highest efficiency scores. Inefficiencies among GM and surgical clinics per year were also found. Both homogeneous groups followed similar trends in the curves. Five GM and ten surgical DMUs under both VRS and CRS remained fully efficient. Conclusions: The economic crisis Greece is facing, necessitates the assessment of National Health System(NHS) hospitals' performance in order to support health policy decision-making and resources allocation.
A487 independent variables on polypharmacy. Data analysis was carried out using SPSS-21. Results:... more A487 independent variables on polypharmacy. Data analysis was carried out using SPSS-21. Results: 644outpatients filled out the questionnaire (RR= 91.7%) witha mean age of 67.8 (SD 13) years and disease duration of11 (SD 8) years. The prevalence of polypharmacy among the sample is 22.5%. Mean number of medications used by each elder was 4.2 (SD 2.5). Approximately 6/10 patients received antidiabetic drug as monotherapy, and 4/10 receivedat least one more medication for other chronic diseases. The majority of the sample suffered from cardiovascular diseases. The findings showed that polypharmacy isaffected significantly by gender (P≤ 0.01; β = 2,093), age (P = 0.005; β = 0,026), presence of ADRs (P = 0.085; β = 0,778), caregiver' help in taking medicines (P = 0.025; β =-0.491), increased drug dosage in order to feel better (P = 0.028; β = 0.403) and self-assessment of health status (P ≤ 0.01; β =-0.451). ConClusions: Change management practices and integrated healthcare networks are needed to be introduced in Greece in order to support health providers to medication decision making as well as to educate elderly about the consequences of polypharmacy. PDB75 AnAlysis of the G-BA Decision-MAkinG criteriA on the Benefit AssessMent of DiABetes treAtMents: is cost An influencinG criterion?
Introduction: The financial crisis in Greece had its strongest impact on unemployment, which led ... more Introduction: The financial crisis in Greece had its strongest impact on unemployment, which led to exacerbation of shrinking incomes and depression symptoms. Aim: To investigate the combined effects of unemployment and economic distress on the Greek population mental health in times of economic crisis. Material and Methods: A crosssectional study was conducted in the Piraeus Manpower Employment Organization (OAED), during September-December 2017, with 21,600 unemployed people records. A random sample was selected among unemployed who attended this entity. A questionnaire was structured including questions on the unemployed' sociodemographic characteristics, the Index of Personal Economic Distress (IPED), and the CES-D (Center for Epidemiological Studies-Depression) scale. Descriptive and inductive statistics were performed in order to find the statistical significance of differences. Binary logistic regression was realized to investigate the associations of unemployment and economic distress as prognostic factors for the experience of symptoms associated with depression. Results: Totally, 130 unemployed participated in the study. 67.7% was female, the mean age was 37.8 years and 47.7% had a secondary educational level. A significant reduction in household monthly income before and after unemployment was observed (p=0.001). The majority of sample was long-term unemployed and 42.3% was short-term. The mean score of IPED was 12, meaning great economic distress. Moreover, based on CES-D score 63.8% of unemployed presented elevated depression and 36.2% no symptoms of depression. Positive correlation was found between the duration of unemployment with IPED (r=0.565) and with CES-D score (r=0.173). The logistic regression showed that the likelihood of expressing depression was influenced by increasing IPED (OR=1.089) and duration of unemployment (OR=1.322). Conclusions: The duration of unemployment and economic hardship led to a higher risk of depressive symptoms, thus policy actions must place greater emphasis on providing additional support through the creation of a more adequate and effective integrated social and health care network.
Introduction Elderly patients are particularly susceptible to polypharmacy issues because of age-... more Introduction Elderly patients are particularly susceptible to polypharmacy issues because of age-related changes in pharmacokinetics and pharmacodynamics as well as to chronic diseases resulting in a continuous increasing demand for drugs. Objective This study captures the prevalence of polypharmacy and adherence in Greece and identifies related risk factors in adult patients with diabetes. Design A cross-sectional study was conducted among patients diagnosed with diabetes mellitus attending public and private outpatients' clinics in the regions of Attica and Western Greece. Results A total of 644 outpatients filled out the questionnaire (relative risk = 91.7%). As far as the medications were concerned, 47.8% of patients had been receiving antidiabetic medication monotherapy, 38.2% combination therapy with two antidiabetic drugs, 11.8% with three drugs, and 2.2% with four drugs. The vast majority of diabetic patients adhered to their medication regimen, and fewer adhered to their physician's diet and physical activity recommendations. Statistically significant differences were found between age group and the existence of polypharmacy (P = 0.005). Additionally, 44.4% of patients with comorbidities exhibited polypharmacy, compared with 4.8% of patients who were diagnosed only with diabetes (P = 0.001). Conclusion The development of new strategies and health policies is necessary for polypharmacy and adherence among diabetic patients to be limited.
Direct medical costs were estimated using tariffs for laboratory tests, diagnostic exams, visits,... more Direct medical costs were estimated using tariffs for laboratory tests, diagnostic exams, visits, and prices for drugs. Procedure and inpatient cost data were collected at Center level. Non medical costs included costs for travel and accommodation, domestic help and informal care. The loss of productivity of patients have been estimated using the human capital approach. The incremental effects of having comorbidities on social costs were estimated by multivariate Generalized Linear Models (log link, Gamma family) adjusting for gender, age, BMI, type of intervention and complications. Costs are expressed in Euro 2013. Results: Among 301 patients enrolled, 108 (36%) had hypertension, 53 (18%) T2DM and 47 (16%) ADD. The raw social cost of intervention were € 8,749 (± € 2,359), € 9,511 (± € 2,292) and € 8,999 (± € 2,275) for patients with hypertension, T2DM and ADD. A significant incremental effect of having T2DM was found on social cost of intervention (€ 751, 95%CI: 242-1,259, p= 0.004). 1 year after intervention reductions of 48%, 81% and 15% were observed for hypertension, T2DM and ADD. The raw social annual costs estimated were € 2,461 (± € 1,490) for hypertension, € 2,424 (± € 951) for T2DM and € 3,582 (± € 2,017) for ADD. Direct non medical costs and indirect costs represent the main component of social cost in patients with hypertension and ADD. ConClusions: Bariatric surgery led to reductions of obesity-related comorbidities. One year after, the economic burden is mainly sustained by patients, their families and the productivity system.
The aim of this paper is to investigate the tourist industry’s satisfaction with medical tourism ... more The aim of this paper is to investigate the tourist industry’s satisfaction with medical tourism in Greece, the factors associated with its performance improvement and the ICT infrastructure underlying it. For this purpose, a nationwide survey was carried out in 2012. According to our findings, satisfaction of tourist company executives with their performance in handling the flow of medical tourists depends on the degree of company staff training on medical tourism. In addition, the important role of state agencies or local government in guaranteeing local infrastructure availability and quality is a fact that influences directly tourism entrepreneurship in the country. Obviously, medical tourism in Greece could constitute an important source of national income and consequently, an alternative for the country to exit the economic crisis, provided care is given to ICT infrastructure and legislation procedures.
care seekers during the second trimester (OR:.82; 95%CI:.68-.99) and third trimester of pregnancy... more care seekers during the second trimester (OR:.82; 95%CI:.68-.99) and third trimester of pregnancy (OR:.50, 95%CI:.39-.64) were less likely to deliver in healthfacilities. ConClusions: Socio-demographic factors: Male headed households, age bracket 20-39 or 40-49, no education, and residence in rural Uganda, was associated with delivering outside health facility. Personal health practices and behaviors: first antenatal visit in second or third trimester of pregnancy was associated with delivering outside health facility.
The objective of this study was to estimate the direct annual cost of treating patients with schi... more The objective of this study was to estimate the direct annual cost of treating patients with schizophrenia in Greece in 2005. Due to the lack of quantitative data, information on the treatment pathway and medical resource utilization of patients were collected from a consensus panel of 9 psychiatrists and 5 health economists. For estimating the costs a bottom up approach from the National Health System perspective was used. The panel of experts defined three patient categories based on the severity of the disease and the medical setting where treatment is received: (a) outpatient setting, (b) ambulatory care, (c) inpatient setting and long-term care. The annual direct cost of treatment per patient was found to be 3,187 € (2,659-4,166 €) in the first category, 10,135 € (7,429-13,972 €) in the second category and 20,782 € (17,482-25,462 €) in the third category. The total cost of treatment increased with the severity of the disease and the use of hospitalization. Systematic data colle...
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Papers by Mary Geitona