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Koufaki MI, Fragoulakis V, Díaz-Villamarín X, Karamperis K, Vozikis A, Swen JJ, Dávila-Fajardo CL, Vasileiou KZ, Patrinos GP, Mitropoulou C. Economic evaluation of pharmacogenomic-guided antiplatelet treatment in Spanish patients suffering from acute coronary syndrome participating in the U-PGx PREPARE study. Hum Genomics 2023; 17:51. [PMID: 37287029 DOI: 10.1186/s40246-023-00495-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 05/24/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Cardiovascular diseases and especially Acute Coronary Syndrome (ACS) constitute a major health issue impacting millions of patients worldwide. Being a leading cause of death and hospital admissions in many European countries including Spain, it accounts for enormous amounts of healthcare expenditures for its management. Clopidogrel is one of the oldest antiplatelet medications used as standard of care in ACS. METHODS In this study, we performed an economic evaluation study to estimate whether a genome-guided clopidogrel treatment is cost-effective compared to conventional one in a large cohort of 243 individuals of Spanish origin suffering from ACS and treated with clopidogrel. Data were derived from the U-PGx PREPARE clinical trial. Effectiveness was measured as survival of individuals while study data on safety and efficacy, as well as on resource utilization associated with each adverse drug reaction were used to measure costs to treat these adverse drug reactions. A generalized linear regression model was used to estimate cost differences for both study groups. RESULTS Based on our findings, PGx-guided treatment group is cost-effective. PGx-guided treatment demonstrated to have 50% less hospital admissions, reduced emergency visits and almost 13% less ADRs compared to the non-PGx approach with mean QALY 1.07 (95% CI, 1.04-1.10) versus 1.06 (95% CI, 1.03-1.09) for the control group, while life years for both groups were 1.24 (95% CI, 1.20-1.26) and 1.23 (95% CI, 1.19-1.26), respectively. The mean total cost of PGx-guided treatment was 50% less expensive than conventional therapy with clopidogrel [€883 (95% UI, €316-€1582), compared to €1,755 (95% UI, €765-€2949)]. CONCLUSION These findings suggest that PGx-guided clopidogrel treatment represents a cost-effective option for patients suffering from ACS in the Spanish healthcare setting.
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Affiliation(s)
- Margarita-Ioanna Koufaki
- Laboratory of Pharmacogenomics and Individualized Therapy, Department of Pharmacy, University of Patras School of Health Sciences, Patras, Greece
| | - Vasileios Fragoulakis
- The Golden Helix Foundation, 91 Waterloo Road, Capital Tower 6th Floor, London, SE1 9RT, UK
| | | | - Kariofyllis Karamperis
- Laboratory of Pharmacogenomics and Individualized Therapy, Department of Pharmacy, University of Patras School of Health Sciences, Patras, Greece
- The Golden Helix Foundation, 91 Waterloo Road, Capital Tower 6th Floor, London, SE1 9RT, UK
| | - Athanassios Vozikis
- Laboratory of Health Economics and Management (LabHEM), Economics Department, University of Piraeus, Piraeus, Greece
| | - Jesse J Swen
- Leiden University Medical Center, Leiden, The Netherlands
| | - Cristina L Dávila-Fajardo
- Clinical Pharmacy Department, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitaria (ibs.Granada), Granada, Spain
| | - Konstantinos Z Vasileiou
- Laboratory of Pharmacogenomics and Individualized Therapy, Department of Pharmacy, University of Patras School of Health Sciences, Patras, Greece
| | - George P Patrinos
- Laboratory of Pharmacogenomics and Individualized Therapy, Department of Pharmacy, University of Patras School of Health Sciences, Patras, Greece
- Department of Genetics and Genomics, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, Abu Dhabi, United Arab Emirates
- Zayed Center for Health Sciences, United Arab Emirates University, Al-Ain, Abu Dhabi, United Arab Emirates
| | - Christina Mitropoulou
- The Golden Helix Foundation, 91 Waterloo Road, Capital Tower 6th Floor, London, SE1 9RT, UK.
- Department of Genetics and Genomics, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, Abu Dhabi, United Arab Emirates.
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Linardou H, Lampaki S, Koliou GA, Vozikis A, Boutis A, Nikolaidi A, Kontogiorgos I, Papakotoulas P, Christopoulou A, Spyratos D, Bafaloukos D, Psyrri A, Grivas A, Koumarianou A, Tsiakitzis K, Mauri D, Rigakos G, Aravantinos G, Papantoniou P, Oikonomopoulos G, Fountzilas E, Koufaki MI, Kaparelou M, Liolis E, Mountzios G, Kosmidis P, Fountzilas G, Samantas E. Real-world Data and Economic Evaluation of Nivolumab in Previously Treated Non-small Cell Lung Cancer Greek Patients. Anticancer Res 2023; 43:2799-2812. [PMID: 37247889 DOI: 10.21873/anticanres.16449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/21/2023] [Accepted: 04/25/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND/AIM Nivolumab is an FDA-approved immune checkpoint inhibitor (ICI) for patients with advanced, pre-treated non-small cell lung cancer (NSCLC). However, treatment profiles and patient outcomes often differ in routine clinical practice while the financial impact of approved therapies is largely unknown. In this study, we investigated the efficacy, tolerability, and economic impact of nivolumab in real-world settings (RWS) in Greece. PATIENTS AND METHODS Patients diagnosed with advanced pre-treated NSCLC, receiving nivolumab were recruited from October 2015 until November 2019 across 18 different clinical centers in Greece. Endpoints included progression-free survival (PFS), overall survival (OS), objective response rate (ORR), and safety. Cost analysis was conducted using a third-party public-payer perspective (National Organization for Healthcare Services Provision; EOPYY). RESULTS A total of 346 patients, median age 66.5 years, were included. With 43.4 months median follow-up, median PFS was 7.8 months and median OS 15.8 months. The 1-year OS rate was 56.5%, 2-year OS 38.8%, and 3-year OS 27.3%. The ORR was 29.5% and DCR 58.7%, with a median response duration of 26.8 months. Patients with objective response were more likely to experience long-term survival (HR=0.14, p<0.001). Only 8.4% of patients experienced grade 3-4 adverse events. The presence of immune-related adverse events was associated with improved OS (HR=0.77, p=0.043). Nivolumab-associated economic burden accounted for €2,214.10 per cycle for each patient, mainly attributed to drug-acquisition costs. CONCLUSION This is the first report of real-world efficacy, safety, and economic burden of nivolumab in pre-treated patients with NSCLC in Greece. Indirectly compared to clinical trials, nivolumab was associated with improved efficacy in RWS, further supporting its use in clinical practice and providing insights on clinical prognosticators. The main cost component affecting the nivolumab economic burden was drug-acquisition costs, while toxicity-associated cost was negligible.
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Affiliation(s)
- Helena Linardou
- Fourth Oncology Department & Comprehensive Clinical Trials Center, Metropolitan Hospital, Athens, Greece;
| | - Sofia Lampaki
- Pulmonary Department, Lung Cancer Oncology Unit, Aristotle University of Thessaloniki, G. Papanicolaou Hospital, Thessaloniki, Greece
| | | | - Athanassios Vozikis
- Laboratory of Health Economics and Management, Economics Dept., University of Piraeus, Piraeus, Greece
| | - Anastasios Boutis
- First Department of Clinical Oncology, Theagenio Hospital, Thessaloniki, Greece
| | | | - Ioannis Kontogiorgos
- Laboratory of Health Economics and Management, Economics Dept., University of Piraeus, Piraeus, Greece
| | - Pavlos Papakotoulas
- First Department of Clinical Oncology, Theagenio Hospital, Thessaloniki, Greece
| | | | - Dionysios Spyratos
- Pulmonary Department, Lung Cancer Oncology Unit, Aristotle University of Thessaloniki, G. Papanicolaou Hospital, Thessaloniki, Greece
| | | | - Amanda Psyrri
- Section of Medical Oncology, Department of Internal Medicine, Attikon University Hospital, Faculty of Medicine, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Anastasios Grivas
- Second Department of Internal Medicine, Agios Savvas Cancer Hospital, Athens, Greece
| | - Anna Koumarianou
- Hematology-Oncology Unit, Fourth Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Karyofyllis Tsiakitzis
- Pharmacy Department, Aristotle University of Thessaloniki, G. Papanicolaou Hospital, Thessaloniki, Greece
| | - Davide Mauri
- Department of Medical Oncology, Medical School, University of Ioannina, Ioannina, Greece
| | - Georgios Rigakos
- Third Department of Medical Oncology, Hygeia Hospital, Athens, Greece
| | - Gerasimos Aravantinos
- Second Department of Medical Oncology, Agii Anargiri Cancer Hospital, Athens, Greece
| | - Panagiotis Papantoniou
- Laboratory of Health Economics and Management, Economics Dept., University of Piraeus, Piraeus, Greece
| | | | - Elena Fountzilas
- Second Department of Medical Oncology, Euromedica General Clinic of Thessaloniki, Thessaloniki, Greece
- European University Cyprus, Engomi, Cyprus
| | - Margarita-Ioanna Koufaki
- Laboratory of Health Economics and Management, Economics Dept., University of Piraeus, Piraeus, Greece
| | - Maria Kaparelou
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece
| | - Elias Liolis
- Division of Oncology, Department of Medicine, University Hospital, University of Patras Medical School, Patras, Greece
| | - Giannis Mountzios
- Fourth Department of Medical Oncology and Clinical Trials Unit, Henry Dunant Hospital Center, Athens, Greece
| | - Paris Kosmidis
- Second Department of Medical Oncology, Hygeia Hospital, Athens, Greece
| | - George Fountzilas
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki, Greece
- Aristotle University of Thessaloniki, Thessaloniki, Greece
- Department of Medical Oncology, German Oncology Center, Limassol, Cyprus
| | - Epaminondas Samantas
- Third Department of Medical Oncology, Agii Anargiri Cancer Hospital, Athens, Greece
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3
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Mountzios G, Lampaki S, Koliou GA, Vozikis A, Kontogiorgos I, Papantoniou P, Koufaki MI, Res E, Boutis A, Christopoulou A, Pastelli N, Grivas A, Aravantinos G, Lalla E, Oikonomopoulos G, Koumarianou A, Spyratos D, Bafaloukos D, Rigakos G, Papakotoulas P, Fountzilas G, Linardou H. An Observational Study to Assess the Molecular Epidemiology and Direct Medical Costs of Epidermal Growth Factor Receptor (EGFR) Mutations in Patients with Advanced EGFR Mutation-Positive Non-Small Cell Lung Cancer Treated with Afatinib in Real-World Clinical Settings in Greece. Lung Cancer (Auckl) 2021; 12:93-102. [PMID: 34512058 PMCID: PMC8415762 DOI: 10.2147/lctt.s318007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/09/2021] [Indexed: 01/08/2023]
Abstract
Purpose Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) are the preferred first-line option for patients with advanced, EGFR-mutant non-small cell lung cancer (NSCLC). Afatinib, a second-generation irreversible EGFR-TKI, has been extensively used in Greece in this setting; however, real-world data regarding molecular epidemiology and financial implications of afatinib use are lacking. Materials and Methods This was an observational, non-interventional, multicenter, retrospective cohort study, based on real-world data collected from the medical charts/records of patients treated with afatinib between 15/03/2015 and 25/06/2020 and were recorded on a web-based data capture system. Cox models were used to assess the prognostic significance of clinicopathological parameters with respect to clinical outcomes of interest. Cost analysis was conducted from a public third-payer perspective, and only direct medical costs reimbursed by the payer were considered. Results A total of 59 patients were treated with afatinib for their EGFR mutation-positive advanced NSCLC; the median age was 61 years (range: 37-91). Performance status was zero in 61%, and brain metastases were present in 13.6%. Forty-four patients (74.6%) had a deletion in exon 19 only, while nine (15.3%) had a mutation in exon 21, 8 of them in L858R and one in L861Q. At a median follow-up of 41.8 months (95% CI 35.9-51.4), the median PFS was 14.3 months (95% CI 12.2-16.4), and the median OS was 29 months (95% CI 25.6-33.4). Corresponding values for patients with deletion 19 only were 14.3 months (95% CI 11.5-18.5) and 28.1 months (95% CI 21.1-32.6), respectively. The mean expenditure for the treatment of each patient equals €25,333.68; with €21,865.06 being attributed to drug acquisition costs, €3325.35 to monitoring costs and €143.27 to adverse event treatment-related costs. Conclusion Long-term data in the real-world setting in Greece confirm activity, tolerability and cost-effectiveness of afatinib as first-line treatment of patients with advanced EGFR-mutant NSCLC. Clinical Trial Registration Clinicaltrials.gov NCT04640870.
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Affiliation(s)
- Giannis Mountzios
- Fourth Department of Medical Oncology and Clinical Trials Unit Henry Dunant Hospital Center, Athens, Greece
| | - Sofia Lampaki
- Pulmonary Department, Lung Cancer Oncology Unit, Aristotle University of Thessaloniki, G. Papanicolaou Hospital, Thessaloniki, Greece
| | | | - Athanassios Vozikis
- Laboratory of Health Economics and Management, Department of Economics, University of Piraeus, Piraeus, Greece
| | - Ioannis Kontogiorgos
- Laboratory of Health Economics and Management, Department of Economics, University of Piraeus, Piraeus, Greece
| | - Panagiotis Papantoniou
- Laboratory of Health Economics and Management, Department of Economics, University of Piraeus, Piraeus, Greece
| | - Margarita-Ioanna Koufaki
- Laboratory of Health Economics and Management, Department of Economics, University of Piraeus, Piraeus, Greece
| | - Eleni Res
- Third Department of Medical Oncology, Agii Anargiri Cancer Hospital, Athens, Greece
| | - Anastasios Boutis
- First Department of Clinical Oncology, Theagenio Hospital, Thessaloniki, Greece
| | | | - Nicoleta Pastelli
- Department of Pathology, G. Papanicolaou Hospital, Thessaloniki, Greece
| | - Anastasios Grivas
- Second Department of Internal Medicine, Agios Savvas Cancer Hospital, Athens, Greece
| | - Gerasimos Aravantinos
- Second Department of Medical Oncology, Agii Anargiri Cancer Hospital, Athens, Greece
| | - Efthalia Lalla
- Third Department of Clinical Oncology, Theagenio Hospital, Thessaloniki, Greece
| | | | - Anna Koumarianou
- Hematology-Oncology Unit, Fourth Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dionisios Spyratos
- Pulmonary Department, Lung Cancer Oncology Unit, Aristotle University of Thessaloniki, G. Papanicolaou Hospital, Thessaloniki, Greece
| | | | - Georgios Rigakos
- Third Department of Medical Oncology, Hygeia Hospital, Athens, Greece
| | - Pavlos Papakotoulas
- First Department of Clinical Oncology, Theagenio Hospital, Thessaloniki, Greece
| | - George Fountzilas
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki, Greece.,Aristotle University of Thessaloniki, Thessaloniki, Greece.,Department of Medical Oncology, German Oncology Center, Limassol, Cyprus
| | - Helena Linardou
- Fourth Oncology Department, Metropolitan Hospital, Athens, Greece
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Fountzilas E, Koliou GA, Vozikis A, Rapti V, Nikolakopoulos A, Boutis A, Christopoulou A, Kontogiorgos I, Karageorgopoulou S, Lalla E, Tryfonopoulos D, Boukovinas I, Rapti C, Nikolaidi A, Karteri S, Moirogiorgou E, Binas I, Mauri D, Aravantinos G, Zagouri F, Saridaki Z, Psyrri A, Bafaloukos D, Koumarianou A, Res E, Linardou H, Mountzios G, Razis E, Fountzilas G, Koumakis G. Real-world clinical outcome and toxicity data and economic aspects in patients with advanced breast cancer treated with cyclin-dependent kinase 4/6 (CDK4/6) inhibitors combined with endocrine therapy: the experience of the Hellenic Cooperative Oncology Group. ESMO Open 2021; 5:S2059-7029(20)32649-1. [PMID: 32817060 PMCID: PMC7437702 DOI: 10.1136/esmoopen-2020-000774] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/25/2020] [Accepted: 05/28/2020] [Indexed: 12/16/2022] Open
Abstract
Background We evaluated real-world clinical outcomes and toxicity data and assessed treatment-related costs in patients with advanced breast cancer who received treatment with cyclin-dependent kinase inhibitors (CDKi). Patients and methods We conducted a prospective–retrospective analysis of patients with advanced hormone receptor-positive, human epidermal growth factor receptor 2-negative breast cancer who received a CDKi, in combination with endocrine therapy, at any line of treatment. The primary endpoint was progression-free survival (PFS). Cost analysis was conducted from a public third-payer (National Organization for Healthcare Services Provision (EOPYY)) perspective, assessing only costs related to direct medical care, including drug therapy costs and adverse drug reaction (ADR)-related costs. Results From July 2015 to October 2019, 365 women received endocrine therapy combined with CDKi; median age was 61 years, postmenopausal 290 (80.6%) patients. CDKi were administered as first-line treatment in 149 (40.9%) patients, second-line treatment in 96 (26.4%) and third-line treatment and beyond in 119 (32.7%) patients. The most common adverse events were neutropenia, anaemia, thrombocytopenia and fatigue. Grade 3–4 adverse events occurred in 86 (23.6%) patients, whereas 8 (2.2%) patients permanently discontinued treatment due to toxicity. The median PFS for patients who received CDKi as first-line, second-line and third-line treatment and beyond was 18.7, 12 and 7.4 months, respectively. The median overall survival since the initiation of CDKi treatment was 29.9 months (95% CI: 23.0–not yet reached (NR)). The mean pharmaceutical therapy cost estimated per cycle was 2 724.12 € for each patient, whereas the main driver of the ADR-related costs was haematological adverse events. Conclusions Treatment with CDKi was well tolerated, with a low drug discontinuation rate. Patients who received CDKi as first-line treatment had improved PFS and OS compared with second-line treatment and beyond. The main component of direct medical costs assessed in the cost analysis comprises CDKi pharmaceutical therapy costs. Trial registration number NCT04133207
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Affiliation(s)
- Elena Fountzilas
- Second Department of Medical Oncology, Euromedica General Clinic, Thessaloniki, Greece
| | | | | | - Vassiliki Rapti
- Second Department of Internal Medicine, Agios Savvas Cancer Hospital, Athens, Greece
| | - Achilleas Nikolakopoulos
- Division of Oncology, Department of Medicine, University Hospital, University of Patras Medical School, Patras, Greece
| | - Anastasios Boutis
- First Department of Clinical Oncology, Theagenio Hospital, Thessaloniki, Greece
| | | | | | | | - Efthalia Lalla
- Third Department of Clinical Oncology, Theagenio Hospital, Thessaloniki, Greece
| | | | | | - Cleopatra Rapti
- Department of Medical Oncology, 251 Airforce General Hospital, Athens, Greece
| | | | - Sofia Karteri
- Division of Oncology, Department of Medicine, University Hospital, University of Patras Medical School, Patras, Greece
| | | | - Ioannis Binas
- Second Department of Medical Oncology, Metropolitan Hospital, Piraeus, Greece
| | - Davide Mauri
- Department of Medical Oncology, University Hospital of Ioannina, Ioannina, Greece
| | - Gerasimos Aravantinos
- Second Department of Medical Oncology, Agii Anargiri Cancer Hospital, Athens, Greece
| | - Flora Zagouri
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | | | - Amanda Psyrri
- Section of Medical Oncology, Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Dimitrios Bafaloukos
- First Department of Medical Oncology, Metropolitan Hospital, Piraeus, Athens, Greece
| | - Anna Koumarianou
- Hematology-Oncology Unit, Fourth Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Res
- Third Department of Medical Oncology, Agii Anargiri Cancer Hospital, Athens, Greece
| | - Helena Linardou
- Fourth Oncology Department, Metropolitan Hospital, Athens, Greece
| | - Giannis Mountzios
- Second Oncology Department and Clinical Trials Unit, Henry Dunant Hospital Center, Athens, Greece
| | - Evangelia Razis
- Third Department of Medical Oncology, Hygeia Hospital, Athens, Greece
| | - George Fountzilas
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Aristotle University of Thessaloniki, Thessaloniki, Greece.,German Oncology Center, Limassol, Cyprus
| | - Georgios Koumakis
- Second Department of Internal Medicine, Agios Savvas Cancer Hospital, Athens, Greece
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Giannouchos TV, Ukert B, Vozikis A, Steletou E, Souliotis K. Informal out-of-pocket payments experience and individuals' willingness-to-pay for healthcare services in Greece. Health Policy 2021; 125:693-700. [PMID: 33838935 DOI: 10.1016/j.healthpol.2021.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 03/19/2021] [Accepted: 04/01/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Informal out-of-pocket payments to healthcare providers are not uncommon in the Greek health system. We explore individuals' willingness-to-pay (WTP) to secure zero out-of-pocket full coverage for healthcare services and medications and we estimate the impact of past informal payments and individuals' opinion about the legalization of informal payments on WTP. METHODS We conducted a survey of 2841 participants from November 2016 to February 2017. We obtained information on WTP using the contingent valuation method. A two-part regression model was used to estimate the association between WTP, informal payments, and respondents' opinion about legalizing such payments. RESULTS About 80% of the respondents were willing to pay an average of €95 per month to obtain free access to full healthcare coverage and medications. About 65% of the respondents were involved in an informal payment at least once during the past four months with an average payment of €247. Higher informal payments and supportive opinions towards the legalization of informal payments increased the likelihood of WTP and were also positively associated with increased WTP amounts overall (p < 0.001). CONCLUSIONS This survey reveals that individuals' WTP is critically affected by previous experiences and attitudes towards informal payments. Our results imply that the potential introduction of official fees might not suffice to limit informal payments and suggest the need for stricter regulatory policies.
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Affiliation(s)
- Theodoros V Giannouchos
- Pharmacotherapy Outcomes Research Center, College of Pharmacy, University of Utah, 30 S 2000 E, Salt Lake City, 84112, UT, USA; Population Informatics Lab, Texas A&M University, 212 Adriance Lab Rd, College Station, 77843, TX, USA; Laboratory of Health Economics & Management, Economics Department, University of Piraeus, Karaoli ke Dimitriou 80, 185 34, Piraeus, Greece.
| | - Benjamin Ukert
- Department of Health Policy & Management, School of Public Health, Texas A&M University, 212 Adriance Lab Rd, 77843, College Station, TX, USA
| | - Athanassios Vozikis
- Laboratory of Health Economics & Management, Economics Department, University of Piraeus, Karaoli ke Dimitriou 80, 185 34, Piraeus, Greece
| | - Evangelia Steletou
- University Regional General Hospital of Patras, University of Patras, 26504, Patras, Rion, Greece
| | - Kyriakos Souliotis
- Department of Social and Education Policy, University of Peloponnese, Damaskinou & Kolokotroni Str., 20100, Corinth, Greece
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Mitropoulou C, Karamperis K, Koromina M, Papantoniou P, Skokou M, Kanellakis F, Mitropoulos K, Vozikis A. Systematic review of economic evaluation studies in psychiatric pharmacogenomics. Eur Psychiatry 2021. [PMCID: PMC9475923 DOI: 10.1192/j.eurpsy.2021.1024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IntroductionNowadays, many relevant gene-drug associations have been discovered, but pharmacogenomics (PGx)-guided treatment needs to be cost-effective as well as clinically beneficial to be incorporated into standard health-care.ObjectivesTo address current challenges, this systematic review provides an update regarding previously published studies, which assessed the cost-effectiveness of pharmacogenomics testing for the prescription of antidepressants and antipsychotics.MethodsOur initial screening revealed 1159 articles, which was subsequently reduced to 32 articles, deducted by analysis of their abstract. Full-text analysis performed by all authors resulted in 18 papers that were further included in the analysis.ResultsOf the 18 studies evaluations, 16 studies (88.89%) drew conclusions in favor of PGx testing, of which 9 (50%) were cost-effective and 7 (38.9%) were less costly based on cost analysis. In brief, we found sufficient evidence on the cost-effectiveness of PGx in psychiatric disease care. More precisely, supportive evidence exists for CYP2D6 and CYP2C19 gene-drug associations and for combinatorial PGx panels, but evidence is limited for many other drug–gene combinations. Amongst the limitations of the field are the unclear explanation of perspective and cost inputs in many economic studies, as well as the underreporting of study design elements, which can influence significantly the economic evaluations.ConclusionsOverall, this systematic review highlights the need for additional research on economic evaluations of PGx implementation with an emphasis on psychiatric pharmacogenomics.
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Sganga G, Baguneid M, Dohmen P, Giamarellos-Bourboulis EJ, Romanini E, Vozikis A, Eckmann C. Management of superficial and deep surgical site infection: an international multidisciplinary consensus. Updates Surg 2021; 73:1315-1325. [PMID: 33770411 PMCID: PMC8397635 DOI: 10.1007/s13304-021-01029-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 03/11/2021] [Indexed: 12/19/2022]
Abstract
Surgical site infections represent a considerable burden for healthcare systems. To obtain a consensus on the impact and future clinical and economic needs regarding SSI management in an era of multidrug resistance. A modified Delphi method was used to obtain consensus among experts from five European countries. The Delphi questionnaire was assembled by a steering committee, verified by a panel of experts and administered to 90 experts in 8 different surgical specialities (Abdominal, Cancer, Cardiac, General surgery, Orthopaedic, Thoracic, Transplant and Vascular and three other specialities (infectious disease, internal medicine microbiology). Respondents (n = 52) reached consensus on 62/73 items including that resistant pathogens are an increasing matter of concern and increase both treatment complexity and the length of hospital stay. There was strong positive consensus on the cost-effectiveness of early discharge (ED) programs, improvement of quality of life with ED and association between increased length of stay and economic burden to the hospital. However, established ED protocols were not widely available in their hospitals. Respondents expressed a positive consensus on the usefulness of antibiotics that allow ED. Surgeons are aware of their responsibility in an interdisciplinary team for the treatment of SSI, and of the impact of multidrug-resistant bacteria in the context of SSI. Reducing the length of hospital stays by applying ED protocols and implementing new treatment alternatives is crucial to reduce harm to patients and costs for the hospital.
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Affiliation(s)
- Gabriele Sganga
- Division of Emergency Surgery and Trauma, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Mohamed Baguneid
- School of Medical Sciences, University of Manchester, Manchester, UK
- Surgical Institute, Al Ain Hospital, Al Ain, United Arab Emirates
- College of Medicine and Health Sciences, UAE University, Al Ain, United Arab Emirates
| | - Pascal Dohmen
- Department of Cardiac Surgery, Heart Center Rostock, University Medicine Rostock, Rostock, Germany
- Department of Cardiothoracic Surgery Faculty of Health Science, University of the Free State, Bloemfontein, South Africa
| | | | - Emilio Romanini
- RomaPro Center for Hip and Knee Arthroplasty, Polo Sanitario San Feliciano, Via Enrico De Ossò 6, Rome, Italy
| | - Athanassios Vozikis
- Laboratory of Health Economics and Management, University of Piraeus, Piraeus, Greece
| | - Christian Eckmann
- Department of General, Visceral and Thoracic Surgery, Klinikum Hannoversch-Muenden, Goettingen University, Göttingen, Germany
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8
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Tsoukalas D, Fragoulakis V, Papakonstantinou E, Antonaki M, Vozikis A, Tsatsakis A, Buga AM, Mitroi M, Calina D. Prediction of Autoimmune Diseases by Targeted Metabolomic Assay of Urinary Organic Acids. Metabolites 2020; 10:E502. [PMID: 33302528 PMCID: PMC7764183 DOI: 10.3390/metabo10120502] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/30/2020] [Accepted: 12/04/2020] [Indexed: 12/12/2022] Open
Abstract
Autoimmune diseases (ADs) are chronic disorders characterized by the loss of self-tolerance, and although being heterogeneous, they share common pathogenic mechanisms. Self-antigens and inflammation markers are established diagnostic tools; however, the metabolic imbalances that underlie ADs are poorly described. The study aimed to employ metabolomics for the detection of disease-related changes in autoimmune diseases that could have predictive value. Quantitative analysis of 28 urine organic acids was performed using Gas Chromatography-Mass Spectrometry in a group of 392 participants. Autoimmune thyroiditis, inflammatory bowel disease, psoriasis and rheumatoid arthritis were the most prevalent autoimmune diseases of the study. Statistically significant differences were observed in the tricarboxylate cycle metabolites, succinate, methylcitrate and malate, the pyroglutamate and 2-hydroxybutyrate from the glutathione cycle and the metabolites methylmalonate, 4-hydroxyphenylpyruvate, 2-hydroxyglutarate and 2-hydroxyisobutyrate between the AD group and the control. Artificial neural networks and Binary logistic regression resulted in the highest predictive accuracy scores (66.7% and 74.9%, respectively), while Methylmalonate, 2-Hydroxyglutarate and 2-hydroxybutyrate were proposed as potential biomarkers for autoimmune diseases. Urine organic acid levels related to the mechanisms of energy production and detoxification were associated with the presence of autoimmune diseases and could be an adjunct tool for early diagnosis and prediction.
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Affiliation(s)
- Dimitris Tsoukalas
- Department of Clinical Pharmacy, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Metabolomic Medicine, Health Clinic for Autoimmune and Chronic Diseases, 10674 Athens, Greece;
- European Institute of Nutritional Medicine (E.I.Nu.M.), 00198 Rome, Italy
| | | | | | - Maria Antonaki
- Laboratory of Health Economics & Management, Economics Department, University of Piraeus, 18534 Piraeus, Greece; (M.A.); (A.V.)
| | - Athanassios Vozikis
- Laboratory of Health Economics & Management, Economics Department, University of Piraeus, 18534 Piraeus, Greece; (M.A.); (A.V.)
| | - Aristidis Tsatsakis
- Laboratory of Toxicology and Forensic Sciences, Medical School, University of Crete, 71003 Heraklion, Greece;
- Department of Analytical and Forensic Medical Toxicology, Sechenov University, 119991 Moscow, Russia
| | - Ana Maria Buga
- Department of Biochemistry, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Mihaela Mitroi
- ENT Department, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Daniela Calina
- Department of Clinical Pharmacy, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
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9
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Giannouchos TV, Vozikis A, Koufopoulou P, Fawkes L, Souliotis K. Informal out-of-pocket payments for healthcare services in Greece. Health Policy 2020; 124:758-764. [DOI: 10.1016/j.healthpol.2020.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/07/2020] [Accepted: 04/14/2020] [Indexed: 11/17/2022]
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10
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Giannouchos TV, Mitsikostas DD, Ohsfeldt RL, Vozikis A, Koufopoulou P. Cost-Effectiveness Analysis of Erenumab Versus OnabotulinumtoxinA for Patients with Chronic Migraine Attacks in Greece. Clin Drug Investig 2019; 39:979-990. [PMID: 31302899 DOI: 10.1007/s40261-019-00827-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Migraine is a common, chronic neurovascular brain disorder with non-negligible multifaceted economic costs. Existing preventive treatments involve the selective use of onabotulinumtoxinA, which aims at migraine morbidity reduction for patients who have failed initial preventive treatment with oral agents. Erenumab is a new preventive treatment for migraines. OBJECTIVE To evaluate the differences in costs and outcomes of the preventive treatment with erenumab versus onabotulinumtoxinA in patients with chronic migraines (CM) in Greece to assess the economic value of this treatment. METHODS We conducted a cost-effectiveness analysis from both the payer and the societal perspective using a decision-tree analytic model. Outcomes were expressed in migraines avoided and in quality-adjusted life-years (QALYs). We obtained model inputs from the existing literature. The decision path adjusted for variation in the probability of adherence and the resulting differential effectiveness between the two treatments. Direct costs included the cost of the two drugs and administration costs, the costs of acute drugs used under usual care, and the costs of hospitalization, physician, and emergency department visits. Indirect costs for the societal perspective analyses included wages lost on workdays. The time-horizon of the analysis was 1 year and all costs were calculated in 2019 euros (€). Sensitivity analyses were conducted to control for parameter uncertainty and to evaluate the robustness of the findings. RESULTS Our results indicate that treatment of CM with erenumab compared to onabotulinumtoxinA resulted in incremental cost-effectiveness ratios (ICERs) of €218,870 and €231,554 per QALY gained and €620 and €656 per migraine avoided, from the societal and the payer's perspective, respectively. Using a common cost-effectiveness threshold equal to three times the local gross domestic product (GDP) per capita (€49,000), for the erenumab ICERs to fall below this threshold, the erenumab price would have to be no more than €192 (societal perspective) or €173 (payer perspective). CONCLUSION The prophylactic treatment of CM with erenumab in Greece might be cost effective compared to the existing alternative of onabotulinumtoxinA from both the payer and the societal perspective, but only at a highly discounted price. Nevertheless, erenumab could be considered a therapeutic option for patients who fail treatment with onabotulinumtoxinA.
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Affiliation(s)
- Theodoros V Giannouchos
- Department of Health Policy and Management, School of Public Health, Texas A&M University, 212 Adriance Lab Rd, College Station, TX, 77843, USA. .,Population Informatics Lab, Texas A&M University, 212 Adriance Lab Rd, College Station, TX, 77843, USA.
| | - Dimos-Dimitrios Mitsikostas
- First Neurology Department, Aeginition Hospital, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias Str., Goudi (2nd Floor), 11527, Athens, Greece
| | - Robert L Ohsfeldt
- Department of Health Policy and Management, School of Public Health, Texas A&M University, 212 Adriance Lab Rd, College Station, TX, 77843, USA.,Population Informatics Lab, Texas A&M University, 212 Adriance Lab Rd, College Station, TX, 77843, USA
| | - Athanassios Vozikis
- Laboratory of Health Economics and Management, Economics Department, University of Piraeus, Karaoli ke Dimitriou 80, 185 34, Pireas, Greece
| | - Paraskevi Koufopoulou
- Laboratory of Health Economics and Management, Economics Department, University of Piraeus, Karaoli ke Dimitriou 80, 185 34, Pireas, Greece.,KAT General Hospital of Attica, Nikis 2, 145 61, Kifisia, Greece
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11
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Simeonidis S, Koutsilieri S, Vozikis A, Cooper DN, Mitropoulou C, Patrinos GP. Application of Economic Evaluation to Assess Feasibility for Reimbursement of Genomic Testing as Part of Personalized Medicine Interventions. Front Pharmacol 2019; 10:830. [PMID: 31427963 PMCID: PMC6688623 DOI: 10.3389/fphar.2019.00830] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 06/27/2019] [Indexed: 11/13/2022] Open
Abstract
Background: The incorporation of genomic testing into clinical practice constitutes an opportunity to improve patients' lives, as it makes possible the implementation of innovative, individualized clinical interventions that maximize efficacy and/or minimize the risk of adverse drug reactions. In order to ensure equal access to genomic testing for all patients, the costs associated with these tests should be reimbursed by their respective national healthcare systems. Given that funding for the public health sector is decreasing in real terms, it is of paramount importance that the emerging interventions are thoroughly evaluated both in terms of their clinical effectiveness and their full economic cost. Objective: The aim of this study was to identify those genome-guided interventions that could be adopted and reimbursed by national healthcare systems. Further, we recorded the underlying factors determining the broad adoption of genome-guided interventions in clinical practice, in order to identify potential reimbursement criteria. Methods: We performed a systematic review of published (PubMed-listed) scientific articles on the economic evaluation of those individualized clinical interventions that include genomic tests. Information on genomic tests reimbursed by the US Medicare program was also included. Subsequently, we correlated the regulatory guidance given for the interventions collated in our systematic review with the corresponding economic evaluation results and policies of the Medicare program. Regulatory guidance information was collected from the PharmGKB online knowledgebase and the Clinical Pharmacogenetics Implementation Consortium (CPIC). Results: Most of the included studies constitute cost-utility analyses, in which the outcome of the interventions has been measured in quality-adjusted life years (QALYs) whereas an estimate of the total cost has been based upon direct medical cost data. Favorable economic evaluation results, as well as concrete evidence demonstrating the clinical utility of pre-emptive genotyping, are considered as prerequisites for the broad adoption and reimbursement of the costs incurred during genomic testing. Indicatively, pre-emptive HLA-B*5701 and TPMT testing before administration of abacavir and azathioprine, respectively, is reimbursed by Medicare based on both economic and efficacy evidence. Likewise, the medical necessary screening for MMR and BRCA1/2 genes are reimbursed for high-risk populations. Conclusions: Our findings further underline the need for further cost-utility analyses within different national healthcare systems, in order to promote the reimbursement of the cost of innovative genome-guided therapeutic interventions.
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Affiliation(s)
- Stavros Simeonidis
- Department of Pharmacy, University of Patras School of Health Sciences, Patras, Greece
| | - Stefania Koutsilieri
- Department of Pharmacy, University of Patras School of Health Sciences, Patras, Greece
| | | | - David N. Cooper
- Institute of Medical Genetics, Cardiff University, Cardiff, United Kingdom
| | | | - George P. Patrinos
- Department of Pharmacy, University of Patras School of Health Sciences, Patras, Greece
- Zayed Center of Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
- Department of Pathology, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
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Fragoulakis V, Bartsakoulia M, Díaz-Villamarín X, Chalikiopoulou K, Kehagia K, Ramos JGS, Martínez-González LJ, Gkotsi M, Katrali E, Skoufas E, Vozikis A, John A, Ali BR, Wordsworth S, Dávila-Fajardo CL, Katsila T, Patrinos GP, Mitropoulou C. Cost-effectiveness analysis of pharmacogenomics-guided clopidogrel treatment in Spanish patients undergoing percutaneous coronary intervention. Pharmacogenomics J 2019; 19:438-445. [PMID: 30647444 DOI: 10.1038/s41397-019-0069-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 10/04/2018] [Accepted: 12/21/2018] [Indexed: 02/08/2023]
Abstract
Clopidogrel is an antiplatelet drug given to patients before and after having a percutaneous coronary intervention (PCI). Genomic variants in the CYP2C19 gene are associated with variable enzyme activities affecting drug metabolism and hence, patients with reduced or increased enzymatic function have increased risk of bleeding. We conducted a cost-effectiveness analysis to compare a pharmacogenomics versus a non-pharmacogenomics-guided clopidogrel treatment for coronary artery syndrome patients undergoing PCI in the Spanish healthcare setting. A total of 549 patients diagnosed with coronary artery disease followed by PCI were recruited. Dual antiplatelet therapy was administrated to all patients from 1 to 12 months after PCI. Patients were classified into two groups: the Retrospective group was treated with clopidogrel based on the clinical routine practice and the Prospective group were initially genotyped for the presence of CYP2C19 variant alleles before treatment with those carrying more than one CYP2C19 variant alleles given prasugrel treatment. We collected data on established clinical and health outcome measures, including, per treatment arm: the percentage of patients that suffered from (a) myocardial infraction, (b) major bleeding and minor bleeding, (c) stroke, (d) the number of hospitalization days, and (e) the number of days patients spent in Intensive Care Unit. Our primary outcome measure for the cost-effectiveness analysis was Quality Adjusted Life Years (QALYs). To estimate the treatment cost for each patient, individual data on its resource used were combined with unit price data, obtained from Spanish national sources. The analysis predicts a survival of 0.9446 QALYs in the pharmacogenomics arm and 0.9379 QALYs in the non-pharmacogenomics arm within a 1-year horizon. The cumulative costs per patient were €2971 and €3205 for the Prospective and Retrospective groups, respectively. The main cost driver of total cost in both arms was hospitalization costs. The incremental cost-effectiveness ratio (ICER) was negative indicating that the PGx was a dominant option. Our data show that pharmacogenomics-guided clopidogrel treatment strategy may represent a cost-effective choice compared with non-pharmacogenomics-guided strategy for patients undergoing PCI.
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Affiliation(s)
| | - Marina Bartsakoulia
- Department of Pharmacy, University of Patras School of Health Sciences, Patras, Greece
| | | | | | - Konstantina Kehagia
- Department of Pharmacy, University of Patras School of Health Sciences, Patras, Greece
| | - Jesús Gabriel Sánchez Ramos
- Cardiología, hospital Universitario San Cecilio/hospital Campus de la Salud, Institute for biomedical research, ibs.GRANADA, Granada, Spain
| | - Luis Javier Martínez-González
- Genomics Unit, Centre for Genomics and Oncological Research (GENYO), University of Granada, Health Sciences Technology Park, Granada, Spain
| | - Maria Gkotsi
- Department of Pharmacy, University of Patras School of Health Sciences, Patras, Greece
| | - Eva Katrali
- Department of Pharmacy, University of Patras School of Health Sciences, Patras, Greece
| | - Efthimios Skoufas
- Department of Pharmacy, University of Patras School of Health Sciences, Patras, Greece
| | | | - Anne John
- Department of Pathology, United Arab Emirates University, College of Medicine and Health Sciences, Al-Ain, UAE
| | - Bassam R Ali
- Department of Pathology, United Arab Emirates University, College of Medicine and Health Sciences, Al-Ain, UAE
| | - Sarah Wordsworth
- Nuffield Department of Population Health, University of Oxford, Health Economics Research Centre, Oxford, UK.,Oxford National Institute for Health Biomedical Research Centre, Oxford, UK
| | | | - Theodora Katsila
- Department of Pharmacy, University of Patras School of Health Sciences, Patras, Greece
| | - George P Patrinos
- Department of Pharmacy, University of Patras School of Health Sciences, Patras, Greece. .,Department of Pathology, United Arab Emirates University, College of Medicine and Health Sciences, Al-Ain, UAE.
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Abstract
BACKGROUND OF CONTEXT Priority setting and resource allocation across various healthcare functions are critical issues in health policy and strategic decision making. As health resources are limited while there are so many health challenges to resolve, consumers and payers have to make difficult decisions about expenditure allocation. OBJECTIVE Our research focus on the (dis)agreement between citizens' preferences and actual public health expenditure across broad healthcare functions, on whether this (dis)agreement is persistent, on whether various demographic factors amplify this (dis)agreement and to derive useful implications for public health policies. SETTING AND PARTICIPANTS Using survey data of 3029 citizens in Greece for the year 2012 and employing logit estimation techniques, we analysed the effect of demographic and other factors in shaping citizens' (dis)agreement with public health expenditure allocation. RESULTS Our results demonstrate the important role of income, family members and residence in shaping citizens' preferences regarding health expenditure priorities in almost all healthcare functions, while other demographic factors such as job, age, gender and marital status do partly associate and play a significant role. CONCLUSIONS Government should encourage the citizens' participation in the decision-making process in order to eliminate the unveiled and significant disagreement between citizens' preferences and actual public health expenditure across all healthcare functions.
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Affiliation(s)
- Sofia Xesfingi
- Department of Economics, University of Piraeus, Piraeus, Greece
| | | | - Yannis Pollalis
- Department of Economics, University of Piraeus, Piraeus, Greece
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14
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Mitropoulou C, Fragoulakis V, Rakicevic LB, Novkovic MM, Vozikis A, Matic DM, Antonijevic NM, Radojkovic DP, van Schaik RH, Patrinos GP. Economic analysis of pharmacogenomic-guided clopidogrel treatment in Serbian patients with myocardial infarction undergoing primary percutaneous coronary intervention. Pharmacogenomics 2016; 17:1775-1784. [PMID: 27767438 DOI: 10.2217/pgs-2016-0052] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Clopidogrel, which is activated by the CYP2C19 enzyme, is among the drugs for which all major regulatory agencies recommend genetic testing to be performed to identify a patient's CYP2C19 genotype in order to determine the optimal antiplatelet therapeutic scheme. The CYP2C19*2 and CYP2C19*3 variants are loss-of-function alleles, leading to abolished CYP2C19 function and thus have the risk of thrombotic events for carriers of these alleles on standard dosages, while the CYP2C19*17 allele results in CYP2C19 hyperactivity. AIMS Here, we report our findings from a retrospective study to assess whether genotyping for the CYP2C19*2 allele was cost effective for myocardial infarction patients receiving clopidogrel treatment in the Serbian population compared with the nongenotype-guided treatment. RESULTS We found that 59.3% of the CYP2C19*1/*1 patients had a minor or major bleeding event versus 42.85% of the CYP2C19*1/*2 and *2/*2, while a reinfarction event occurred only in 2.3% of the CYP21C9*1/*1 patients, compared with 11.2% of the CYP2C19*1/*2 and CYP2C19*2/*2 patients. There were subtle differences between the two patient groups, as far as the duration of hospitalization and rehabilitation is concerned, in favor of the CYP2C19*1/*1 group. The mean cost for the CYP2C19*1/*1 patients was estimated at €2547 versus €2799 in the CYP2C19*1/*2 and CYP2C19*2/*2 patients. Furthermore, based on the overall CYP2C19*1/*2 genotype frequencies in the Serbian population, a break-even point analysis indicated that performing the genetic test prior to drug prescription represents a cost-saving option, saving €13 per person on average. CONCLUSION Overall, our data demonstrate that pharmacogenomics-guided clopidogrel treatment may represent a cost-saving approach for the management of myocardial infarction patients undergoing primary percutaneous coronary intervention in Serbia.
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Affiliation(s)
- Christina Mitropoulou
- Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Vasilios Fragoulakis
- Department of Pharmacy, School of Health Sciences, University of Patras, Patras, Greece.,National School of Public Health, Athens, Greece
| | - Ljiljana B Rakicevic
- Institute for Molecular Genetics & Genetic Engineering, University of Belgrade, Belgrade, Serbia
| | - Mirjana M Novkovic
- Institute for Molecular Genetics & Genetic Engineering, University of Belgrade, Belgrade, Serbia
| | | | - Dragan M Matic
- Emergency Department, Clinic for Cardiology, Clinical Center of Serbia, Belgrade, Serbia
| | - Nebojsa M Antonijevic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic for Cardiology, Clinical Center of Serbia, Belgrade, Serbia
| | - Dragica P Radojkovic
- Institute for Molecular Genetics & Genetic Engineering, University of Belgrade, Belgrade, Serbia
| | - Ron H van Schaik
- Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - George P Patrinos
- Department of Pharmacy, School of Health Sciences, University of Patras, Patras, Greece
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15
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Vozikis A, Cooper DN, Mitropoulou C, Kambouris ME, Brand A, Dolzan V, Fortina P, Innocenti F, Lee MTM, Leyens L, Macek Jr M, Al-Mulla F, Prainsack B, Squassina A, Taruscio D, van Schaik RH, Vayena E, Williams MS, Patrinos GP. Test Pricing and Reimbursement in Genomic Medicine: Towards a General Strategy. Public Health Genomics 2016; 19:352-363. [DOI: 10.1159/000449152] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 08/16/2016] [Indexed: 11/19/2022] Open
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16
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Xesfingi S, Vozikis A. eHealth Literacy: In the Quest of the Contributing Factors. Interact J Med Res 2016; 5:e16. [PMID: 27226146 PMCID: PMC4899620 DOI: 10.2196/ijmr.4749] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 12/02/2015] [Accepted: 03/29/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Understanding the factors that influence eHealth in a country is particularly important for health policy decision makers and the health care market, as it provides critical information to develop targeted and tailored interventions for relevant patient-consumer segments, and further suggests appropriate strategies for training the health illiterate part of the population. OBJECTIVE The objective of the study is to assess the eHealth literacy level of Greek citizens, using the eHealth Literacy Scale (eHEALS), and further explore the factors that shape it and are associated with it. METHODS This empirical study relies on a unique sample of 1064 citizens in Greece in the year 2013. The participants were requested to answer various questions about their ability to solve health-related issues using the Internet, and to provide information about their demographic characteristics and life-style habits. Ordered logit models were used to describe a certain citizen's likelihood of being eHealth literate. RESULTS The demographic factors show that the probability of an individual being eHealth literate decreases by 23% (P=.001) when the individual ages and increases by 53% (P<.001) when he or she acquires higher level of education. Among the life-style variables, physical exercise appears to be strongly and positively associated with the level of eHealth literacy (P=.001). Additionally, other types of technology literacies, such as computer literacy and information literacy, further enhance the eHealth performance of citizens and have the greatest impact among all factors. CONCLUSIONS The factors influencing eHealth literacy are complex and interdependent. However, the Internet is a disruptive factor in the relationship between health provider and health consumer. Further research is needed to examine how several factors associate with eHealth literacy, since, the latter is not only related to health care outcomes but also can be a tool for disseminating social inequalities.
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Affiliation(s)
- Sofia Xesfingi
- University of Piraeus, Department of Economics, University of Piraeus, Piraeus, Greece.
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17
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Xesfingi S, Vozikis A. Patient satisfaction with the healthcare system: Assessing the impact of socio-economic and healthcare provision factors. BMC Health Serv Res 2016; 16:94. [PMID: 26979458 PMCID: PMC4793546 DOI: 10.1186/s12913-016-1327-4] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 03/02/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient satisfaction is an important measure of healthcare quality as it offers information on the provider's success at meeting clients' expectations and is a key determinant of patients' perspective behavioral intention. The aim of this paper is first to assess the degree of patient satisfaction, and second, to study the relationship between patient satisfaction of healthcare system and a set of socio-economic and healthcare provision indicators. METHODS This empirical analysis covers 31 countries for the years 2007, 2008, 2009 and 2012. The dependent variable, the satisfaction index, is defined as the patient satisfaction of their country's health system. We first construct an index of patient satisfaction and then, at a second stage, this index is related to socio-economic and healthcare provision variables. RESULTS Our findings support that there is a strong positive association between patient satisfaction level and healthcare provision indicators, such as nurses and physicians per 100,000 habitants, with the latter being the most important contributor, and a negative association between patient satisfaction level and number of hospital beds. Among the socio-economic variables, public health expenditures greatly shape and positive relate to patient satisfaction, while private spending on health relates negatively. Finally, the elder a patient is, the more satisfied with a country's healthcare system appears to be. CONCLUSIONS We conclude that there is a strong positive association between patient satisfaction and public health expenditures, number of physicians and nurses, and the age of the patient, while there is a negative evidence for private health spending and number of hospital beds.
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Affiliation(s)
- Sofia Xesfingi
- Department of Economics, University of Piraeus, 18534, Piraeus, Greece
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18
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Mitropoulou C, Fragoulakis V, Bozina N, Vozikis A, Supe S, Bozina T, Poljakovic Z, van Schaik RH, Patrinos GP. Economic evaluation of pharmacogenomic-guided warfarin treatment for elderly Croatian atrial fibrillation patients with ischemic stroke. Pharmacogenomics 2016; 16:137-48. [PMID: 25616100 DOI: 10.2217/pgs.14.167] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND & METHODS Economic evaluation in genomic medicine is an emerging discipline to assess the cost-effectiveness of genome-guided treatment. Here, we developed a pharmaco-economic model to assess whether pharmacogenomic (PGx)-guided warfarin treatment of elderly ischemic stroke patients with atrial fibrillation in Croatia is cost effective compared with non-PGx therapy. The time horizon of the model was set at 1 year. RESULTS Our primary analysis indicates that 97.07% (95% CI: 94.08-99.34%) of patients belonging to the PGx-guided group have not had any major complications, compared with the control group (89.12%; 95% CI: 84.00-93.87%, p < 0.05). The total cost per patient was estimated at €538.7 (95% CI: €526.3-551.2) for the PGx-guided group versus €219.7 (95% CI: €137.9-304.2) for the control group. In terms of quality-adjusted life-years (QALYs) gained, total QALYs was estimated at 0.954 (95% CI: 0.943-0.964) and 0.944 (95% CI: 0.931-0.956) for the PGx-guided and the control groups, respectively. The true difference in QALYs was estimated at 0.01 (95% CI: 0.005-0.015) in favor of the PGx-guided group. The incremental cost-effectiveness ratio of the PGx-guided versus the control groups was estimated at €31,225/QALY. CONCLUSION Overall, our data indicate that PGx-guided warfarin treatment may represent a cost-effective therapy option for the management of elderly patients with atrial fibrillation who developed ischemic stroke in Croatia.
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Affiliation(s)
- Christina Mitropoulou
- Department of Clinical Chemistry, Faculty of Medicine & Health Sciences, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
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Douzgou S, Pollalis YA, Vozikis A, Patrinos GP, Clayton-Smith J. Collaborative Crowdsourcing for the Diagnosis of Rare Genetic Syndromes: The DYSCERNE Experience. Public Health Genomics 2015; 19:19-24. [PMID: 26447648 DOI: 10.1159/000440710] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 08/31/2015] [Indexed: 11/19/2022] Open
Abstract
The big-data revolution is creating a challenge for the provision of services in the health sector to keep pace with the expectations of the general population. Utilization of crowdsourcing can impact positively on the quality, cost and speed of healthcare by involving large sections of professionals and the public and creating novel science within an ethical framework. In 2007, the DYSCERNE project was funded by the European Commission Public Health Executive Agency (EU DG Sanco) aimed at setting up a network of expertise for rare dysmorphic disorders. As part of DYSCERNE, a Dysmorphology Diagnostic System was set up to enable clinicians throughout the EU to submit cases electronically for diagnosis using a secure, web-based interface, hosted at specified access points (submitting nodes), in 26 different European countries. DYSCERNE utilized the process of crowdsourcing international expertise for the clinical diagnosis of very rare genetic syndromes of multiple congenital anomalies. This is the first reported account of collaborative crowd sourcing in dysmorphology, as part of a clinical genetics service.
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Affiliation(s)
- Sofia Douzgou
- Department of Economics, University of Piraeus, Piraeus, Greece
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Agaku IT, Blecher E, Filippidis FT, Omaduvie UT, Vozikis A, Vardavas CI. Impact of cigarette price differences across the entire European Union on cross-border purchase of tobacco products among adult cigarette smokers. Tob Control 2015; 25:333-40. [PMID: 25661415 DOI: 10.1136/tobaccocontrol-2014-052015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 01/08/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND We investigated the impact of cigarette price differences across the European Union (EU) on cross-border tobacco purchasing because of cheaper price among current cigarette smokers. METHODS Individual-level tobacco-related data (including cross-border tobacco purchasing behavior) were from the Special Eurobarometer 385 (V.77.1), a cross-sectional survey of persons aged ≥15 years from 27 EU Member States during 2012. Country-specific weighted average prices (WAP) per 1000 cigarettes (as of 1 July 2012) were obtained from the European Commission, and divided by 50 to yield WAP per cigarette pack. The dispersion in EU cigarette prices was measured with the coefficient of variation. Multivariate logistic regression was applied to measure the relationship between EU-wide cigarette price differential and cross-border tobacco purchasing because of cheaper price among current cigarette smokers (n=6896). RESULTS The coefficient of variation for cigarette WAP within the EU was 0.39 (mean price=€3.99/pack). Of all current cigarette smokers in the EU, 26.2% (27.5 million persons) engaged in a cross-border tobacco purchase within the past 12 months, of which 56.3% did so because of cheaper price in another country. EU-wide cigarette price differential was significantly associated with making a cross-border tobacco purchase because of cheaper price (adjusted OR=1.34; 95% CI 1.22 to 1.47). CONCLUSIONS Reducing differences in cigarette tax and price within the EU, coupled with a stricter limitation on the quantity of cigarettes that it is possible to carry from one Member State to another, may help reduce cross-border tax avoidance strategies.
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Affiliation(s)
- Israel T Agaku
- Department of Social and Behavioral Sciences, Center for Global Tobacco Control, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Evan Blecher
- Economic and Health Policy Research, American Cancer Society, Atlanta, Georgia, USA
| | - Filippos T Filippidis
- Department of Social and Behavioral Sciences, Center for Global Tobacco Control, Harvard School of Public Health, Boston, Massachusetts, USA School of Public Health, Imperial College London, London, UK
| | | | | | - Constantine I Vardavas
- Department of Social and Behavioral Sciences, Center for Global Tobacco Control, Harvard School of Public Health, Boston, Massachusetts, USA Clinic of Social and Family Medicine, Department of Social Medicine, School of Medicine, University of Crete, Heraklion, Greece
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Tarantilis F, Athanasakis K, Zavras D, Vozikis A, Kyriopoulos I. Estimates of price and income elasticity in Greece. Greek debt crisis transforming cigarettes into a luxury good: an econometric approach. BMJ Open 2015; 5:e004748. [PMID: 25564137 PMCID: PMC4289736 DOI: 10.1136/bmjopen-2013-004748] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE During the past decades, smoking prevalence in Greece was estimated to be near or over 40%. Following a sharp fall in cigarette consumption, as shown in current data, our objective is to assess smokers' sensitivity to cigarette price and consumer income changes as well as to project health benefits of an additional tax increase. METHODS Cigarette consumption was considered as the dependent variable, with Weighted Average Price as a proxy for cigarette price, gross domestic product as a proxy for consumers' income and dummy variables reflecting smoking restrictions and antismoking campaigns. Values were computed to natural logarithms and regression was performed. Then, four scenarios of tax increase were distinguished in order to calculate potential health benefits. RESULTS Short-run price elasticity is estimated at -0.441 and short-run income elasticity is estimated at 1.040. Antismoking campaigns were found to have a statistically significant impact on consumption. Results indicate that, depending on the level of tax increase, annual per capita consumption could fall by at least 209.83 cigarettes; tax revenue could rise by more than €0.74 billion, while smokers could be reduced by up to 530 568 and at least 465 smoking-related deaths could be averted. CONCLUSIONS Price elasticity estimates are similar to previous studies in Greece, while income elasticity estimates are far greater. With cigarettes regarded as a luxury good, a great opportunity is presented for decisionmakers to counter smoking. Increased taxation, along with focused antismoking campaigns, law reinforcement (to ensure compliance with smoking bans) and intensive control for smuggling could invoke a massive blow to the tobacco epidemic in Greece.
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Affiliation(s)
- Filippos Tarantilis
- Department of Health Economics, National School of Public Health, Athens, Greece
| | - Kostas Athanasakis
- Department of Health Economics, National School of Public Health, Athens, Greece
| | - Dimitris Zavras
- Department of Health Economics, National School of Public Health, Athens, Greece
| | | | - Ioannis Kyriopoulos
- Department of Health Economics, National School of Public Health, Athens, Greece
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Vozikis A, Siganou M. Immigrants’ Satisfaction from the National Health System in Greece: In the Quest of the Contributing Factors. Health (London) 2015. [DOI: 10.4236/health.2015.711157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Vozikis A, Stavropoulou L, Patrinos GP. Community Pharmacists’ Strategies in Greece: An Assessment of the Policy Environment and the Mapping of Key Players. Health (London) 2015. [DOI: 10.4236/health.2015.711170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Riga M, Vozikis A, Pollalis Y, Souliotis K. MERIS (Medical Error Reporting Information System) as an innovative patient safety intervention: a health policy perspective. Health Policy 2014; 119:539-48. [PMID: 25554702 DOI: 10.1016/j.healthpol.2014.12.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 12/03/2014] [Accepted: 12/04/2014] [Indexed: 10/24/2022]
Abstract
The economic crisis in Greece poses the necessity to resolve problems concerning both the spiralling cost and the quality assurance in the health system. The detection and the analysis of patient adverse events and medical errors are considered crucial elements of this course. The implementation of MERIS embodies a mandatory module, which adopts the trigger tool methodology for measuring adverse events and medical errors an intensive care unit [ICU] environment, and a voluntary one with web-based public reporting methodology. A pilot implementation of MERIS running in a public hospital identified 35 adverse events, with approx. 12 additional hospital days and an extra healthcare cost of €12,000 per adverse event or of about €312,000 per annum for ICU costs only. At the same time, the voluntary module unveiled 510 reports on adverse events submitted by citizens or patients. MERIS has been evaluated as a comprehensive and effective system; it succeeded in detecting the main factors that cause adverse events and discloses severe omissions of the Greek health system. MERIS may be incorporated and run efficiently nationally, adapted to the needs and peculiarities of each hospital or clinic.
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Affiliation(s)
- Marina Riga
- Health Economics, School of Economics, Business and International Studies, Department of Economics, University of Piraeus, 80, Karaoli & Dimitriou Street, 18534 Piraeus, Greece
| | - Athanassios Vozikis
- Health Economics and Information Systems, School of Economics, Business and International Studies, Department of Economics, University of Piraeus, 80, Karaoli & Dimitriou Street, 18534 Piraeus, Greece
| | - Yannis Pollalis
- Strategic Management and Policy, School of Economics, Business and International Studies, Department of Economics, University of Piraeus, 80, Karaoli & Dimitriou Street, 18534 Piraeus, Greece
| | - Kyriakos Souliotis
- Health Policy, Faculty of Social Sciences, Department of Social and Educational Policy, University of Peloponnese, Damaskinou & Kolokotroni Str., 20100 Corinth, Greece.
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Athanasiadi E, Fragoulakis V, Vozikis A. Functional Status, Quality of Life And Work Disability for Patients With Rheumatic Diseases in Greece. Value Health 2014; 17:A386-A387. [PMID: 27200878 DOI: 10.1016/j.jval.2014.08.2649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | | | - A Vozikis
- University of Piraeus, Pireaus, Greece
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Mitropoulou C, Mai Y, van Schaik RH, Vozikis A, Patrinos GP. Stakeholder analysis in pharmacogenomics and genomic medicine in Greece. Public Health Genomics 2014; 17:280-6. [PMID: 25228172 DOI: 10.1159/000365896] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The pace of discoveries and advances in genomic research is not reflected in the pace of their translation and incorporation into day-to-day clinical medicine to individualize healthcare decision-making processes. One of the main obstacles is the poor understanding of the policies and the key stakeholders involved in these translation processes. METHODS We used the computerized version of the PolicyMaker political mapping tool to collect and organize important information about the pharmacogenomics and genomic medicine policy environment, serving as a database for assessments of the policy's content, the major players, their power and policy positions, their interests, and networks and coalitions that interconnect them. RESULTS AND CONCLUSIONS Our findings indicate that the genomic medicine policy environment in Greece seems to be rather positive, as the vast majority of the stakeholders express their medium to high support in the initially set goals of genomic medicine policy environment. The Ministry of Health and public healthcare insurance funds seem to oppose it, most likely due to financial constrains. These findings would contribute in selecting and implementing policy measures that will expedite the adoption of genomics into conventional medical interventions.
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Affiliation(s)
- Christina Mitropoulou
- Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, The Netherlands
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27
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Cooper DN, Brand A, Dolzan V, Fortina P, Innocenti F, Michael Lee MT, Macek M, Al-Mulla F, Prainsack B, Squassina A, Vayena E, Vozikis A, Williams MS, Patrinos GP. Bridging genomics research between developed and developing countries: the Genomic Medicine Alliance. Per Med 2014; 11:615-623. [PMID: 29764053 DOI: 10.2217/pme.14.59] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The Genomic Medicine Alliance is a global academic research network that aims to establish and strengthen collaborative ties between the various genomic medicine stakeholders. Its focus lies on the translation of scientific research findings into clinical practice. It brings together experts from disciplines including genome informatics, pharmacogenomics, public health genomics, ethics in genomics and health economics, and it is supervised by a 14-member International Scientific Advisory Committee comprising internationally renowned scientists. The Alliance's official journal, Public Health Genomics, offers members a highly respected publication forum for their original research findings. In the short-to-medium term, the Genomic Medicine Alliance hopes to harmonize research activities between developed and developing countries and to organize educational activities in the field of genomic medicine.
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Affiliation(s)
- David N Cooper
- Institute of Medical Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - Angela Brand
- University of Maastricht, Institute of Public Health Genomics, Maastricht, The Netherlands
| | - Vita Dolzan
- University of Ljubljana, School of Medicine, Ljubljana, Slovenia
| | - Paolo Fortina
- Thomas Jefferson University, Kimmel Cancer Center, Philadelphia, PA, USA
| | - Federico Innocenti
- Institute of Pharmacogenomics & Individualized Therapy, University of North Carolina, Chapel Hill, NC, USA
| | - Ming Ta Michael Lee
- Laboratory for International Alliance on Genomic Research, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Milan Macek
- Charles University Prague & Faculty Hospital Motol, Institute of Biology & Medical Genetics, Prague, Czech Republic
| | - Fahd Al-Mulla
- University of Kuwait, Molecular Pathology Unit, Safat, Kuwait
| | - Barbara Prainsack
- King's College London, Department of Social Science, Health & Medicine, London, UK
| | - Alessio Squassina
- University of Cagliari, School of Medicine, Department of Biomedical Sciences, Cagliari, Italy
| | - Effy Vayena
- University of Zurich, Institute of Biomedical Ethics, Zurich, Switzerland
| | | | - Marc S Williams
- Geisinger Health System, Genomic Medicine Institute, Danville, PA, USA
| | - George P Patrinos
- University of Patras, School of Health Sciences, Department of Pharmacy, University Campus, Rion, GR-26504, Patras, Greece
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Tsalapati K, Vardavas CI, Athanasakis K, Thireos E, Vozikis A, Pavi E, Behrakis P, Kyriopoulos I. Going up in ashes? Smoking-attributable morbidity, hospital admissions and expenditure in Greece. Eur J Public Health 2014; 24:477-9. [DOI: 10.1093/eurpub/cku040] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Mai Y, Mitropoulou C, Papadopoulou XE, Vozikis A, Cooper DN, van Schaik RH, Patrinos GP. Critical appraisal of the views of healthcare professionals with respect to pharmacogenomics and personalized medicine in Greece. Per Med 2014; 11:15-26. [DOI: 10.2217/pme.13.92] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Aim: In the postgenomic era, in many European countries, very little is known regarding the level of awareness of healthcare professionals with respect to pharmacogenomics and personalized medicine. Methods: Here, we report the findings of an in-depth study, involving 86 pharmacists and 208 physicians, to assess their level of awareness of pharmacogenomics and personalized medicine. Results: Our findings indicate that approximately 60% of pharmacists consider their level of knowledge of personalized medicine to be very low, while over half of the pharmacists and physicians intimate that they would be unable to explain the results of pharmacogenomic tests to their customers or patients, respectively. This situation may be directly related to the low level of their undergraduate education in genetics and pharmacogenomics. Conclusion: These findings provide the basis for assessing the views of healthcare professionals in relation to personalized medicine in Greece, and should help to facilitate the integration of genomics into the medical decision-making process.
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Affiliation(s)
- Yuan Mai
- Department of Pharmacy, School of Health Sciences, University of Patras, University Campus, Rion, GR-265 04, Patras, Greece
| | - Christina Mitropoulou
- Erasmus MC, Faculty of Medicine & Health Sciences, Department of Clinical Chemistry, Rotterdam, The Netherlands
| | - Xanthi E Papadopoulou
- Department of Pharmacy, School of Health Sciences, University of Patras, University Campus, Rion, GR-265 04, Patras, Greece
| | | | - David N Cooper
- Institute of Medical Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - Ron H van Schaik
- Erasmus MC, Faculty of Medicine & Health Sciences, Department of Clinical Chemistry, Rotterdam, The Netherlands
| | - George P Patrinos
- Department of Pharmacy, School of Health Sciences, University of Patras, University Campus, Rion, GR-265 04, Patras, Greece
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Alpert HR, Vardavas CI, Chaloupka FJ, Vozikis A, Athanasakis K, Kyriopoulos I, Bertic M, Behrakis PK, Connolly GN. The recent and projected public health and economic benefits of cigarette taxation in Greece. Tob Control 2013; 23:452-4. [DOI: 10.1136/tobaccocontrol-2012-050857] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Mette L, Mitropoulos K, Vozikis A, Patrinos GP. Pharmacogenomics and public health: implementing 'populationalized' medicine. Pharmacogenomics 2012; 13:803-13. [PMID: 22594512 DOI: 10.2217/pgs.12.52] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Pharmacogenomics are frequently considered in personalized medicine to maximize therapeutic benefits and minimize adverse drug reactions. However, there is a movement towards applying this technology to populations, which may produce the same benefits, while saving already scarce health resources. We conducted a narrative literature review to examine how pharmacogenomics and public health can constructively intersect, particularly in resource-poor settings. We identified 27 articles addressing the research question. Real and theoretical connections between public health and pharmacogenomics were presented in the areas of disease, drugs and public policy. Suggested points for consideration, such as educational efforts and cultural acceptability, were also provided. Including pharmacogenomics in public health can result in both health-related and economic benefits. Including pharmacogenomics in public health holds promise but deserves extensive consideration. To fully realize the benefits of this technology, support is needed from private, public and governmental sectors in order to ensure the appropriateness within a society.
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Affiliation(s)
- Lindsey Mette
- Charité - Universitätsmedizin, Berlin School of Public Health, Berlin, Germany
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Mitropoulos K, Johnson L, Vozikis A, Patrinos GP. Relevance of pharmacogenomics for developing countries in Europe. ACTA ACUST UNITED AC 2011; 26:143-6. [DOI: 10.1515/dmdi.2011.028] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Goulionis JE, Vozikis A, Benos V, Nikolakis D. On the decision rules of cost-effective treatment for patients with diabetic foot syndrome. Clinicoecon Outcomes Res 2010; 2:121-6. [PMID: 21935321 PMCID: PMC3169963 DOI: 10.2147/ceor.s11981] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Indexed: 12/30/2022] Open
Abstract
Objective: To assess the cost-effectiveness of two treatments (medical treatment and amputation) in patients with diabetic foot syndrome, one of the most disabling diabetic complications. Diabetes mellitus is a massive health care problem worldwide with a current prevalence of 150 millions diabetic cases, estimated to increase to 300 million cases in 2025. Methods: Integrating medical knowledge and advances into the clinical setting is often difficult due to the complexity of the algorithms and protocols. Clinical decision support systems assist the clinician in applying new information to patient care through the analysis of patient-specific clinical variables. We require strategic decision support to analyze the cost-effectiveness of these programs compared to the status quo. We provide a simple partially observable Markov model to investigate that issue, and we propose an heuristic algorithm to find the best policy of intervention. Results: This study assesses the potential cost-effectiveness of two alternative treatment interventions in patients with diabetic foot syndrome. The implementation of the heuristic algorithm solution will assist doctors in clinical decision making, and health care organizations in evaluating medication choices for effective treatment. Finally, our study reveals that treatment programs are highly cost-effective for patients at high risk of diabetic foot ulcers and lower extremity amputations.
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Affiliation(s)
- John E Goulionis
- Department of Statistics and Insurance Science, University of Piraeus, Piraeus, Greece
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Goulionis JE, Vozikis A. A validation of two temporal disease clusters tests with a simple epidemic model. Journal of Statistics and Management Systems 2009. [DOI: 10.1080/09720510.2009.10701443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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35
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Goulionis JE, Vozikis A. Medical decision making for patients with Parkinson disease under Average Cost Criterion. Aust New Zealand Health Policy 2009; 6:15. [PMID: 19549341 PMCID: PMC2717981 DOI: 10.1186/1743-8462-6-15] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Accepted: 06/24/2009] [Indexed: 11/10/2022]
Abstract
Parkinson's disease (PD) is one of the most common disabling neurological disorders and results in substantial burden for patients, their families and the as a whole society in terms of increased health resource use and poor quality of life. For all stages of PD, medication therapy is the preferred medical treatment. The failure of medical regimes to prevent disease progression and to prevent long-term side effects has led to a resurgence of interest in surgical procedures. Partially observable Markov decision models (POMDPs) are a powerful and appropriate technique for decision making. In this paper we applied the model of POMDP's as a supportive tool to clinical decisions for the treatment of patients with Parkinson's disease. The aim of the model was to determine the critical threshold level to perform the surgery in order to minimize the total lifetime costs over a patient's lifetime (where the costs incorporate duration of life, quality of life, and monetary units). Under some reasonable conditions reflecting the practical meaning of the deterioration and based on the various diagnostic observations we find an optimal average cost policy for patients with PD with three deterioration levels.
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Affiliation(s)
- John E Goulionis
- Department of Statistics and Insurance Science, University of Piraeus, 80 Karaoli & Dimitriou Street, 18534 Piraeus, Greece.
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Vozikis A, Georgiakodis F. Health insurance record: an additional educational tool in teaching health insurance. Stud Health Technol Inform 2000; 57:238-47. [PMID: 10947661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- A Vozikis
- Dept. Of Statistics and Insurance Science, University of Piraeus, Greece
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Vozikis A, Dounavis P. OECD Health Data software package: an additional educational tool in teaching health and vital statistics. Stud Health Technol Inform 1997; 51:210-6. [PMID: 10179624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- A Vozikis
- Dept. of Statistics and Insurance Science University of Piraeus, Greece
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