1
|
Rikos N, Mema E, Triantafyllou C, Kleftonikolou H, Mazaraki E, Gounelas G, Kourlaba G. Professional quality of life, psychological well-being, and work engagement of healthcare professionals in two Greek hospitals during COVID-19: A cross-sectional study. Work 2024:WOR230386. [PMID: 38251089 DOI: 10.3233/wor-230386] [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] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND During the COVID-19 pandemic, the mental health of healthcare professionals has emerged as an issue of great concern. OBJECTIVE To investigate the levels of professional quality of life, psychological well-being, and work engagement among healthcare professionals in two Greek hospitals during the COVID-19 pandemic. METHODS A cross-sectional study was conducted in December 2021 in two public hospitals in Greece. To assess the levels of professional quality of life, psychological well-being, and work engagement, respondents completed the Professional Quality of Life Scale Version 5 (ProQOL-V), the Psychological Well-being (PWB) scale, and the Utrecht Work Engagement Scale (UWES-17). RESULTS A total of 150 questionnaires were distributed, and 102 were returned (response rate: 68%). It was found that as burnout levels increased, the levels of work engagement decreased (rho = -0.36, p-value < 0.01). Higher levels of compassion satisfaction were associated with higher work engagement (rho = 0.48, p-value < 0.01). Multivariable analysis revealed that healthcare personnel's contact with patients or service users exposed to or who have experienced traumatic events was associated with less positive relationships with others (and, consequently, lower levels of psychological well-being) (p-value = 0.035). CONCLUSIONS Healthcare professionals in the two public hospitals in Greece, experienced moderate levels of compassion satisfaction, burnout, and secondary traumatic stress during the COVID-19 pandemic. Their psychological well-being was also found to be moderate, and their levels of work engagement were moderate to high. Supporting the physical and psychological well-being of healthcare professionals is essential for their ability to provide high-quality care in times of crisis, such as during the COVID-19 pandemic.
Collapse
Affiliation(s)
- Nikos Rikos
- Department of Nursing, School of Health Sciences, Hellenic Mediterranean University, Heraklion, Greece
| | - Erion Mema
- Department of Nursing, School of Health Sciences, Hellenic Mediterranean University, Heraklion, Greece
| | | | - Hellen Kleftonikolou
- Department of Nursing, School of Health Sciences, Hellenic Mediterranean University, Heraklion, Greece
| | - Emmanouella Mazaraki
- Department of Nursing, School of Health Sciences, Hellenic Mediterranean University, Heraklion, Greece
| | | | - Georgia Kourlaba
- Department of Nursing, School of Health Sciences, University of Peloponnese, Tripoli, Greece
| |
Collapse
|
2
|
Papadopoulou A, Karavalakis G, Papadopoulou E, Xochelli A, Bousiou Z, Vogiatzoglou A, Papayanni PG, Georgakopoulou A, Giannaki M, Stavridou F, Vallianou I, Kammenou M, Varsamoudi E, Papadimitriou V, Giannaki C, Sileli M, Stergiouda Z, Stefanou G, Kourlaba G, Gounelas G, Triantafyllidou M, Siotou E, Karaglani A, Zotou E, Chatzika G, Boukla A, Papalexandri A, Koutra MG, Apostolou D, Pitsiou G, Morfesis P, Doumas M, Karampatakis T, Kapravelos N, Bitzani M, Theodorakopoulou M, Serasli E, Georgolopoulos G, Sakellari I, Fylaktou A, Tryfon S, Anagnostopoulos A, Yannaki E. SARS-CoV-2-specific T cell therapy for severe COVID-19: a randomized phase 1/2 trial. Nat Med 2023; 29:2019-2029. [PMID: 37460756 DOI: 10.1038/s41591-023-02480-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 06/28/2023] [Indexed: 07/22/2023]
Abstract
Despite advances, few therapeutics have shown efficacy in severe coronavirus disease 2019 (COVID-19). In a different context, virus-specific T cells have proven safe and effective. We conducted a randomized (2:1), open-label, phase 1/2 trial to evaluate the safety and efficacy of off-the-shelf, partially human leukocyte antigen (HLA)-matched, convalescent donor-derived severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific T cells (CoV-2-STs) in combination with standard of care (SoC) in patients with severe COVID-19 compared to SoC during Delta variant predominance. After a dose-escalated phase 1 safety study, 90 participants were randomized to receive CoV-2-ST+SoC (n = 60) or SoC only (n = 30). The co-primary objectives of the study were the composite of time to recovery and 30-d recovery rate and the in vivo expansion of CoV-2-STs in patients receiving CoV-2-ST+SoC over SoC. The key secondary objective was survival on day 60. CoV-2-ST+SoC treatment was safe and well tolerated. The study met the primary composite endpoint (CoV-2-ST+SoC versus SoC: recovery rate 65% versus 38%, P = 0.017; median recovery time 11 d versus not reached, P = 0.052, respectively; rate ratio for recovery 1.71 (95% confidence interval 1.03-2.83, P = 0.036)) and the co-primary objective of significant CoV-2-ST expansion compared to SοC (CoV-2-ST+SoC versus SoC, P = 0.047). Overall, in hospitalized patients with severe COVID-19, adoptive immunotherapy with CoV-2-STs was feasible and safe. Larger trials are needed to strengthen the preliminary evidence of clinical benefit in severe COVID-19. EudraCT identifier: 2021-001022-22 .
Collapse
Affiliation(s)
- Anastasia Papadopoulou
- Hematopoietic Cell Transplantation Unit, Department of Hematology Gene and Cell Therapy Center, George Papanikolaou Hospital, Thessaloniki, Greece
| | - George Karavalakis
- Hematopoietic Cell Transplantation Unit, Department of Hematology Gene and Cell Therapy Center, George Papanikolaou Hospital, Thessaloniki, Greece
| | - Efthymia Papadopoulou
- Department of Respiratory Medicine, George Papanikolaou Hospital, Thessaloniki, Greece
| | - Aliki Xochelli
- Department of Immunology, National Peripheral Histocompatibility Center, Hippokration General Hospital, Thessaloniki, Greece
| | - Zoi Bousiou
- Hematopoietic Cell Transplantation Unit, Department of Hematology Gene and Cell Therapy Center, George Papanikolaou Hospital, Thessaloniki, Greece
| | | | - Penelope-Georgia Papayanni
- Hematopoietic Cell Transplantation Unit, Department of Hematology Gene and Cell Therapy Center, George Papanikolaou Hospital, Thessaloniki, Greece
- Department of Genetics, Development and Molecular Biology, School of Biology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aphrodite Georgakopoulou
- Hematopoietic Cell Transplantation Unit, Department of Hematology Gene and Cell Therapy Center, George Papanikolaou Hospital, Thessaloniki, Greece
- Department of Genetics, Development and Molecular Biology, School of Biology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Giannaki
- Hematopoietic Cell Transplantation Unit, Department of Hematology Gene and Cell Therapy Center, George Papanikolaou Hospital, Thessaloniki, Greece
| | - Fani Stavridou
- Hematopoietic Cell Transplantation Unit, Department of Hematology Gene and Cell Therapy Center, George Papanikolaou Hospital, Thessaloniki, Greece
| | - Ioanna Vallianou
- Hematopoietic Cell Transplantation Unit, Department of Hematology Gene and Cell Therapy Center, George Papanikolaou Hospital, Thessaloniki, Greece
| | - Maria Kammenou
- Hematopoietic Cell Transplantation Unit, Department of Hematology Gene and Cell Therapy Center, George Papanikolaou Hospital, Thessaloniki, Greece
| | - Evangelia Varsamoudi
- Hematopoietic Cell Transplantation Unit, Department of Hematology Gene and Cell Therapy Center, George Papanikolaou Hospital, Thessaloniki, Greece
| | - Vasiliki Papadimitriou
- Hematopoietic Cell Transplantation Unit, Department of Hematology Gene and Cell Therapy Center, George Papanikolaou Hospital, Thessaloniki, Greece
| | - Chrysavgi Giannaki
- 'A' Intensive Care Unit, George Papanikolaou Hospital, Thessaloniki, Greece
| | - Maria Sileli
- 'B' Intensive Care Unit, George Papanikolaou Hospital, Thessaloniki, Greece
| | - Zoi Stergiouda
- Department of Anesthesiology, George Papanikolaou Hospital, Thessaloniki, Greece
| | | | - Georgia Kourlaba
- Department of Nursing, University of Peloponnese, Tripolis, Greece
| | | | - Maria Triantafyllidou
- Hematopoietic Cell Transplantation Unit, Department of Hematology Gene and Cell Therapy Center, George Papanikolaou Hospital, Thessaloniki, Greece
| | - Eleni Siotou
- Hematopoietic Cell Transplantation Unit, Department of Hematology Gene and Cell Therapy Center, George Papanikolaou Hospital, Thessaloniki, Greece
| | | | - Eleni Zotou
- Hematopoietic Cell Transplantation Unit, Department of Hematology Gene and Cell Therapy Center, George Papanikolaou Hospital, Thessaloniki, Greece
- Department of Genetics, Development and Molecular Biology, School of Biology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgia Chatzika
- Department of Immunology, National Peripheral Histocompatibility Center, Hippokration General Hospital, Thessaloniki, Greece
| | - Anna Boukla
- Department of Immunology, National Peripheral Histocompatibility Center, Hippokration General Hospital, Thessaloniki, Greece
| | - Apostolia Papalexandri
- Hematopoietic Cell Transplantation Unit, Department of Hematology Gene and Cell Therapy Center, George Papanikolaou Hospital, Thessaloniki, Greece
| | - Maria-Georgia Koutra
- Hematopoietic Cell Transplantation Unit, Department of Hematology Gene and Cell Therapy Center, George Papanikolaou Hospital, Thessaloniki, Greece
| | - Dimitra Apostolou
- Department of Respiratory Failure, George Papanikolaou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgia Pitsiou
- Department of Respiratory Failure, George Papanikolaou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Petros Morfesis
- 1st Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Michalis Doumas
- 2nd Propedeutic Department of Internal Medicine, Hippokrateio Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | - Militsa Bitzani
- 'A' Intensive Care Unit, George Papanikolaou Hospital, Thessaloniki, Greece
| | - Maria Theodorakopoulou
- National and Kapodistrian University of Athens, Evaggelismos General Hospital, Athens, Greece
| | - Eva Serasli
- Department of Respiratory Medicine, George Papanikolaou Hospital, Thessaloniki, Greece
| | - Grigorios Georgolopoulos
- Hematopoietic Cell Transplantation Unit, Department of Hematology Gene and Cell Therapy Center, George Papanikolaou Hospital, Thessaloniki, Greece
| | - Ioanna Sakellari
- Hematopoietic Cell Transplantation Unit, Department of Hematology Gene and Cell Therapy Center, George Papanikolaou Hospital, Thessaloniki, Greece
| | - Asimina Fylaktou
- Department of Immunology, National Peripheral Histocompatibility Center, Hippokration General Hospital, Thessaloniki, Greece
| | - Stavros Tryfon
- Department of Respiratory Medicine, George Papanikolaou Hospital, Thessaloniki, Greece
| | - Achilles Anagnostopoulos
- Hematopoietic Cell Transplantation Unit, Department of Hematology Gene and Cell Therapy Center, George Papanikolaou Hospital, Thessaloniki, Greece
| | - Evangelia Yannaki
- Hematopoietic Cell Transplantation Unit, Department of Hematology Gene and Cell Therapy Center, George Papanikolaou Hospital, Thessaloniki, Greece.
- Department of Medicine, University of Washington, Seattle, WA, USA.
| |
Collapse
|
3
|
Beletsi A, Stefanou G, Kourlaba G. Time From Marketing Authorization to Reimbursement of Medicines in Greece After the Introduction of the Health Technology Assessment Process From July 2018 to April 2022. Value Health Reg Issues 2023; 36:58-65. [PMID: 37030032 DOI: 10.1016/j.vhri.2023.03.001] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 02/04/2023] [Accepted: 03/07/2023] [Indexed: 04/09/2023]
Abstract
OBJECTIVES This study aimed to quantify the median time from marketing authorization (MA) to the inclusion of medicines in the reimbursement list after the introduction of the health technology assessment process in Greece. METHODS From July 2018 to April 2022, the Ministerial Decisions (MDs) and reimbursement lists, posted on the website of the Ministry of Health, were reviewed. The following information was collected for the medicines: the date that MDs and positive reimbursement lists were issued, the MA date, the date of the official price publication, and the type of the health technology assessment application. The time from MA to listing was calculated as the difference between the MA date and the date that the relevant reimbursement list was issued. RESULTS During the study period, 93 MDs were issued, from which 79 (85%) were positive and 14 (15%) were negative. Focusing on medicines included in the positive list for the first time, the median time from MA to listing for the new molecules was found to be 34.8 (interquartile range 25.7-41.3) months. This time was statistically significantly shortened for fixed dose combinations (20.9 [15.3-45.4] months, P = .008), and biosimilars (23 [16.6-28.2] months, P = .001). For generics was 17.6 (interquartile range 10-30) months, statistically significantly lower than that of new molecules (P < .001). CONCLUSIONS The time from MA to the inclusion of medicines in the reimbursement list in Greece is significantly long, especially for innovative medicines. Thus, policy makers should consider this point to optimize and improve patients' subsidized access.
Collapse
|
4
|
Lampropoulou DI, Papadimitriou M, Papadimitriou C, Filippou D, Kourlaba G, Aravantinos G, Gazouli M. The Role of EMT-Related lncRNAs in Ovarian Cancer. Int J Mol Sci 2023; 24:10079. [PMID: 37373222 DOI: 10.3390/ijms241210079] [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: 05/13/2023] [Revised: 06/09/2023] [Accepted: 06/10/2023] [Indexed: 06/29/2023] Open
Abstract
Ovarian cancer (OC) is one of the deadliest cancers worldwide; late diagnosis and drug resistance are two major factors often responsible for high morbidity and treatment failure. Epithelial-to-mesenchymal transition (EMT) is a dynamic process that has been closely linked with cancer. Long non-coding RNAs (lncRNAs) have been also associated with several cancer-related mechanisms, including EMT. We conducted a literature search in the PubMed database in order to sum up and discuss the role of lncRNAs in regulating OC-related EMT and their underlying mechanisms. Seventy (70) original research articles were identified, as of 23 April 2023. Our review concluded that the dysregulation of lncRNAs is highly associated with EMT-mediated OC progression. A comprehensive understanding of lncRNAs' mechanisms in OC will help in identifying novel and sensitive biomarkers and therapeutic targets for this malignancy.
Collapse
Affiliation(s)
| | - Marios Papadimitriou
- Myeloma Division, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL 33136, USA
- Second Department of Surgery, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Christos Papadimitriou
- Second Department of Surgery, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Dimitrios Filippou
- Department of Anatomy and Surgical Anatomy, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- National Organization for Medicines (EOF), 15562 Athens, Greece
| | - Georgia Kourlaba
- Department of Nursing, University of Peloponnese, 22100 Tripoli, Greece
| | | | - Maria Gazouli
- Department of Basic Medical Sciences, Laboratory of Biology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| |
Collapse
|
5
|
Skouras AZ, Antonakis-Karamintzas D, Tsolakis C, Tsantes AE, Kourlaba G, Zafeiris I, Soucacos F, Papagiannis G, Triantafyllou A, Houhoula D, Savvidou O, Koulouvaris P. Pre- and Postoperative Exercise Effectiveness in Mobility, Hemostatic Balance, and Prognostic Biomarkers in Hip Fracture Patients: A Study Protocol for a Randomized Controlled Trial. Biomedicines 2023; 11:biomedicines11051263. [PMID: 37238934 DOI: 10.3390/biomedicines11051263] [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: 03/15/2023] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 05/28/2023] Open
Abstract
Hip fractures are a major health concern, particularly for older adults, as they can reduce life quality, mobility loss, and even death. Current evidence reveals that early intervention is recommended for endurance in patients with hip fractures. To our knowledge, preoperative exercise intervention in patients with hip fractures remains poorly researched, and no study has yet applied aerobic exercise preoperatively. This study aims to investigate the short-term benefits of a supervised preoperative aerobic moderate-intensity interval training (MIIT) program and the added effect of an 8-week postoperative MIIT aerobic exercise program with a portable upper extremity cycle ergometer. The work-to-recovery ratio will be 1-to-1, consisting of 120 s for each bout and four and eight rounds for the pre- and postoperative programs, respectively. The preoperative program will be delivered twice a day. A parallel group, single-blinded, randomized controlled trial (RCT) was planned to be conducted with 58 patients each in the intervention and control groups. This study has two primary purposes. First, to study the effect of a preoperative aerobic exercise program with a portable upper extremity cycle ergometer on immediate postoperative mobility. Second, to investigate the additional effect of an 8-week postoperative aerobic exercise program with a portable upper extremity cycle ergometer on the walking distance at eight weeks after surgery. This study also has several secondary objectives, such as ameliorating surgical and keeping hemostatic balance throughout exercise. This study may expand our knowledge of preoperative exercise effectiveness in hip fracture patients and enhance the current literature about early intervention benefits.
Collapse
Affiliation(s)
- Apostolos Z Skouras
- 1st Department of Orthopaedic Surgery, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Dimitrios Antonakis-Karamintzas
- 1st Department of Orthopaedic Surgery, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Charilaos Tsolakis
- 1st Department of Orthopaedic Surgery, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
- Sports Performance Laboratory, School of Physical Education & Sports Science, National and Kapodistrian University of Athens, 17237 Athens, Greece
| | - Argirios E Tsantes
- Laboratory of Haematology and Blood Bank Unit, "Attiko" Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Georgia Kourlaba
- Faculty of Health, Department of Nursing, University of Peloponnese, 23100 Sparta, Greece
| | - Ioannis Zafeiris
- 1st Department of Orthopaedic Surgery, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Fotini Soucacos
- 1st Department of Orthopaedic Surgery, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Georgios Papagiannis
- 1st Department of Orthopaedic Surgery, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
- Biomechanics Laboratory, Department of Physiotherapy, University of the Peloponnese, 23100 Sparta, Greece
| | - Athanasios Triantafyllou
- 1st Department of Orthopaedic Surgery, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
- Biomechanics Laboratory, Department of Physiotherapy, University of the Peloponnese, 23100 Sparta, Greece
| | - Dimitra Houhoula
- Department of Food Science and Technology, University of West Attica, 12244 Egaleo, Greece
| | - Olga Savvidou
- 1st Department of Orthopaedic Surgery, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Panagiotis Koulouvaris
- 1st Department of Orthopaedic Surgery, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
| |
Collapse
|
6
|
Magiouf KS, Fragiadaki K, Charpidou A, Syrigos A, Kotteas E, Kourlaba G. Impact of biologic therapies on risk of adverse cardiovascular events in patients with Ankylosing Spondylitis or Psoriatic Arthritis: A systematic literature review. ARP Rheumatol 2023; 2:53-63. [PMID: 36809367] [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] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
BACKGROUND Recent evidence highlights increased mortality and morbidity due to cardiovascular disease (CVD), especially within the two major forms of Spondyloarthropathies (SpAs), Ankylosing Spondylitis (AS) and Psoriatic Arthritis (PsA). Healthcare professionals and patients in these populations should be alerted regarding the high risk of cardiovascular (CV) events and thus, customize the treatment strategy accordingly. OBJECTIVE This systematic literature review aimed to determine the effects of biological therapies on serious CV events in AS and PsA. METHODS Screening for the study was carried out using PubMed and Scopus databases from the database's inception to the 17th of July 2021. The literature search strategy for this review is based on the Population, Intervention, Comparator, Outcomes (PICOs) framework. Randomized controlled trials (RCTs) of biologic therapies for the treatment of AS and/or PsA were included. The primary outcome measure was the number of serious CV events reported during the placebo-controlled phase. RESULTS 4,422 articles were generated from keywords, eligibility criteria, and databases. Following the screening, we retained 13 studies for analysis: 3 in AS and 10 in PsA. Meta-analysis of results was not feasible due to the small number of the identified studies, the heterogeneity of the biologic treatment and the included populations, as well as the infrequently reported requested endpoint. According to our review, biologic treatments are safe options as for CV risk in patients with PsA or AS. CONCLUSION Further and more extensive trials in AS/PsA patients at high risk of CV events are needed before firm conclusions can be drawn.
Collapse
Affiliation(s)
| | - Kalliopi Fragiadaki
- National and Kapodistrian University of Athens School of Health Sciences, Athens, Greece
| | - Adrianni Charpidou
- "Sotiria" Hospital for Diseases of the Chest, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandros Syrigos
- "Sotiria" Hospital for Diseases of the Chest, National and Kapodistrian University of Athens, Athens, Greece
| | - Elias Kotteas
- "Sotiria" Hospital for Diseases of the Chest, National and Kapodistrian University of Athens, Athens, Greece
| | | |
Collapse
|
7
|
Tzenetidis N, Kourlaba G, Triantafyllou C, Tzenetidis V, Koulouvaris P, Myrianthefs P. Practices and educational needs of Hellenic Police Officers in providing first aid/cardiopulmonary resuscitation: A cross-sectional survey. Work 2023:WOR220150. [PMID: 36683479 DOI: 10.3233/wor-220150] [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] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND It is well known that police officers (POs) are expected to be the first responders in emergency cases requiring First Aid (FA) such as cardiac arrest. OBJECTIVE Description of practices and educational needs of Hellenic POs in providing FA/Cardiopulmonary Resuscitation (CPR) in case of medical emergencies and description of the equipment of professional FA kit. METHODS An anonymous cross-sectional survey was conducted from January 1, 2016, to December 31, 2017, using a self-administered questionnaire designed to serve the purposes of this particular survey. The instrument consisted of 53 questions (multiple choice and open-ended questions) administered in a convenience sample of 700 POs of the Attica prefecture. RESULTS A sample of 520 POs (constables and lieutenants) completed the questionnaire (response rate = 74.28%). Among the participants, 248 (47.7 %) declared that they had provided FA/CPR in the past, while among those declaring that they had never provided FA/PCR (n = 248), 153 (61.7%) said that they had experienced FA/CPR needs, but did not know what they had to do. Moreover, only 18.1% (94/520) of the POs answered that they have FA equipment in their professional equipment, which mainly includes bandages (54/94, 57.4%), while 29.7% of POs provided answers about their educational needs (313 in total) declared that they would like to be educated in bleeding control. CONCLUSION There is a need to educate and train Greek POs in first aid and CPR in an organized and mandatory way in order to meet emergency needs.
Collapse
Affiliation(s)
- Nikolaos Tzenetidis
- Department of Nursing, School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgia Kourlaba
- Department of Nursing, Faculty of Health Sciences, University of Peloponnese, Tripoli Greece
| | - Christos Triantafyllou
- Department of Nursing, School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Panagiotis Koulouvaris
- First Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Pavlos Myrianthefs
- Department of Nursing, School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
8
|
Gourzoulidis G, Koulentaki M, Kattamis A, Bouzani M, Giatra C, Chotzagiannoglou V, Beletsi A, Kourlaba G. Cost-Utility Analysis of Pegaspargase for the Treatment of Acute Lymphoblastic Leukemia in Greece. Clin Drug Investig 2022; 42:999-1008. [PMID: 36227415 DOI: 10.1007/s40261-022-01207-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND OBJECTIVE Acute lymphoblastic leukemia (ALL) is an acute, rapidly progressing and life-threatening form of cancer involving immature lymphocytes called lymphoblasts. ALL is the most common subtype of leukemia in children and adolescents. The aim of the present study was to assess the cost-utility of pegaspargase versus L-asparaginase, both followed by Erwinase in the therapy sequence, as a treatment option for pediatric, adolescent, and adult patients with ALL in Greece. METHODS A published cost-utility model comprising a decision tree and a state-transition Markov model was adapted from a public payer perspective to compare a pegaspargase treatment sequence with an L-asparaginase sequence. Efficacy and safety data, as well as utility values, were extracted from the published literature. Direct costs pertaining to drug acquisition, administration, and management of hypersensitivity were considered in the analysis (€2020). Model-extrapolated outcomes included quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness ratios (ICER). All future outcomes were discounted at 3.5% per annum. Sensitivity analyses were used to explore the impact of changing input data. RESULTS The analysis showed that the pegaspargase sequence was estimated to produce 0.05 additional QALYs (18.12 vs. 18.07) and lower cost of - €1698 compared with L-asparaginase, indicating that the pegaspargase sequence was a dominant treatment strategy (improved outcomes with reduced costs) compared with L-asparaginase. Deterministic sensitivity analysis confirmed the cost-effective profile of pegaspargase. At the defined willingness-to-pay threshold of €54,000/QALY gained, probabilistic sensitivity analysis showed that pegaspargase had a 100% probability of being cost effective relative to the L-asparaginase sequence. CONCLUSION The pegaspargase sequence was found to be less costly and more effective (in terms of QALYs) in relation to the L-asparaginase sequence, representing a dominant strategic option for Greek public payers in ALL.
Collapse
Affiliation(s)
| | | | - Antonis Kattamis
- First Department of Pediatrics, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Maria Bouzani
- Hematology and Lymphoma Department, "Evangelismos" Athens General Hospital, Athens, Greece
| | - Chara Giatra
- Hematology and Lymphoma Department, "Evangelismos" Athens General Hospital, Athens, Greece
| | | | | | | |
Collapse
|
9
|
Papadopoulou A, Karavalakis G, Papadopoulou E, Xochelli A, Bousiou Z, Vogiatzoglou A, Papayanni P, Georgakopoulou A, Giannaki M, Stavridou F, Vallianou I, Kammenou M, Varsamoudi E, Papadimitriou V, Giannaki C, Sileli M, Stergiouda Z, Stefanou G, Kourlaba G, Triantafyllidou M, Siotou E, Karaglani A, Zotou E, Chatzika G, Boukla A, Apostolou D, Pitsiou G, Morfesis P, Bartzoudis D, Imprialos K, Karampatakis T, Kapravelos N, Bitzani M, Theodorakopoulou M, Serasli E, Sakellari I, Fylaktou A, Tryfon S, Anagnostopoulos A, Yannaki E. Immunotherapy: SAFETY AND EFFICACY OF SARS-COV-2-SPECIFIC T CELLS AS ADOPTIVE IMMUNOTHERAPY FOR HIGH-RISK COVID-19 PATIENTS: A PHASE I/II, RANDOMIZED CLINICAL TRIAL. Cytotherapy 2022. [PMCID: PMC9035757 DOI: 10.1016/s1465-3249(22)00147-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
10
|
Gourzoulidis G, Zisimopoulou O, Boubouchairopoulou N, Michailidi C, Lowry C, Tzanetakos C, Kourlaba G. Cost-effectiveness Analysis of Lorlatinib in Patients Previously Treated with Anaplastic Lymphoma Kinase Inhibitors for Non-small Cell Lung Cancer in Greece. J Health Econ Outcomes Res 2022; 9:50-57. [PMID: 35620456 PMCID: PMC8853822 DOI: 10.36469/jheor.2022.32983] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/18/2022] [Indexed: 06/04/2023]
Abstract
Background: Non-small cell lung cancer (NSCLC), which accounts for about 80%-85% of lungcancer cases, is a leading cause of cancer-related death worldwide. Lorlatinib is a potent third-generation anaplastic lymphoma kinase (ALK) inhibitor approved for the treatment of patients with advanced, ALK-positive NSCLC previously treated with at least one second-generation ALK tyrosine kinase inhibitor. Objective: The present study assessed the cost-effectiveness of lorlatinib vs pemetrexed with platinum combination of carboplatin or cisplatin (P-ChT) in Greece. Methods: A partitioned survival model with three health states, referring to pre-progression, progressed disease, and death, was locally adapted from a Greek payer perspective over a lifetime horizon. Clinical and safety data and utility values applied in the model were extracted from the literature. A matching-adjusted indirect comparison of lorlatinib and P-ChT was performed. Only direct medical costs (€) from 2020 were included in the analysis. Primary outcomes were patient life years (LYs), quality-adjusted life years (QALYs), total costs, and incremental cost-effectiveness ratios per QALY and LY gained. All future outcomes were discounted at 3.5% per annum. A probabilistic sensitivity analysis was conducted to account for model uncertainty. Results: The analysis showed that, over a lifetime horizon, the estimated total costs of lorlatinib and P-ChT were €81 754 and €12 343, respectively. Lorlatinib was more effective than P-ChT with 2.4 and 1.5 more LYs and QALYs gained, respectively. The generated incremental cost-effectiveness ratios of lorlatinib compared with P-ChT were €28 613 per LY gained and €46 102 per QALY gained. Probabilistic sensitivity analysis confirmed the deterministic results. Conclusion: The present analysis suggests that lorlatinib may be considered as a cost-effective option compared with P-ChT in Greece for the treatment of patients with advanced, ALK-positive NSCLC whose disease has progressed after at least one second-generation ALK tyrosine kinase inhibitor. In addition, this option addresses a significant unmet medical need.
Collapse
|
11
|
Karagiannidou S, Kourlaba G, Zaoutis T, Maniadakis N, Papaevangelou V. Attributable Mortality for Pediatric and Neonatal Central Line-Associated Bloodstream Infections in Greece. J Pediatr Intensive Care 2021. [DOI: 10.1055/s-0041-1740448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
AbstractCentral line-associated bloodstream infections (CLABSIs) are the most frequent pediatric hospital-acquired infections and significantly impact outcomes. The aim of this study was to estimate the attributable mortality for CLABSIs in pediatric and neonatal patients in Greece. A retrospective matched-cohort study was performed, in two tertiary pediatric hospitals. Inpatients with a central line in neonatal and pediatric intensive care units (NICUs and PICUs), hematology/oncology units, and a bone marrow transplantation unit between June 2012 and June 2015 were eligible. Patients with confirmed CLABSI were enrolled on the day of the event and were matched (1:1) to non-CLABSI patients by hospital, hospitalization unit, and length of stay prior to study enrollment (188 children enrolled, 94 CLABSIs). Attributable mortality was estimated. During the study period, 22 CLABSIs and nine non-CLABSIs died (23.4 vs. 9.6%, respectively, p = 0.011), leading to an attributable mortality of 13.8% (95% confidence interval [CI] = 3.4–24.3%). Children in PICUs were more likely to die, presenting an attributable mortality of 20.2% (95% CI = − 1.4–41.8%), without reaching, however, statistical significance. After multiple logistic regression, CLABSIs were four times more likely to die (odds ratio [OR] = 4.29, 95% CI = 1.28–14.36, p = 0.018). Survival analysis showed no difference in time to death after study enrollment between CLABSIs and non-CLABSIs (log-rank p = 0.137, overall median survival time = 7.8 months). Greek pediatric mortality rates are increased by the CLABSI occurrence, highlighting the importance of infection prevention strategies.
Collapse
Affiliation(s)
- Sofia Karagiannidou
- Center for Clinical Epidemiology and Outcomes Research, Non-Profit Civil Partnership, Athens, Greece
| | - Georgia Kourlaba
- Center for Clinical Epidemiology and Outcomes Research, Non-Profit Civil Partnership, Athens, Greece
- ECONCARE, LP, Athens, Greece
| | - Theoklis Zaoutis
- Center for Clinical Epidemiology and Outcomes Research, Non-Profit Civil Partnership, Athens, Greece
- Department of Pediatrics, Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Nikolaos Maniadakis
- Department of Health Services Management, National School of Public Health, Athens, Greece
| | - Vassiliki Papaevangelou
- Third Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, University General Hospital ATTIKON, Athens, Greece
| |
Collapse
|
12
|
Vassilikopoulos T, Kalokairinou A, Kourlaba G, Grapsa E. Evaluation of Pupils' Knowledge about Kidney Health. Int J Environ Res Public Health 2021; 18:12811. [PMID: 34886537 PMCID: PMC8657303 DOI: 10.3390/ijerph182312811] [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] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/25/2021] [Accepted: 12/01/2021] [Indexed: 11/30/2022]
Abstract
The purpose of this study was to investigate the level of renal function knowledge of primary school pupils in Greece. We conducted a cross-sectional study with a convenience sample of 220 pupils, coming from the 5th and 6th grades of general education schools. A questionnaire consisting of 11 questions was developed from scratch. However, based on an analysis of Cronbach's alpha values obtained when individual questions were deleted, two questions were removed from the analysis, and only nine remained for analysis and participated in the calculation of the knowledge score. Moreover, the gender and daily habits of pupils regarding water consumption and frequency of urination were recorded. Pupils had a high percentage of correct knowledge about the number of kidneys (95.2%), whether a child may have problems with the kidneys (85.5%) and whether a person can survive with one kidney (68.5%). Low levels of knowledge were observed in the function and role of the kidneys (36.4%), as well as the part of the body where the kidneys are located (30.9%). The median (interquartile range (IQR)) total knowledge score was 6 (5-7), with no difference detected between genders (p = 0.135). A statistically significant difference between pupils of 5th and 6th grades was found but the difference did not seem to be clinically significant (p = 0.035). The present research demonstrates that pupils' knowledge of renal function and the protection of their kidneys needs improvement.
Collapse
Affiliation(s)
- Theodore Vassilikopoulos
- Nephrology Department, Aretaieio University Hospital, School of Medicine, National & Kapodistrian University of Athens, 11528 Athens, Greece;
| | - Athena Kalokairinou
- Faculty of Nursing, National & Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Georgia Kourlaba
- School of Medicine, National & Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Eirini Grapsa
- Nephrology Department, Aretaieio University Hospital, School of Medicine, National & Kapodistrian University of Athens, 11528 Athens, Greece;
| |
Collapse
|
13
|
Kopsidas I, Chorianopoulou E, Kourkouni E, Triantafyllou C, Molocha NM, Koniordou M, Maistreli S, Tsopela CG, Maroudi-Manta S, Filippou D, Zaoutis T, Kourlaba G. COVID-19 pandemic impact on seasonal flu vaccination: A cross-sectional study. Pneumon 2021. [DOI: 10.18332/pne/136173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
|
14
|
Melikoki V, Kourlaba G, Kanavaki I, Fessatou S, Papaevangelou V. Seroprevalence of Hepatitis C in Children Without Identifiable Risk-Factors: A Systematic Review and Meta-Analysis. J Pediatr Gastroenterol Nutr 2021; 72:e140-e148. [PMID: 33633077 DOI: 10.1097/mpg.0000000000003099] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Hepatitis C virus (HCV) remains a major public health burden for >30 years since its discovery. It is estimated that >80 million people have been already infected. Direct-acting antiviral (DAA) treatment is now approved for young children over the age of 3 years. Treating children before the development of high-risk behaviors is optimal. Thus, assessing the current epidemiology of HCV in children becomes important and may promote awareness. METHODS Articles describing the prevalence of hepatitis C in children, were systematically reviewed. To assess HCV infection prevalence in the general population, studies discussing high-risk groups alone were excluded. RESULTS Data from 58 studies were analyzed. National data was scarce. An overall prevalence of HCV in children of 0.87% was found, ranging from 0.34% in Europe to 3.02% in Africa. Prevalence of viremic infection is important and data synthesis from available data indicated that HCV viremia was detected in 56.8% of children. The prevalence of HCV according to sex was described in 25 studies but no difference between sexes was detected. HCV prevalence was significantly higher in children older than 10 years (0.97%) when compared to those ages under 10 years old (0.75%, P < 0.001). CONCLUSIONS Considering probable underdiagnosis of HCV infection in children, this information reveals that prevalence is substantial. One may argue that future strategies aiming towards HCV elimination, may need to include antiviral treatment of pre-adolescent children as well.
Collapse
Affiliation(s)
| | - Georgia Kourlaba
- Center for Clinical Epidemiology and Outcomes Research (CLEO), Athens
| | - Ino Kanavaki
- Third Department of Pediatrics, National and Kapodistrian University of Athens, School of Medicine, University General Hospital ATTIKON, Athens, Greece
| | - Smaragdi Fessatou
- Third Department of Pediatrics, National and Kapodistrian University of Athens, School of Medicine, University General Hospital ATTIKON, Athens, Greece
| | - Vassiliki Papaevangelou
- Third Department of Pediatrics, National and Kapodistrian University of Athens, School of Medicine, University General Hospital ATTIKON, Athens, Greece
| |
Collapse
|
15
|
Gourzoulidis G, Koulentaki M, Koumarianou A, Samadas E, Androulakis N, Xynogalos S, Papakotoulas P, Boukovinas I, Karamouzis M, Souglakos J, Chotzagiannoglou V, Beletsi A, Kourlaba G. Cost-effectiveness of trifluridine/tipiracil as a third-line treatment of metastatic gastric cancer, including adenocarcinoma of the gastrohesophageal junction, among patients previously treated in Greece. Expert Rev Pharmacoecon Outcomes Res 2021; 22:259-269. [PMID: 33900864 DOI: 10.1080/14737167.2021.1921576] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 12/24/2022]
Abstract
Objective: To evaluate the cost-effectiveness of trifluridine/tipiracil (FTD/TPI) compared with best supportive care (BSC) for the treatment of patients with metastatic gastric cancer(mGC), including gastroesophageal junction adenocarcinoma(GEJ), who have received at least two prior therapies for metastatic disease and are eligible for third-line treatment, in Greece.Methods: A partitioned survival model was locally adapted from a public payer perspective over a 10-year time horizon. Clinical, safety and utility data were extracted from literature. Resource consumption data obtained from a panel of local experts using a questionnaire developed for the study was combined with unit costs obtained from official sources. All costs reflect the year 2020 (€). Outcomes of the model were patients' life years (LYs) and quality-adjusted life years (QALYs), total costs and incremental cost-effectiveness ratio (ICER) per QALY and LY gained.Results: The total cost per patient was estimated to be €6,965 for FTD/TPI and €1,906 for BSC, while FTD/TPI was associated with 0.180 and 0.107 increments in LYs and QALYs, respectively, compared with BSC, resulting in an ICER of €47,144 per QALY gained and €28,112 per LY gained.Conclusion: FTD/TPI was estimated to be a cost-effective treatment option for eligible third line mGC patients, including GEJ in Greece.
Collapse
Affiliation(s)
| | | | - Anna Koumarianou
- Hematology Oncology Unit, Fourth Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | | | - Nikolaos Androulakis
- Medical Oncology Unit, Pananio-Venizelio General Hospital of Heraklion, Heraklion, Greece
| | | | - Pavlos Papakotoulas
- First Department of Clinical Oncology, Theagenio Hospital, Thessaloniki, Greece
| | | | - Michalis Karamouzis
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - John Souglakos
- Department of Medical Oncology, University Hospital of Heraklion, Crete, Greece
| | | | | | | |
Collapse
|
16
|
Karampatsou SI, Genitsaridi SM, Michos A, Kourkouni E, Kourlaba G, Kassari P, Manios Y, Charmandari E. The Effect of a Life-Style Intervention Program of Diet and Exercise on Irisin and FGF-21 Concentrations in Children and Adolescents with Overweight and Obesity. Nutrients 2021; 13:1274. [PMID: 33924457 PMCID: PMC8070027 DOI: 10.3390/nu13041274] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/06/2021] [Accepted: 04/09/2021] [Indexed: 01/04/2023] Open
Abstract
Overweight and obesity in childhood and adolescence represent major public health problems of our century, and account for increased morbidity and mortality in adult life. Irisin and Fibroblast Growth Factor 21 (FGF-21) have been proposed as prognostic and/or diagnostic biomarkers in subjects with obesity and metabolic syndrome, because they increase earlier than other traditional biomarkers. We determined the concentrations of Irisin and FGF-21 in children and adolescents with overweight and obesity before and after one year of a life-style intervention program of diet and physical exercise and explored the impact of body mass index (BMI) reduction on the concentrations of Irisin, FGF-21 and other cardiometabolic risk factors. Three hundred and ten (n = 310) children and adolescents (mean age ± SD: 10.5 ± 2.9 years) were studied prospectively. Following one year of the life-style intervention program, there was a significant decrease in BMI (p = 0.001), waist-to-hip ratio (p = 0.024), waist-to-height ratio (p = 0.024), and Irisin concentrations (p = 0.001), and an improvement in cardiometabolic risk factors. There was no alteration in FGF-21 concentrations. These findings indicate that Irisin concentrations decreased significantly as a result of BMI reduction in children and adolescents with overweight and obesity. Further studies are required to investigate the potential role of Irisin as a biomarker for monitoring the response to lifestyle interventions and for predicting the development of cardiometabolic risk factors.
Collapse
Affiliation(s)
- Sofia I. Karampatsou
- Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens, ‘Aghia Sophia’ Children’s Hospital, 11527 Athens, Greece; (S.I.K.); (S.M.G.); (P.K.)
| | - Sofia M. Genitsaridi
- Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens, ‘Aghia Sophia’ Children’s Hospital, 11527 Athens, Greece; (S.I.K.); (S.M.G.); (P.K.)
| | - Athanasios Michos
- Division of Infectious Diseases, First Department of Pediatrics, National and Kapodistrian University of Athens, ‘Aghia Sophia’ Children’s Hospital, 11527 Athens, Greece;
| | - Eleni Kourkouni
- Center for Clinical Epidemiology and Outcomes Research (CLEO), 11528 Athens, Greece; (E.K.); (G.K.)
| | - Georgia Kourlaba
- Center for Clinical Epidemiology and Outcomes Research (CLEO), 11528 Athens, Greece; (E.K.); (G.K.)
| | - Penio Kassari
- Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens, ‘Aghia Sophia’ Children’s Hospital, 11527 Athens, Greece; (S.I.K.); (S.M.G.); (P.K.)
| | - Yannis Manios
- Department of Nutrition and Dietetics, Harokopio University of Athens, Kallithea, 17671 Athens, Greece;
| | - Evangelia Charmandari
- Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens, ‘Aghia Sophia’ Children’s Hospital, 11527 Athens, Greece; (S.I.K.); (S.M.G.); (P.K.)
- Division of Endocrinology and Metabolism, Center of Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, 11527 Athens, Greece
| |
Collapse
|
17
|
Vellopoulou K, Stefanou G, Tzanetakos C, Boubouchairopoulou N, Nakou M, Gourzoulidis G, Kourlaba G. Cost-effectiveness of tofacitinib for the treatment of moderate to severe active ulcerative colitis in Greece. Eur J Gastroenterol Hepatol 2021; 33:325-333. [PMID: 32976189 DOI: 10.1097/meg.0000000000001916] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of tofacitinib versus other treatment options currently available for the management of adult patients with moderate-to-severe ulcerative colitis, who have had an inadequate response, loss of response, or were intolerant to conventional therapy or a biologic agent, in Greece. METHODS A Markov model was adapted for projecting lifetime costs and outcomes, for a cohort of patients with moderate-to-severe ulcerative colitis from a Greek payer perspective. Patients entered the model in the active ulcerative colitis state and transitioned to a remission or response state or they underwent colectomy. Following an initial 8-week induction treatment period, patients received maintenance therapy until loss of response. Nonresponders could switch to up to two subsequent biologic lines. Clinical efficacy, adverse event rates and utilities derived from OCTAVE trials and a network-meta-analysis (NMA), while adverse event-related disutilities were obtained from the literature. Information on treatment pathways and resource use was provided by an advisory board due to a lack of local data. Unit costs derived from official national sources (€, 2018). RESULTS Over a life-time horizon, treating moderate-to-severe active ulcerative colitis with tofacitinib resulted in additional quality-adjusted life-years (QALYs) and lower total costs compared to vedolizumab (0.018; €6408), infliximab (biosimilar) (0.009; €3031), golimumab (0.042; €1988) and infliximab (originator) (0.009; €6724). Hence, tofacitinib was estimated to be dominant over all comparators. CONCLUSION The results of the analysis suggest that in the Greek setting, tofacitinib could be considered a cost-effective (dominant) treatment option for the treatment of patients with moderate-to-severe active ulcerative colitis.
Collapse
|
18
|
Kokkotou E, Stefanou G, Syrigos N, Gourzoulidis G, Ntalakou E, Apostolopoulou A, Charpidou A, Kourlaba G. End-of-life cost for lung cancer patients in Greece: a hospital-based retrospective study. J Comp Eff Res 2021; 10:315-324. [PMID: 33605788 DOI: 10.2217/cer-2020-0167] [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] [Indexed: 11/21/2022] Open
Abstract
Objective: The aim of the present study was to estimate the cost of treating patients with lung cancer at their end-of-life (EOL) phase of care in Greece. Materials & methods: A hospital-based retrospective study was conducted in the Oncology Unit of 'Sotiria' Hospital, in Athens, Greece. All lung cancer patients who died between 1 January 2015 and 31 December 2018 with at least 6 months follow-up were enrolled in the study. Healthcare resource utilization data, including inpatient and outpatient ones, during the last 6 months before death was extracted from a registry kept in the unit. This data were combined with the corresponding local unit costs to calculate the 6, 3 and 1-month EOL cost in €2019 values. Results: A total of 122 patients met the inclusion criteria. The mean (standard deviation) age at diagnosis was 67.8 (8.9) years with 78.7% of patients being male and 55.0% diagnosed at stage IV. About 52.5% of patients had been diagnosed with adenocarcinoma, 28.7% with squamous non-small-cell lung cancer types and 18.9% with small-cell-lung cancer. The median overall survival of these patients was 10.8 months. During the EOL periods, the mean cost/patient in the last 6, 3 and 1 month were €7665, €3351 and €1009, respectively. Pharmaceutical cost was the key driver of the total cost (75% of the total 6-month) followed by radiation therapy (16.2%). The median EOL 6-month cost was marginally statistically significantly higher among patients with adenocarcinoma (€9031) compared with squamous (€6606) and to small-cell-lung cancer (€5474). Conclusion: The findings of the present study indicate that lung cancer treatment incurs high costs in Greece, mainly attributed to pharmaceutical expenses, even at the EOL phase.
Collapse
Affiliation(s)
- Eleni Kokkotou
- 3rd Department of Medicine, Oncology Unit, Athens Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | | | - Nikolaos Syrigos
- 3rd Department of Medicine, Oncology Unit, Athens Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | | | - Eleutheria Ntalakou
- 3rd Department of Medicine, Oncology Unit, Athens Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | - Anna Apostolopoulou
- 3rd Department of Medicine, Oncology Unit, Athens Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | - Andriani Charpidou
- 3rd Department of Medicine, Oncology Unit, Athens Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | | |
Collapse
|
19
|
Magklara E, Angelis S, Solia E, Katsimantas A, Kourlaba G, Kostakis G, Tsakotos G, Zaoutis T, Filippou D. The Role of Medical Students During COVID-19 Era. A Review. Acta Biomed 2021; 92:e2021032. [PMID: 33682809 PMCID: PMC7975932 DOI: 10.23750/abm.v92i1.10873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 11/13/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND AIM OF THE WORK Since December 2019, the world has been facing the coronavirus (COVID-19) pandemic crisis. The rapid and effortless spread of the virus has led the World Health Organization to adopt unprecedented large-scale preventive measures. Our aim is to investigate the impact of COVID-19 on the mental health of medical students, and to evaluate their awareness and aptitude for contributing to the fight against COVID-19 contagion. METHODS PubMed electronic database was employed for the research using the following terms: "medical students and COVID-19", "mental health of medical students and COVID-19", "knowledge of medical students and COVID-19", "preventive behavior of medical students and COVID-19". RESULTS Twenty-one articles were included; ten assess the knowledge of medical students on COVID-19, seven present whether they demonstrate appropriate preventive behavior according to global guidelines, seven examine the impact of the pandemic on their mental health, five examine their role on the side of trained healthcare workers. Some articles combine more than one of the above mentioned domains. CONCLUSIONS Medical students seem to demonstrate an adequate level of knowledge upon COVID-19 and implement proper strategies to prevent its spread. Further training is essential to improve some aspects in this field. Social media has proven to be the optimal source of information for medical students, which is incompatible with their future careers as doctors. The pandemic had a negative impact on medical students, expressed as fear regarding the virus spread; nevertheless, many have felt the need to assist healthcare systems under appropriate precautions.
Collapse
Affiliation(s)
- Elli Magklara
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
| | - Stavros Angelis
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
| | - Eirini Solia
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
| | - Antonios Katsimantas
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
| | - Georgia Kourlaba
- Center for clinical epidemiology and outcomes research (CLEO), Athens, Greece.
| | - Georgios Kostakis
- School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece.
| | - Georgios Tsakotos
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
| | - Theoklis Zaoutis
- Center for clinical epidemiology and outcomes research (CLEO), Athens, Greece.
| | - Dimitrios Filippou
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
| |
Collapse
|
20
|
Kourlaba G, Kourkouni E, Maistreli S, Tsopela CG, Molocha NM, Triantafyllou C, Koniordou M, Kopsidas I, Chorianopoulou E, Maroudi-Manta S, Filippou D, Zaoutis TE. Willingness of Greek general population to get a COVID-19 vaccine. Glob Health Res Policy 2021; 6:3. [PMID: 33509291 PMCID: PMC7843240 DOI: 10.1186/s41256-021-00188-1] [Citation(s) in RCA: 90] [Impact Index Per Article: 30.0] [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: 11/06/2020] [Accepted: 01/21/2021] [Indexed: 01/08/2023] Open
Abstract
Background Epidemiological data indicate that a large part of population needs to be vaccinated to achieve herd immunity. Hence, it is of high importance for public health officials to know whether people are going to get vaccinated for COVID-19. The objective of the present study was to examine the willingness of adult residents in Greece to receive a COVID-19 vaccine. Methods A cross-sectional was survey conducted among the adult general population of Greece between April 28, 2020 to May 03, 2020 (last week of lockdown), using a mixed methodology for data collection: Computer Assisted Telephone Interviewing (CATI) and Computer Assisted web Interviewing (CAWI). Using a sample size calculator, the target sample size was found to be around 1000 respondents. To ensure a nationally representative sample of the urban/rural population according to the Greek census 2011, a proportionate stratified by region systematic sampling procedure was used to recruit particpants. Data collection was guided through a structured questionnaire. Regarding willingness to COVID-19 vaccination, participants were asked to answer the following question: “If there was a vaccine available for the novel coronavirus, would you do it?” Results Of 1004 respondents only 57.7% stated that they are going to get vaccinated for COVID-19. Respondents aged > 65 years old, those who either themselves or a member of their household belonged to a vulnerable group, those believing that the COVID-19 virus was not developed in laboratories by humans, those believing that coronavirus is far more contagious and lethal compared to the H1N1 virus, and those believing that next waves are coming were statistically significantly more likely to be willing to get a COVID-19 vaccine. Higher knowledge score regarding symptoms, transmission routes and prevention and control measures against COVID-19 was significantly associated with higher willingness of respondents to get vaccinated. Conclusion A significant proportion of individuals in the general population are unwilling to receive a COVID-19 vaccine, stressing the need for public health officials to take immediate awareness-raising measures. Supplementary Information The online version contains supplementary material available at 10.1186/s41256-021-00188-1.
Collapse
Affiliation(s)
- Georgia Kourlaba
- Center for Clinical Epidemiology and Outcomes Research (CLEO), Athens, Greece. .,ECONCARE LP, Athens, Greece.
| | - Eleni Kourkouni
- Center for Clinical Epidemiology and Outcomes Research (CLEO), Athens, Greece
| | - Stefania Maistreli
- Center for Clinical Epidemiology and Outcomes Research (CLEO), Athens, Greece
| | | | | | | | - Markela Koniordou
- Center for Clinical Epidemiology and Outcomes Research (CLEO), Athens, Greece
| | - Ioannis Kopsidas
- Center for Clinical Epidemiology and Outcomes Research (CLEO), Athens, Greece
| | | | | | - Dimitrios Filippou
- Department of Anatomy and Surgical Anatomy, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Theoklis E Zaoutis
- Center for Clinical Epidemiology and Outcomes Research (CLEO), Athens, Greece.,Division of Infectious Diseases, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
| |
Collapse
|
21
|
Triantafyllou C, Chorianopoulou E, Kourkouni E, Zaoutis TE, Kourlaba G. Prevalence, incidence, length of stay and cost of healthcare-acquired pressure ulcers in pediatric populations: A systematic review and meta-analysis. Int J Nurs Stud 2020; 115:103843. [PMID: 33373805 DOI: 10.1016/j.ijnurstu.2020.103843] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 04/30/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Pressure ulcers are a major problem for national healthcare systems since they frequently occur in hospitalized patients, negatively affecting patients' quality of life and extending duration of hospitalization. OBJECTIVE To systematically review the available evidence regarding the incidence, prevalence, attributable length of stay and cost of hospital-acquired pressure ulcers in pediatric populations. DESIGN A systematic review and meta-analysis. METHODS A systematic search (March 15, 2020) was conducted in PubMed, Scopus, and ProQuest databases. Cross-sectional and cohort studies of neonates and children aged <21 years old were eligible for inclusion when full text was available in English and data for at least one of the following criteria was provided: incidence, prevalence, attributable length of stay or healthcare cost due to hospital-acquired pressure ulcers. Study quality was evaluated using the Joanna Briggs Institute Critical Appraisal Tools. Random effects models were used to synthesize data. Heterogeneity and publication bias were evaluated. RESULTS From the 1055 studies appeared in literature search, 21 studies were included in the systematic review and 19 were included in the meta-analysis. The overall prevalence ranged from 0.47% to 31.2% and cumulative incidence ranged from 3.7% to 27%. The pooled prevalence was estimated at 7.0% (95% confidence interval (CI): 4.3%-10.4%) and the pooled cumulative incidence at 14.9% (95% CI: 7.7%-23.9%). The pooled prevalence among neonates was 27.0% (95% CI: 22.1%-33.1%) among children aged less than 1 year old was 19.2% (95% CI: 9.4%-31.3%) and among children older than 1 year was 12.3% (95% CI: 2.3%-27.9%). The cumulative incidence of hospital-acquired pressure ulcers in neonates was 9.8% (95% CI: 2.9%-19.8%) and in children aged <1 year old was 11.3% (95% CI: 4.4%-20.7%), while no data was available to estimate this figure for children older than 1 year. The attributable length of stay ranged from 0.9 to 14.1 days and the attributable cost ranged from $894.69 to $98,730.24 (United States dollars; value of a dollar in 2020) per patient with hospital-acquired pressure ulcers. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS The results of this meta-analysis indicate that hospital-acquired pressure ulcers occur frequently in pediatric populations with a great variation across different age groups. Moreover, although limited data are available, it seems that hospital-acquired pressure ulcers have significant economic implications for the healthcare systems since they prolong patients' hospitalization stay; these findings further highlight the need for implementation of patient-based prevention strategies. SYSTEMATIC REVIEW REGISTRATION NUMBER Not registered Tweetable abstract: Hospital-acquired pressure ulcers occur frequently in pediatric populations, prolonging their hospitalization and increasing the healthcare cost.
Collapse
Affiliation(s)
- Christos Triantafyllou
- Center for Clinical Epidemiology and Outcomes Research (CLEO), Non-Profit Civil Partnership, 5 Chatzigianni Mexi str., 11528 Athens, Greece.
| | - Evangelia Chorianopoulou
- Center for Clinical Epidemiology and Outcomes Research (CLEO), Non-Profit Civil Partnership, 5 Chatzigianni Mexi str., 11528 Athens, Greece.
| | - Eleni Kourkouni
- Center for Clinical Epidemiology and Outcomes Research (CLEO), Non-Profit Civil Partnership, 5 Chatzigianni Mexi str., 11528 Athens, Greece.
| | - Theoklis E Zaoutis
- Center for Clinical Epidemiology and Outcomes Research (CLEO), Non-Profit Civil Partnership, 5 Chatzigianni Mexi str., 11528 Athens, Greece; Division of Infectious Diseases, The Children's Hospital of Philadelphia, Department of Pediatrics, 3401 Civic Center Blvd., 19104 Philadelphia, Pennsylvania, United States.
| | - Georgia Kourlaba
- Center for Clinical Epidemiology and Outcomes Research (CLEO), Non-Profit Civil Partnership, 5 Chatzigianni Mexi str., 11528 Athens, Greece; ECONCARE, LP, 5 Chatzigianni Mexi str., 11528 Athens, Greece
| |
Collapse
|
22
|
Paltoglou G, Dimitropoulos I, Kourlaba G, Charmandari E. The effect of treatment with recombinant human growth hormone (rhGH) on linear growth and adult height in children with idiopathic short stature (ISS): a systematic review and meta-analysis. J Pediatr Endocrinol Metab 2020; 33:1577-1588. [PMID: 33035189 DOI: 10.1515/jpem-2020-0287] [Citation(s) in RCA: 8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 08/23/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVES Idiopathic short stature (ISS) is a recognized, albeit a controversial indication for treatment with recombinant human growth hormone (rhGH).The objective of the present study was to conduct a systematic review of the literature and meta-analyses of selected studies about the use of rhGH in children with ISS on linear growth and adult height (AH). METHODS A systematic literature search was conducted to identify relevant studies published till February 28, 2017 in the following databases: Medline (PubMed), Scopus and Cochrane Central Registry of Controlled Trials. After exclusion of duplicate studies, 3,609 studies were initially identified. Of those, 3,497 studies were excluded during the process of assessing the title and/or the abstract. The remaining 112 studies were evaluated further by assessing the full text; 21 of them fulfilled all the criteria in order to be included in the current meta-analysis. RESULTS Children who received rhGH had significantly higher height increment at the end of the first year, an effect that persisted in the second year of treatment and achieved significantly higher AH than the control group. The difference between the two groups was equal to 5.3 cm (95% CI: 3.4-7 cm) for male and 4.7 cm (95% CI: 3.1-6.3 cm) for female patients. CONCLUSION In children with ISS, treatment with rhGH improves short-term linear growth and increases AH compared with control subjects. However, the final decision should be made on an individual basis, following detailed diagnostic evaluation and careful consideration of both risks and benefits of rhGH administration.
Collapse
Affiliation(s)
- George Paltoglou
- Department of Paediatric Endocrinology, Evelina Children's Hospital, London, UK.,Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, 'Aghia Sophia' Children's Hospital, Athens, Greece
| | | | - Georgia Kourlaba
- Center for Clinical Epidemiology and Outcomes Research (CLEO), Athens, Greece
| | - Evangelia Charmandari
- Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, 'Aghia Sophia' Children's Hospital, Athens, Greece.,Division of Endocrinology and Metabolism, Center for Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| |
Collapse
|
23
|
Bobetsis YA, Kotsikoris I, Liapis CD, Liasis N, Kakisis J, Kourlaba G, Lazari P, Antonopoulos CN, Deliargyris EN, Madianos PN. Association between periodontal disease and vulnerable plaque morphology in patients undergoing carotid endarterectomy. Int J Cardiol Heart Vasc 2020; 30:100601. [PMID: 32802936 PMCID: PMC7419330 DOI: 10.1016/j.ijcha.2020.100601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 07/10/2020] [Accepted: 07/20/2020] [Indexed: 01/23/2023]
Abstract
Periodontal disease is associated with echolucent plaques. Periodontal disease is associated with increased macrophages in plaques. Periodontal disease is associated with decreased smooth muscle cells in plaques. Periodontal disease is associated with plaque instability.
Background Periodontal disease (PD) is a chronic inflammatory oral condition with potentially important systemic sequelae. We sought to determine whether the presence of PD in patients with severe carotid disease was associated with morphological features consistent with carotid plaque instability. Methods A total of 52 dentate patients hospitalized for carotid endarterectomy (CEA) had standardized assessments of their periodontal status, including measurements of probing pocket depth (PPD), clinical attachment level (CAL) and bleeding on probing (BoP). Carotid plaque morphology was assessed by ultrasound using the gray scale median (GSM) score and by immunohistochemistry using anti-CD68 and anti-alpha-actin antibodies, markers for macrophages and smooth muscle cells (SMCs) respectively. Results In total 30/52 patients (58%) had PD. Significant associations were noted between low GSM on ultrasound and each mm in PPD (p = 0.001), each mm in CAL (p = 0.002) and with a 10% increase in BoP (p = 0.009). Using the standardized PERIO definition the association remained robust (aOR = 10.4 [95% CI:2.3–46.3], p = .002). Significant associations were also observed with high macrophage accumulation and each individual PD measure (p < 0.01 for PPD, CAL and BoP) and with the PERIO definition (aOR = 15 [95% CI:1.8–127.8], p = .01). Similarly, low SMC density was also significantly associated with individual measures of PD (p < 0.05 for PPD, CAL and BoP), but not with the PERIO definition (aOR 3.4 [95% CI:0.9–12.8], p = .07). Conclusions The presence of PD was significantly associated with both ultrasound and immunohistochemistry features of carotid plaque instability in patients undergoing CEA.
Collapse
Affiliation(s)
- Yiorgos A Bobetsis
- Dept of Periodontology, School of Dentistry, National and Kapodistrian University of Athens, Greece
| | | | - Christos D Liapis
- Dept of Vascular Surgery, Medical School, National and Kapodistrian University of Athens, Greece.,Vascular & Endovascular Clinic, Athens Medical Center, Athens, Greece
| | - Nikolaos Liasis
- Dept of Vascular Diagnosis, Euromedic Greece, Athens, Greece
| | - John Kakisis
- Dept of Vascular Surgery, Medical School, National and Kapodistrian University of Athens, Greece
| | - Georgia Kourlaba
- 1 and 2 Dept of Pediatrics, Medical School, National and Kapodistrian University of Athens, Greece
| | - Paraskevi Lazari
- Dept of Pathology, Nikaia General Hospital, Piraeus, Greece.,Dept of Pathology, West Attica General Hospital, Athens, Greece
| | | | | | - Phoebus N Madianos
- Dept of Periodontology, School of Dentistry, National and Kapodistrian University of Athens, Greece
| |
Collapse
|
24
|
Dimopoulou D, Kourlaba G, Antoniadou A, Mariolis L, Kavatha D, Stoungioti S, Kekkou K, Dinopoulos A, Alexopoulou E, Papaevangelou V. Low birth weight and head circumference as potential biomarkers of sensorineural hearing loss in asymptomatic congenitally CMV-infected infants. J Clin Virol 2020; 129:104471. [DOI: 10.1016/j.jcv.2020.104471] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 05/15/2020] [Accepted: 05/23/2020] [Indexed: 11/30/2022]
|
25
|
Kourlaba G, Stefanou G, Tsalamandris S, Oikonomou E, Papageorgiou G, Nikas N, Tousoulis D, Maniadakis N. Incidence and cost of bleeding events requiring hospitalization in patients with atrial fibrillation treated with acenocoumarol in Greece. Hellenic J Cardiol 2020; 62:234-240. [PMID: 32683128 DOI: 10.1016/j.hjc.2020.06.013] [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: 05/05/2020] [Revised: 06/17/2020] [Accepted: 06/26/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND To estimate the incidence of hemorrhagic events in patients with atrial fibrillation (AF) treated with acenocoumarol, and the management cost of those requiring hospitalization in Greece. METHODS A nationwide telephone survey was conducted between December 2017 and January 2018, to identify cardiologists who treat AF patients with acenocoumarol. A total of 300 cardiologists were selected and reported the number of AF acenocoumarol-treated patients during the past 12 months and the number of those who experienced a hemorrhagic event. The hospital charges to sickness fund and the cost of resource utilization of AF patients hospitalized between January 2013 and June 2017 at a tertiary hospital in Athens due to acenocoumarol-related bleedings were retrieved. RESULTS Out of 48,255 AF patients, 12,633 (26.2%) were treated with acenocoumarol. In all, 5.1% of patients experienced a hemorrhagic event with the incidence of bleeding requiring hospitalization being 1.7%. The most common bleeding site was the gastrointestinal system (51.5%). The mean (95% CI) management cost per bleeding event requiring hospitalization was €1,202 (€1,058-€1,420). The higher cost was that of intracranial bleeding €3,887 (€2,700-€5,046). The expected annual economic burden for the management of bleedings related to acenocoumarol and requiring hospitalization was estimated at €1,463,955. CONCLUSIONS The incidence of bleeding events in AF acenocoumarol-treated patients in Greece as well as the estimated annual economic burden for the management of bleeding events requiring hospitalization, emphasize the need to comply with the current guidelines and to optimize therapeutic strategies for the management of AF side effects with oral anticoagulants, particularly in patients with high bleeding risk.
Collapse
Affiliation(s)
| | | | - Sotiris Tsalamandris
- 1st Department of Cardiology, 'Hippokration' Hospital, University of Athens Medical School, 114 Vassilissis Sofias Avenue, 115 27, Athens, Greece
| | - Evangelos Oikonomou
- 1st Department of Cardiology, 'Hippokration' Hospital, University of Athens Medical School, 114 Vassilissis Sofias Avenue, 115 27, Athens, Greece
| | - Giannis Papageorgiou
- Boehringer-Ingelheim Hellas, 340 Andrea Syngrou Avenue, 176 73, Kallithea, Greece
| | - Nikos Nikas
- Boehringer-Ingelheim Hellas, 340 Andrea Syngrou Avenue, 176 73, Kallithea, Greece
| | - Dimitris Tousoulis
- 1st Department of Cardiology, 'Hippokration' Hospital, University of Athens Medical School, 114 Vassilissis Sofias Avenue, 115 27, Athens, Greece
| | - Nikos Maniadakis
- Department of Public Health Policies, University of West Attica, 196 Alexandras Avenue, 115 21, Athens, Greece
| |
Collapse
|
26
|
Marvaki A, Kourlaba G, Kadda O, Vasilopoulos G, Rovina N, Koutsoukou A, Kotanidou A. A Comparative Study Between Two Support Surfaces for Pressure Ulcer Prevention and Healing in ICU Patients. Cureus 2020; 12:e8785. [PMID: 32724736 PMCID: PMC7381843 DOI: 10.7759/cureus.8785] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 06/23/2020] [Indexed: 12/03/2022] Open
Abstract
Objective The aim of this research was to compare the effectiveness of two mattresses used in intensive care unit (ICU) high-risk patients in terms of pressure ulcers (PUs) prevention and healing. Materials and Methods The studied sample consisted of 70 consecutive patients aged 18 to 65 years hospitalized in two ICUs of a general hospital in Athens, Greece. Virtuoso Mattress System (LINET, Slaný, Czech Republic) was used in 35 patients, and standard memory foam mattress was used in the rest of participants. Patients were firstly assessed on enrollment and then every 72 hours in order to record the appearance or not of PUs, location of PUs, and stage of PUs, with the maximum follow-up not exceeding the 21 days. A number of clinical and biochemical factors, medical treatment, and vital signs were also recorded at each time point. Results Of the 70 patients, 40 (57.1%) were men, and the mean ± standard deviation age of the sample was 46.1 ± 14.5 years. The most common area of PUs was the buttocks (34.3%) followed by the shoulders (22.3%), with no statistically significant difference detected between the two groups. Moreover, the proportion of patients having PUs at stage 2 or higher was 23.8% on the third day after admission and 61.1% on the sixth day, with no difference detected between the two groups. Cox proportional hazard model revealed that the Virtuoso mattress was associated with almost 56% lower risk of developing PUs compared with standard foam mattress (HR [95% CI]: 0.44 [0.20-0.93]). The percentage of patients healed using the Virtuoso mattress was significantly lower compared with the standard foam mattress at all time points, with the results reaching statistical significance only on the 12th day after admission (7.7% vs. 66.7%; p < 0.05). Conclusions The Virtuoso mattress seems to be more effective compared with standard foam mattresses in the prevention of PUs, whereas the standard foam mattresses are more effective in PU healing process.
Collapse
Affiliation(s)
- Aikaterini Marvaki
- Internal Medicine, National and Kapodistrian University of Athens Medical School, Athens, GRC
| | - Georgia Kourlaba
- Epidemiology, Center of Clinical Epidemiology and Outcomes Research, Athens, GRC
| | - Olga Kadda
- Nursing, Onassis Cardiac Surgery Center, Athens, GRC
| | | | - Nikoleta Rovina
- Internal Medicine, National and Kapodistrian University of Athens Medical School, Athens, GRC
| | - Antonia Koutsoukou
- Internal Medicine, National and Kapodistrian University of Athens Medical School, Athens, GRC
| | - Anastasia Kotanidou
- Internal Medicine, National and Kapodistrian University of Athens Medical School, Athens, GRC
| |
Collapse
|
27
|
Kopsidas I, Tsopela GC, Maroudi-Manta S, Kourkouni E, Charalampopoulos D, Sirogianni A, Collins ME, Lourida A, Kourlaba G, Zaoutis TE, Coffin SE. Increasing healthcare workers' uptake of seasonal influenza vaccination in a tertiary-care pediatric hospital in Greece with a low-cost, tailor-made, multifaceted strategy. Vaccine 2020; 38:4609-4615. [PMID: 32430148 DOI: 10.1016/j.vaccine.2020.05.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 04/06/2020] [Accepted: 05/04/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Healthcare workers' (HCW) seasonal influenza vaccination (SIV) is critical to prevent nosocomial influenza. However, HCW vaccination rates remain unacceptably low in many European institutions. A two-year three-step initiative was implemented at a tertiary-care pediatric hospital with 750 beds in Athens, Greece with the aim of increasing SIV among HCW. METHODS Α cross-sectional anonymous survey of HCWs was conducted during the 2015-16 influenza season with the aim to evaluate attitudes, knowledge, and specific barriers and facilitators for SIV. Stratified analysis was used to identify factors associated with no prior history of influenza vaccination. Multifaceted interventions were implemented in the 2016-2017 season. These included 1) education around influenza disease and SIV, and 2) communication of availability and opportunity (time and place) of SIV. Interventions were designed to target HCWs with the lowest SIV rates in the previous three years. RESULTS We achieved a 67% response rate, with 363 respondents (106 doctors, 145 nurses, 101 other hospital staff; 11 did not provide their profession). Most (64%) had not been vaccinated in the previous three years; only 14% received the vaccine annually. Non-vaccination rates were significantly higher among nurses (76%) and cleaning and food-service workers (73%) compared to doctors (40%) (P < 0.001). Protection of self, family, patients and colleagues were the most common motivations. Concerns about the safety and effectiveness of the vaccine, the belief that one does not belong to a high-risk group were the most common barriers. The interventions led to an increase in SIV uptake by the HCWs in the hospital, from 19% to 31%. CONCLUSIONS In a country with very low reported rates of vaccination among HCWs, a simple, low-cost, tailor-made intervention strategy can lead to an increase in SIV uptake. Stratifying data according to vaccination history may reveal a diversity of targets for improvement that might otherwise be missed.
Collapse
Affiliation(s)
- Ioannis Kopsidas
- Centre for Clinical Epidemiology and Outcomes Research(CLEO), Athens, Greece.
| | | | | | - Eleni Kourkouni
- Centre for Clinical Epidemiology and Outcomes Research(CLEO), Athens, Greece
| | | | | | - Madeline E Collins
- Centre for Clinical Epidemiology and Outcomes Research(CLEO), Athens, Greece
| | - Athanasia Lourida
- Infection Control Committee, Aghia Sophia Children's Hospital, Athens, Greece
| | - Georgia Kourlaba
- Centre for Clinical Epidemiology and Outcomes Research(CLEO), Athens, Greece
| | - Theoklis E Zaoutis
- Centre for Clinical Epidemiology and Outcomes Research(CLEO), Athens, Greece; Department of Pediatrics, Perelman School of Medicine at University of Pennsylvania; Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Susan E Coffin
- Department of Pediatrics, Perelman School of Medicine at University of Pennsylvania; Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| |
Collapse
|
28
|
Vellopoulou K, Bakakos P, Loukides S, Maniadakis N, Kourlaba G. The Economic Burden of Asthma in Greece: A Cross-Sectional Study. Appl Health Econ Health Policy 2019; 17:629-640. [PMID: 30997609 DOI: 10.1007/s40258-019-00469-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND The high prevalence rates of asthma worldwide and the chronic nature of the disease make asthma a major cause of morbidity, imposing a significant socio-economic burden in many countries. Specifically in Greece, the self-reported prevalence of asthma reached 9% in 2017. OBJECTIVES The objective of this study was to estimate the total management cost of asthma in Greece and its potential determinants. METHODS A population-based, random-digit-dialed telephone nationwide survey was conducted to recruit patients with asthma in Greece (n = 353). A structured questionnaire was used to collect data on demographic and lifestyle characteristics, exacerbations, asthma control, medical resource utilization, and productivity loss during the past 12 months. The total annual direct cost from the societal, payer, and patient perspective as well as the indirect cost was calculated. All costs refer to the year 2017 (€). The significance level was set to α = 0.05. RESULTS The mean (95% confidence interval) annual total cost per patient for asthma management from the societal, payer, and patient perspective was €895 (696-1105), €673 (497-861), and €151 (119-188), respectively. The direct medical cost accounted for almost 90% of the total cost, whereas only 4% was attributed to the indirect cost. The direct medical cost was mainly driven by the medication cost (48%). The total annual societal cost was statistically significantly higher in those with not well-controlled asthma (p = 0.014) and those experiencing exacerbations during the past 12 months (p < 0.001) than in their counterparts. The total annual economic burden of asthma in Greece was estimated at €727 million and €547 million from the societal and payer perspective, respectively. CONCLUSION Our findings indicate that asthma imposes a high economic burden on society and the healthcare system in Greece. Therefore, greater investment in interventions aimed at asthma control and prevention of acute exacerbations may reduce the overall burden of asthma in Greece.
Collapse
Affiliation(s)
| | - Petros Bakakos
- 1st Respiratory Medicine Department, Medical School, National and Kapodistrian University of Athens, Sotiria Chest Diseases Hospital, Athens, Greece
| | - Stelios Loukides
- 2nd Respiratory Medicine Department, Medical School, National and Kapodistrian University of Athens, Attikon General Hospital, Chaidari, Greece
| | - Nikos Maniadakis
- Department οf Health Services Organization and Management, National School οf Public Health, Athens, Greece
| | | |
Collapse
|
29
|
Kourlaba G, Hillas G, Vassilakopoulos T, Maniadakis N. The Economic Burden of Chronic Obstructive Pulmonary Disease in Greece. Appl Health Econ Health Policy 2019; 17:111-121. [PMID: 30328016 DOI: 10.1007/s40258-018-0431-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a leading cause of disability and death worldwide, imposing a substantial socioeconomic burden on societies and patients due to the long-term management required. OBJECTIVE To assess the economic burden of COPD in Greece and its potential determinants. METHODS A population-based, random-digit dialled, telephone nationwide survey was conducted to recruit patients with COPD in Greece (N = 351). A structured questionnaire was used to collect data. The total annual cost per patient from a societal perspective was calculated. RESULTS The mean (95% CI) annual total cost per patient for the management of COPD from a societal perspective was €2150 (€1879-€2443). The total annual cost was mainly driven by the medication cost (36.1%), followed by the cost of hospitalizations (26.7%) and long-term oxygen therapy (13.8%). Multiple generalized linear model revealed that age, COPD Assessment Test (CAT) score and exacerbations were independently associated with the total annual cost. CONCLUSION Investment in interventions aiming at delaying progression of disease, preventing acute exacerbations, and managing chronic symptoms are required to reduce the overall economic burden of COPD in Greece.
Collapse
Affiliation(s)
| | - Georgios Hillas
- Department of Critical Care of Evangelismos Hospital, Medical School of National and Kapodistrian University of Athens, Athens, Greece
| | - Theodoros Vassilakopoulos
- Department of Critical Care of Evangelismos Hospital, Medical School of National and Kapodistrian University of Athens, Athens, Greece
| | - Nikos Maniadakis
- Department οf Health Services Organization and Management, National School οf Public Health, Athens, Greece
| |
Collapse
|
30
|
Gourzoulidis G, Maniadakis N, Petrakis D, Souglakos J, Pentheroudakis G, Kourlaba G. Economic evaluation of trifluridine and tipiracil hydrochloride in the treatment of metastatic colorectal cancer in Greece. J Comp Eff Res 2019; 8:133-142. [DOI: 10.2217/cer-2018-0076] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Aim: To evaluate the cost–effectiveness of trifluridine and tipiracil hydrochloride (FTD/TPI) compared with best supportive care (BSC) or regorafenib for the treatment of patients with metastatic colorectal cancer who have been previously treated with or are not considered candidates for available therapies including fluoropyrimidine-, oxaliplatin- and irinotecan-based chemotherapies, anti-VEGF agents and anti-EGFR agents in Greece. Methods: A partitioned survival model was locally adapted from a third-party payer perspective over a 10 year time horizon. Efficacy data and utility values were extracted from published studies. Resource consumption data were obtained from local experts using a questionnaire developed for the purpose of the study and was combined with unit costs obtained from official sources. All costs reflect the year 2017 in euros. Primary outcomes were patients’ life years (LYs), quality-adjusted life years (QALYs), total costs and incremental cost–effectiveness ratios (ICERs) per QALY and LYs gained. Results: Total life time cost per patient for FTD/TPI, BSC and regorafenib was estimated to be €10,087, €1,879 and €10,850, respectively. In terms of health outcomes, FTD/TPI was associated with 0.25 and 0.11 increment in LYs compared with BSC and regorafenib, respectively. Furthermore, FTD/TPI was associated with 0.17, and 0.07 increment in QALYs compared with BSC and regorafenib, resulting in ICERs of €32,759 per LY gained and €49,326 per QALY gained versus BSC. Moreover, FTD/TPI was a dominant alternative over regorafenib. Conclusion: The results indicate that FTD/TPI may represent a cost-effective treatment option compared with other alternative therapies as a third-line treatment of metastatic colorectal cancer in Greece.
Collapse
Affiliation(s)
| | - Nikos Maniadakis
- Department of Health Services Organization and Management, National School of Public Health, Athens, Greece
| | - Dimitrios Petrakis
- Department of Oncology, University of Ioannina Medical School, Ioannina, Greece
- Society for Study of Clonal Heterogeneity of Neoplasia (EMEKEN), Ioannina, Greece
| | - John Souglakos
- Laboratory of Tumor Cell Biology, Medical School, University of Crete, Heraklion, Greece
| | - George Pentheroudakis
- Department of Oncology, University of Ioannina Medical School, Ioannina, Greece
- Society for Study of Clonal Heterogeneity of Neoplasia (EMEKEN), Ioannina, Greece
| | | |
Collapse
|
31
|
Kakourou G, Kahraman S, Ekmekci GC, Tac HA, Kourlaba G, Kourkouni E, Sanz AC, Martin J, Malmgren H, Giménez C, Gold V, Carvalho F, Billi C, Chow JFC, Vendrell X, Kokkali G, Liss J, Steffann J, Traeger-Synodinos J. The clinical utility of PGD with HLA matching: a collaborative multi-centre ESHRE study. Hum Reprod 2019; 33:520-530. [PMID: 29432583 DOI: 10.1093/humrep/dex384] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 12/26/2017] [Indexed: 12/16/2022] Open
Abstract
STUDY QUESTION Has PGD-HLA been successful relative to diagnostic and clinical efficacy? SUMMARY ANSWER The diagnostic efficacy of PGD-HLA protocols was found lower in this study in comparison to published PGD-HLA protocols and to that reported for general PGD by ESHRE (78.5 vs 94.1% and vs 92.6%, respectively), while the clinical efficacy has proven very difficult to assess due to inadequate follow-up of both the ART/PGD and HSCT procedure outcomes. WHAT IS KNOWN ALREADY The first clinical cases for PGD-HLA were reported in 2001. It is now a well-established procedure, with an increasing number of cycles performed every year. However, PGD-HLA is still offered by relatively few PGD centres, the currently available data is fragmented and most reports on PGD-HLA applications are limited in number and scope. Published systematic details on methodology, diagnostic results, overall ART success and haematopoietic stem cell transplantation (HSCT) outcomes are limited, precluding an evaluation of the true clinical utility of PGD-HLA cycles. STUDY DESIGN, SIZE, DURATION This retrospective multi-centre cohort study aimed to investigate the diagnostic and clinical efficacy of the PGD-HLA procedure and the aspects of PGD-HLA cycles influencing positive outcomes: birth of genetically suitable donor-baby (or babies) and HSCT. In April 2014, 32 PGD centres (Consortium members and non-members) with published/known PGD-HLA activity were invited to participate. Between February and September 2015, 14 centres submitted their data, through a custom-designed secure database, with unique login access for each centre. Data parameters covered all aspects of PGD-HLA cycles (ART, embryology and genetic diagnosis), donor-babies born and HSCT. PARTICIPANTS/MATERIALS, SETTING, METHODS From 716 cycles submitted by 14 centres (performed between August 2001 and September 2015), the quality evaluation excluded 12 cycles, leaving 704, from 364 couples. The online database, based on REDCap, a free, secure, web-based data-capture application, was customized by Centre for Clinical Epidemiology and Outcomes Research (CLEO), Athens. Continuous variables are presented using mean, standard deviation, median and interquartile range, and categorical variables are presented as absolute and relative frequencies. MAIN RESULTS AND THE ROLE OF CHANCE The data included 704 HLA-PGD cycles. Mean maternal age was 33.5 years. Most couples (81.3%) requested HLA-typing with concurrent exclusion of a single monogenic disease (58.6% for beta-thalassaemia). In 92.5% couples, both partners were fertile, with an average 1.93 HLA-PGD cycles/couple. Overall, 9751 oocytes were retrieved (13.9/cycle) and 5532 embryos were analysed (7.9/cycle). Most cycles involved fresh oocytes (94.9%) and Day 3 embryo biopsy (85.3%). In 97.5% of cycles, the genotyping method involved PCR only. Of 4343 embryos diagnosed (78.5% of analysed embryos), 677 were genetically suitable (15.4% of those analysed for HLA alone, 11.6% of those analysed for HLA with exclusion of monogenic disease). Of the 364 couples, 56.6% achieved an embryo transfer (ET) and 598 embryos were transferred in 382 cycles, leading to 164 HCG-positive pregnancies (pregnancy rate/ET 41.3%, pregnancy rate/initiated cycle 23.3%) and 136 babies born (live birth rate/ET 34.3%, live birth rate/initiated cycle 19.3%) to 113 couples. Data analysis identified the following limitations to the overall success of the HLA-PGD procedure: the age of the mother undergoing the treatment cycle, the number of oocytes collected per cycle and genetic chance. HSCT was reported for 57 cases, of which 64.9% involved combined umbilical cord-blood and bone marrow transplantation from the HLA-identical sibling donor; 77.3% of transplants reported no complications. LIMITATIONS REASONS FOR CAUTION The findings of the study may be limited as not all PGD centres with PGD-HLA experience participated. Reporting bias on completion of the online database may be another potential limitation. Furthermore, the study is based on retrospective data collection from centres with variable practices and strategies for ART, embryology and genetic diagnosis. WIDER IMPLICATIONS OF THE FINDINGS This is the first multi-centre study evaluating the clinical utility of PGD-HLA, indicating variations in practice and outcomes throughout 15 years and between centres. The study highlights parameters important for positive outcomes and provides important information for both scientists and couples interested in initiating a cycle. Above all, the study underlines the need for better collaboration between all specialists involved in the ART-PGD/HLA procedure, as well as the need for comprehensive and prospective long-term data collection, and encourages all specialists to aim to properly evaluate and follow-up all procedures, with the ultimate aim to promote best practice and encourage patient informed decision making. STUDY FUNDING/COMPETING INTEREST(S) The study wishes to acknowledge ESHRE for funding the customization of the REDCap database. There are no competing interests. TRIAL REGISTRATION NUMBER N/A.
Collapse
Affiliation(s)
- G Kakourou
- Department of Medical Genetics, Choremio Research Laboratory, National and Kapodistrian University of Athens, Thivon & Livadias, Athens 11527, Greece
| | - S Kahraman
- Istanbul Memorial Hospital, ART and Reproductive Genetics Unit, Piyale Pasa Bulvari, 34385 Okmeydani sisli-Instanbul, Turkey
| | - G C Ekmekci
- Istanbul Memorial Hospital, ART and Reproductive Genetics Unit, Piyale Pasa Bulvari, 34385 Okmeydani sisli-Instanbul, Turkey
| | - H A Tac
- Istanbul Memorial Hospital, ART and Reproductive Genetics Unit, Piyale Pasa Bulvari, 34385 Okmeydani sisli-Instanbul, Turkey
| | - G Kourlaba
- Center for Clinical Epidemiology and Outcomes Research (CLEO), 5 Chatzigianni Mexi 11528, Athens, Greece
| | - E Kourkouni
- Center for Clinical Epidemiology and Outcomes Research (CLEO), 5 Chatzigianni Mexi 11528, Athens, Greece
| | - A Cervero Sanz
- Igenomix, Parc Científic Universitat de Valéncia, Calle Catedrático Agustín Escardino 9, 46980 Paterna (València), Spain
| | - J Martin
- Igenomix, Parc Científic Universitat de Valéncia, Calle Catedrático Agustín Escardino 9, 46980 Paterna (València), Spain
| | - H Malmgren
- Stockholm PGD Center, Karolinska University Hospital, Karolinska Universitetssjukhuset, Karolinska vägen, 171 76 Solna, Sweden
| | - C Giménez
- Reprogenetics Spain, Carrer de Tuset, 23, 08006 Barcelona, Spain
| | - V Gold
- PGD Lab, Lis Fertility Institute, Lis Maternity and Women's Hospital, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 6423906, Israel
| | - F Carvalho
- Department of Pathology, Faculty of Medicine, University of Porto, Al. Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, R. Alfredo Allen, 4200-135 Porto, Portugal
| | - C Billi
- Preimplantation Diagnosis Department, Alfalab Private Diagnostic Laboratory Medical S.A., Anastasiou Georgiou 11, 115 24 Athens, Greece
| | - J F C Chow
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Tsan Yuk Hospital Preimplantation Genetic Diagnosis Laboratory, Tsan Yuk Hospital, 30 Hospital Road, Sai Ying Pun, Hong Kong
| | - X Vendrell
- Reproductive Genetics Unit, Sistemas Genómicos Ltd, Ronda G.Marconi 6, 46980 Paterna (València), Spain
| | - G Kokkali
- Genesis Athens Clinic, Reproductive Medicine Unit, 14 Papanikoli Str, Chalandri 15232, Athens, Greece
| | - J Liss
- Invicta Fertility and Reproductive Center, 10 Rajska St., 80-850 Gdansk, Poland
| | - J Steffann
- Université Paris Descartes-Sorbonne Paris Cité, Institut Imagine, INSERM UMR1163, Laboratoire de Génétique, APHP Hopital Necker-Enfants Malades, 149 rue de Sévres, 75743 PARIS CEDEX 15, Paris, France
| | - J Traeger-Synodinos
- Department of Medical Genetics, Choremio Research Laboratory, National and Kapodistrian University of Athens, Thivon & Livadias, Athens 11527, Greece
| |
Collapse
|
32
|
Karagiannidou S, Zaoutis T, Maniadakis N, Papaevangelou V, Kourlaba G. Attributable length of stay and cost for pediatric and neonatal central line-associated bloodstream infections in Greece. J Infect Public Health 2019; 12:372-379. [PMID: 30616938 DOI: 10.1016/j.jiph.2018.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 09/11/2018] [Revised: 12/14/2018] [Accepted: 12/17/2018] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Central line-associated bloodstream infections (CLABSIs) are the most frequent pediatric hospital-acquired infections and are associated with significant morbidity and healthcare costs. The aim of our study was to determine the attributable length of stay (LOS) and cost for CLABSIs in pediatric patients in Greece, for which there is currently a paucity of data. METHODS A retrospective matched-cohort study was performed in two tertiary pediatric hospitals. Inpatients with a central line in neonatal and pediatric intensive care units, hematology/oncology units, and a bone marrow transplantation unit between June 2012 and June 2015 were eligible. Patients with confirmed CLABSI were enrolled on the day of the event and were matched (1:1) to patients without CLABSI (non-CLABSIs) by hospital, unit, and LOS prior to study enrollment (188 children enrolled, 94 CLABSIs). The primary outcome measure was the attributable LOS and cost. Baseline demographic and clinical characteristics were recorded. Attributable outcomes were calculated as the differences in estimates of outcomes between CLABSIs and non-CLABSIs, after adjustment for propensity score and potential confounders. RESULTS There were no differences between the two groups regarding their baseline characteristics. After adjustment for age, gender, matching characteristics, central line management after study enrollment, and propensity score, the mean LOS and cost were 57.5days and €31,302 in CLABSIs versus 36.6days and €17,788 in non-CLABSIs. Overall, a CLABSI was associated with a mean (95% CI) adjusted attributable LOS and cost of 21days (7.3-34.8) and €13,727 (5,758-21,695), respectively. No significant difference was detected in LOS and cost by hospitalization unit. CONCLUSIONS CLABSIs were found to impose a significant economic burden in Greece, a finding that highlights the importance of implementing CLABSI prevention strategies.
Collapse
Affiliation(s)
- Sofia Karagiannidou
- Center for Clinical Epidemiology and Outcomes Research (CLEO), Non-Profit Civil Partnership, Athens, Greece.
| | - Theoklis Zaoutis
- Center for Clinical Epidemiology and Outcomes Research (CLEO), Non-Profit Civil Partnership, Athens, Greece; Division of Infectious Diseases, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nikolaos Maniadakis
- Department of Health Services Management, National School of Public Health, Athens, Greece
| | - Vassiliki Papaevangelou
- Third Department of Pediatrics, National and Kapodistrian University of Athens, School of Medicine, University General Hospital ATTIKON, Athens, Greece
| | - Georgia Kourlaba
- Center for Clinical Epidemiology and Outcomes Research (CLEO), Non-Profit Civil Partnership, Athens, Greece
| |
Collapse
|
33
|
Kourlaba G, Bakakos P, Loukides S, Vellopoulou K, Solakidi A, Maniadakis N. The self-reported prevalence and disease burden of asthma in Greece. J Asthma 2018; 56:478-497. [PMID: 29718784 DOI: 10.1080/02770903.2018.1471704] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES The primary objective was to estimate the self-reported prevalence of asthma in Greece. The secondary one was to assess the impact of asthma control on patients' health related Quality-of-Life (HRQoL), productivity loss, daily activities and psychological distress. METHODS A population-based, random-digit dialing, telephone nationwide survey was conducted to recruit patients with asthma. Among the responders, 3,946 met the age criterion (≥18 years) and completed the screening questions regarding asthma. Of them, 353 subjects reported that they had been diagnosed with asthma sometime in their life and completed the survey. Data on demographic and lifestyle characteristics, asthma control, comorbidities, limitations in daily activities, psychological distress, productivity loss, as well as HRQoL, were collected through telephone interview. RESULTS The lifetime self-reported prevalence of asthma was found to be 9.10% (95% CI:8.14%-9.94%). Sixty three percent of patients had well-controlled (WC) asthma. Asthma control was associated with gender, age, and specific comorbidities. Moreover, patients with not well-controlled (NWC) asthma were more likely to have missed work and reduced productivity during the past 12 months due to their asthma (p < 0.01). Patients with NWC asthma were more likely to declare psychological distress and limitations in their daily living activities. Patients' HRQoL with NWC asthma was significantly worse (0.65 ± 0.24) compared to those with WC asthma (0.86 ± 0.17, p ≤ 0.001). CONCLUSIONS The results of this survey revealed the link between the asthma control and burden of disease demonstrating the need for the implementation of programs aiming at the management of chronic symptoms related to this condition.
Collapse
Affiliation(s)
| | - Petros Bakakos
- b 1st Respiratory Medicine Department , National and Kapodistrian University of Athens , Athens , Greece
| | - Stelios Loukides
- c 2nd Respiratory Medicine Department , National and Kapodistrian University of Athens , Chaidari , Greece
| | | | | | - Nikos Maniadakis
- d Department οf Health Services Organization and Management , National School οf Public Health , Athens , Greece
| |
Collapse
|
34
|
Tzanetakos C, Bargiota A, Kourlaba G, Gourzoulidis G, Maniadakis N. Cost Effectiveness of Exenatide Once Weekly Versus Insulin Glargine and Liraglutide for the Treatment of Type 2 Diabetes Mellitus in Greece. Clin Drug Investig 2018; 38:67-77. [PMID: 29080210 DOI: 10.1007/s40261-017-0586-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the long-term cost effectiveness of exenatide once weekly (ExQW) versus insulin glargine (IG) or liraglutide 1.2 mg (Lira1.2mg) for the treatment of adult patients with type 2 diabetes mellitus (T2DM) not adequately controlled on oral antidiabetic drug (OAD) therapy in Greece. METHODS The published and validated Cardiff Diabetes Model was used to project clinical and economic outcomes over a patient's lifetime. Clinical data were retrieved from a head-to-head clinical trial (DURATION 3) and a published network meta-analysis comparing ExQW with IG or Lira1.2mg, respectively. Following a Greek third-party payer perspective, direct medical costs related to drug acquisition, consumables, developed micro- and macrovascular complications, maintenance treatment, as well as treatment-related adverse events were considered. Cost and utility data were extracted from literature and publicly available official sources and assigned to model parameters to calculate total quality-adjusted life-years (QALYs) and total costs as well as incremental cost-effectiveness ratios (ICERs). Sensitivity analyses explored the impact of changes in input data. RESULTS Over a patient's lifetime, ExQW was associated with 0.458 or 0.039 incremental QALYs compared with IG or Lira1.2mg, respectively, at additional costs of €2061 or €110, respectively. The ICER for ExQW was €4499/QALY compared with IG and €2827/QALY compared with Lira1.2mg. Results were robust across various one-way and scenario analyses. At the defined willingness-to-pay threshold of €36,000/QALY, probabilistic sensitivity analysis showed that ExQW had a 100 or 88.2% probability of being cost effective relative to IG or Lira1.2mg, respectively. CONCLUSIONS ExQW was estimated to be cost effective relative to IG or Lira1.2mg for the treatment of T2DM in adults not adequately controlled on OAD therapy in Greece.
Collapse
Affiliation(s)
- Charalampos Tzanetakos
- Department of Health Services Organization and Management, National School of Public Health, 196 Alexandras Avenue, 11521, Athens, Greece.
| | - Alexandra Bargiota
- Department of Endocrinology and Metabolic Diseases, University of Thessaly School of Medicine, Larissa, Greece
| | - Georgia Kourlaba
- Collaborative Center for Clinical Epidemiology and Outcomes Research (CLEO), "Aghia Sophia" Children's Hospital, Athens, Greece
| | - George Gourzoulidis
- Department of Health Services Organization and Management, National School of Public Health, 196 Alexandras Avenue, 11521, Athens, Greece
| | - Nikos Maniadakis
- Department of Health Services Organization and Management, National School of Public Health, 196 Alexandras Avenue, 11521, Athens, Greece
| |
Collapse
|
35
|
Gourzoulidis G, Kourlaba G, Kakisis J, Matsagkas M, Giannakoulas G, Gourgoulianis KI, Vassilakopoulos T, Maniadakis N. Cost-Effectiveness Analysis of Rivaroxaban for Treatment of Deep Vein Thrombosis and Pulmonary Embolism in Greece. Clin Drug Investig 2018; 37:833-844. [PMID: 28608312 DOI: 10.1007/s40261-017-0540-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVE Venous thromboembolism (VTE), comprising deep-vein thrombosis (DVT) and pulmonary embolism (PE), is a major healthcare concern that results in substantial morbidity and mortality with great economic burden for healthcare systems. Hence, the need for effective and efficient treatment of patients with VTE is important for both clinical and economic reasons. The objective of this study was to evaluate the cost effectiveness of rivaroxaban compared to standard of care (SoC) with enoxaparin followed by dose-adjusted vitamin-K antagonists for the treatment of DVT and PE in Greece. METHODS An existing Markov model was locally adapted from a third-party payer perspective to reflect the management and complications of DVT and PE in the course of 3-month cycles, up to death. The clinical inputs and utility values were extracted from published studies. Direct medical costs, obtained from local resources, were incorporated in the model and refer to year 2017. Both costs and outcomes were discounted at 3.5%. The incremental cost-effectiveness ratio (ICER) per quality-adjusted life year (QALY) gained was calculated. Probabilistic sensitivity analysis (PSA) was carried out to deal with uncertainty. RESULTS The base-case analysis showed that rivaroxaban in 3- and 6-month treatment duration for DVT and PE, respectively, as this is the common clinical practice in Greece, was associated with a 0.02 and 0.01 increment in QALYs compared to SoC, respectively. Rivaroxaban was associated with a reduced total cost in DVT (€85) but with an additional total cost in PE (€2) compared to SoC. Therefore, rivaroxaban was a dominant (less costly, more effective) and cost-effective (ICER: €177) alternative over SoC for the management of DVT and PE, respectively. PSA revealed that the probability of rivaroxaban being cost effective at a threshold of €34,000 per QALY gained was 99% and 81% for DVT and PE, respectively. CONCLUSION Rivaroxaban may represent a cost-effective option relative to SoC for the management of DVT and PE in Greece.
Collapse
Affiliation(s)
- George Gourzoulidis
- Department of Health Services Organization and Management, National School of Public Health, 196 Alexandras Avenue, 11521, Athens, Greece.
| | - Georgia Kourlaba
- The Stavros Niarchos Foundation-Collaborative Center for Clinical Epidemiology and Outcomes Research (CLEO), School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - John Kakisis
- Department of Vascular Surgery, Attikon Hospital, Athens University Medical School, Athens, Greece
| | - Mitiadis Matsagkas
- Department of Surgery - Vascular Surgery Unit, School of Medicine, University of Ioannina, Ioannina, Greece
| | - George Giannakoulas
- First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloníki, Greece
| | | | - Theodoros Vassilakopoulos
- Department of Critical Care and Pulmonary Services, Evangelismos Hospital, University of Athens Medical School, Athens, Greece
| | - Nikos Maniadakis
- Department of Health Services Organization and Management, National School of Public Health, 196 Alexandras Avenue, 11521, Athens, Greece
| |
Collapse
|
36
|
Gourzoulidis G, Tzanetakos C, Ioannidis I, Tsapas A, Kourlaba G, Papageorgiou G, Maniadakis N. Cost-Effectiveness of Empagliflozin for the Treatment of Patients with Type 2 Diabetes Mellitus at Increased Cardiovascular Risk in Greece. Clin Drug Investig 2018; 38:417-426. [DOI: 10.1007/s40261-018-0620-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|
37
|
Maniadakis N, Kourlaba G, Shen J, Holtorf A. Comprehensive taxonomy and worldwide trends in pharmaceutical policies in relation to country income status. BMC Health Serv Res 2017; 17:371. [PMID: 28545440 PMCID: PMC5445358 DOI: 10.1186/s12913-017-2304-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 05/19/2016] [Accepted: 05/11/2017] [Indexed: 01/01/2023] Open
Abstract
Background Rapidly evolving socioeconomic and technological trends make it challenging to improve access, effectiveness and efficiency in the use of pharmaceuticals. This paper identifies and systematically classifies the prevailing pharmaceutical policies worldwide in relation to a country’s income status. Methods A literature search was undertaken to identify and taxonomize prevailing policies worldwide. Countries that apply those policies and those that do not were then grouped by income status. Results Pharmaceutical policies are linked to a country’s socioeconomics. Developed countries have universal coverage and control pharmaceuticals with external and internal price referencing systems, and indirect price–cost controls; they carry out health technology assessments and demand utilization controls. Price-volume and risk-sharing agreements are also evolving. Developing countries are underperforming in terms of coverage and they rely mostly on restrictive state controls to regulate prices and expenditure. Conclusions There are significant disparities worldwide in the access to pharmaceuticals, their use, and the reimbursement of costs. The challenge in high-income countries is to maintain access to care whilst dealing with trends in technology and aging. Essential drugs should be available to all; however, many low- and middle-income countries still provide most of their population with only poor access to medicines. As economies grow, there should be greater investment in pharmaceutical care, looking to the policies of high-income countries to increase efficiency. Pharmaceutical companies could also develop special access schemes with low prices to facilitate coverage in low-income countries. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2304-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- N Maniadakis
- Department of Health Services Organization, National School of Public Health, 196 Alexandras Avenue, 115 21, Athens, Greece.
| | - G Kourlaba
- EVROSTON LP, Athens, Greece.,Collaborative Center of Clinical Epidemiology and Outcomes Research (CLEO), Non-Profit Company, Athens, Greece
| | - J Shen
- Head Market Access, Abbott Products Operations, Hegenheimermattweg 127, AG, 4123, Allschwil, Switzerland
| | - A Holtorf
- Managing Director, Health Outcomes Strategies, Colmarestrasse 58, 4055, Basel, Switzerland
| |
Collapse
|
38
|
Tzanetakos C, Tzioufas A, Goules A, Kourlaba G, Theodoratou T, Christou P, Maniadakis N. Cost-utility analysis of certolizumab pegol in combination with methotrexate in patients with moderate-to-severe active rheumatoid arthritis in Greece. Rheumatol Int 2017; 37:1441-1452. [PMID: 28523420 DOI: 10.1007/s00296-017-3736-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 12/05/2016] [Accepted: 05/05/2017] [Indexed: 12/19/2022]
Abstract
We aimed to evaluate the cost-effectiveness of certolizumab pegol (CZP), a pegylated fc-free anti-TNF, as add-on therapy to methotrexate (MTX) versus etanercept, adalimumab, or golimumab in patients with moderate-to-severe active rheumatoid arthritis (RA) not responding to the conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs). A Markov model (6-month cycle length) assessed health and cost outcomes of CZP versus other anti-TNFs recommended for RA in Greece over a patient's lifetime. Following discontinuation of first-line anti-TNF, patients switched to second anti-TNF and then to a biologic with another mode of action. Sequential use of csDMARDs followed third biologic. Clinical data and utilities were extracted from published literature. Analysis was conducted from third-party payer perspective in Greece. Costs (drug acquisition, administration, monitoring, and patient management) were considered for 2014. Results presented are incremental cost-effectiveness ratios (ICERs) per quality-adjusted life year (QALY). Probabilistic sensitivity analysis (PSA) ascertained robustness of base-case findings. Base-case analysis indicated that CZP+MTX was more costly and more effective compared with Etanercept+MTX (base-case ICER: €3,177 per QALY), whilst versus adalimumab/golimumab, CZP was dominant (less costly, more effective). For all comparisons, CZP treatment resulted in greater improvements in life expectancy and QALYs. PSA indicated that at the willingness-to-pay threshold of €34,000/QALY, CZP+MTX was associated with a 71.6, 97.9, or 99.2% probability of being cost-effective versus etanercept, golimumab, or adalimumab, respectively, in combination with MTX. This analysis demonstrates CZP+MTX to be a cost-effective alternative over Etanercept+MTX and a dominant option over Adalimumab+MTX and Golimumab+MTX for management of RA in Greece.
Collapse
Affiliation(s)
- C Tzanetakos
- Department of Health Services Organization and Management, National School of Public Health, 196 Alexandras Avenue, 11521, Athens, Greece.
| | - A Tzioufas
- Laboratory and Clinic of Pathophysiology, Athens Medical School, Laiko Hospital, Athens, Greece
| | - A Goules
- Laboratory and Clinic of Pathophysiology, Athens Medical School, Laiko Hospital, Athens, Greece
| | - G Kourlaba
- Collaborative Center for Clinical Epidemiology and Outcomes Research (CLEO), Aghia Sophia Children's Hospital, Athens, Greece
| | | | | | - N Maniadakis
- Department of Health Services Organization and Management, National School of Public Health, 196 Alexandras Avenue, 11521, Athens, Greece
| |
Collapse
|
39
|
Tzanetakos C, Tentolouris N, Kourlaba G, Maniadakis N. Cost-Effectiveness of Dapagliflozin as Add-On to Metformin for the Treatment of Type 2 Diabetes Mellitus in Greece. Clin Drug Investig 2016; 36:649-59. [PMID: 27221806 DOI: 10.1007/s40261-016-0410-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Type 2 diabetes mellitus (T2DM) is a chronic progressive disease that has been spread worldwide over the past three decades and associated with increased morbidity and mortality resulting in considerable socioeconomic implications for national healthcare systems. Effective management of disease is highly needed ensuring patients receive the best possible care within the available budget. The objective of this study was to evaluate the long-term cost-effectiveness of dapagliflozin, a sodium-glucose co-transporter-2 (SGLT-2) inhibitor, compared with a sulfonylurea (SU) or a dipeptidyl-peptidase-4 inhibitor (DPP-4i), when added to metformin, in T2DM patients inadequately controlled on metformin alone in Greece. METHODS The published and validated Cardiff diabetes model, a lifetime micro-simulation model, was adapted to a Greek healthcare setting to determine the incidence of micro- and macro-vascular complications and diabetes-specific and all-cause mortality. Clinical, cost, and utility data were retrieved from literature and assigned to model parameters to calculate total quality-adjusted life-years (QALYs) and total costs as well as incremental cost-effectiveness ratios (ICERs). The analysis was conducted from the perspective of a third-party payer in Greece. Uncertainty surrounding important model parameters was explored with univariate and probabilistic sensitivity analyses (PSA). RESULTS Over a patient's lifetime, dapagliflozin was associated with 0.48 and 0.04 incremental QALYs compared with SU and DPP-4i, respectively, at additional costs of €5142 and €756, respectively. The corresponding ICERs were €10,623 and €17,695 per QALY gained versus the treatment with SU and DPP-4i, respectively. Results were robust across various univariate and scenario analyses. At the defined willingness-to-pay threshold of €34,000 per QALY gained, PSA estimated that treatment with dapagliflozin had a 100 % and 79.7 % probability of being cost-effective relative to the SU and DPP-4i treatments. CONCLUSIONS Dapagliflozin in combination with metformin was shown to be a cost-effective treatment alternative for patients with T2DM whose metformin regimen does not provide sufficient glycemic control in a Greek healthcare setting.
Collapse
Affiliation(s)
- Charalampos Tzanetakos
- Department of Health Services Organization and Management, National School of Public Health, 196 Alexandras Avenue, 11521, Athens, Greece.
| | - Nicholas Tentolouris
- First Department of Propaedeutic and Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Georgia Kourlaba
- Collaborative Center for Clinical Epidemiology and Outcomes Research (CLEO), "Aghia Sophia" Children`s Hospital, Athens, Greece
| | - Nikos Maniadakis
- Department of Health Services Organization and Management, National School of Public Health, 196 Alexandras Avenue, 11521, Athens, Greece
| |
Collapse
|
40
|
Solakidi A, Kourlaba G, Kontovinis L, Bournakis E, Boutis A, Koutsoukos K, Syrios J, Tzovaras A, Chatzikou M, Michailidi C, Maniadakis N. Economic evaluation of pazopanib as first-line treatment of metastatic renal cell carcinoma in Greece. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw377.14] [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: 11/13/2022] Open
|
41
|
Kourlaba G, Gourzoulidis G, Andrikopoulos G, Tsioufis K, Beletsi A, Maniadakis N. Economic evaluation of trimetazidine in the management of chronic stable angina in Greece. BMC Health Serv Res 2016; 16:520. [PMID: 27678370 PMCID: PMC5039874 DOI: 10.1186/s12913-016-1779-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 10/27/2015] [Accepted: 09/22/2016] [Indexed: 11/12/2022] Open
Abstract
Background To evaluate the cost-effectiveness of trimetazidine (TMZ) as add-on therapy to standard-of-care (SoC) compared to SoC alone in patients with chronic stable angina who did not respond adequately to first line therapy with b-blockers, nitrates or calcium channel antagonists in Greece. Methods A Markov model with 3-month cycles and 1-year time horizon was developed to assess the comparators. The analysis was conducted from a third-party payer perspective. The clinical inputs and utility values were extracted from the published literature. Resource consumption data were obtained from local experts, using a questionnaire developed for the purpose of the study and were combined with unit cost data (in €2016) obtained from official sources. Cost effectiveness was assessed by calculating the incremental cost effectiveness ratio (ICER). Probabilistic sensitivity analysis (PSA) was performed to account for uncertainty and variation in the input parameters of the model. Results The analysis showed that the cost of TMZ plus SoC was €1755.57 versus €1751.76 of SoC alone. In terms of health outcomes, TMZ plus SoC was associated with 0.6650 QALYs versus 0.6562 QALYs for SoC alone. The incremental analysis resulted in an ICER of €430.67 per QALY gained. PSA revealed that the probability of TMZ plus SoC being cost-effective over SoC was 89 %, at a threshold of €34,000 per QALY gained. Conclusion The results indicate that TMZ as add –on treatment may be a highly cost-effective option for the symptomatic treatment of patients with chronic stable angina in Greece relative to SoC alone. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1779-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Georgia Kourlaba
- The Stavros Niarchos Foundation-Collaborative Center for Clinical Epidemiology and Outcomes Research (CLEO), National and Kapodistrian University of Athens, School of Medicine, Thivon & Papadiamantopoulou, Athens, 115 27, Greece.
| | - George Gourzoulidis
- Department of Health Services Organization & Management, National School of Public Health, Athens, Greece
| | | | - Konstantinos Tsioufis
- Hippokration General Hospital, First Cardiology Clinic, University of Athens, Athens, Greece
| | | | - Nikos Maniadakis
- Department of Health Services Organization & Management, National School of Public Health, Athens, Greece
| |
Collapse
|
42
|
Abstract
Background The objective of the study was to estimate the self-reported prevalence of chronic obstructive pulmonary disease (COPD) in Greece and to quantify its burden on patients’ daily activities, productivity, and psychological status. Methods A population-based, random digit-dialed telephone nationwide survey was conducted between July 10, 2015 and July 31, 2015 in order to recruit patients with COPD in Greece. Among the 11,471 persons contacted, 3,414 met the inclusion criterion of age ≥40 years and completed the screening questions regarding COPD. Of the 362 subjects who reported that they had been diagnosed with COPD, 351 completed the survey. Data on demographic and lifestyle characteristics, comorbidities, disease history, perceived disease severity, breathlessness severity, symptoms severity, limitations in daily activities, psychological distress, and productivity were collected. All data were collected through the telephone interview method using a structured questionnaire. Results The overall self-reported COPD prevalence was 10.6%. Among 351 participants, only 9% reported that they suffered from severe breathlessness. The mean COPD assessment test score was 19.0, with 84% of participants having a COPD assessment test score ≥10. As for the perceived severity of COPD, the majority of subjects considered that their respiratory condition was of moderate (34.2%) or mild severity (33.9%). Overall, the participants reported a significant impact of COPD on their daily life. For instance, 61.5% of them reported that their respiratory condition has affected their sports activities. Moreover, 73% of subjects considered that the health care system could do more for them than it actually does. Almost one-fourth of the participants reported that they had missed work during the past 12 months due to their respiratory symptoms, with the mean number of days lost being 10. Conclusion This survey provides insightful data regarding the impact of COPD on Greek patients’ everyday life, psychology, and productivity, revealing the increased individual morbidity and the significant burden of this condition on society.
Collapse
Affiliation(s)
| | - Georgios Hillas
- Department of Critical Care of Evangelismos Hospital, Medical School of National & Kapodistrian University of Athens
| | - Theodoros Vassilakopoulos
- Department of Critical Care of Evangelismos Hospital, Medical School of National & Kapodistrian University of Athens
| | - Nikos Maniadakis
- Department of Health Services Organization and Management, National School of Public Health, Athens, Greece
| |
Collapse
|
43
|
Dimopoulou A, Kourlaba G, Psarris A, Coffin S, Spoulou V, Zaoutis T. Perioperative antimicrobial prophylaxis in pediatric patients in Greece: Compliance with guidelines and impact of an educational intervention. J Pediatr Surg 2016; 51:1307-11. [PMID: 26711690 DOI: 10.1016/j.jpedsurg.2015.11.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 11/03/2015] [Accepted: 11/22/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND/PURPOSE Appropriate antimicrobial prophylaxis (PAP) prevents surgical site infections (SSI). The aim of this study was to evaluate the effectiveness of an educational intervention to improve adherence to PAP guidelines in pediatric patients. METHODS A three-phase prospective study with a pre-post design was conducted from April 2013 to December 2014. All patients who underwent one or more surgical procedures were enrolled. A modified Centers for Disease Control's (CDC) Denominator for Procedure form was used to collect clinical and PAP data. The educational intervention was targeted at all pediatric surgeons in the department. Outcomes assessed were the appropriateness of the agent selected for PAP (according to international guidelines) and appropriate termination of PAP within 24h of surgery completion. SSI rates were calculated before and after the intervention. RESULTS During the study period 889 children were enrolled (219 in the preintervention and 670 in the postintervention period). The percentage of patients receiving appropriate PAP improved from 6.2% to 77.1% after the educational intervention (p<0.001). The median duration of PAP was reduced from 5 to 1days in preintervention and postintervention period, respectively. There was no increase in the rate of SSIs (0.93% and 0.92%, p=0.992, in preinterventionand postintervention, respectively). CONCLUSIONS An educational intervention targeted at pediatric surgeons improved the selection of agent and timely discontinuation of PAP.
Collapse
Affiliation(s)
- Anastasia Dimopoulou
- Department of Pediatric Surgery, "Aghia Sophia" Children's Hospital, Athens, Greece.
| | - Georgia Kourlaba
- The Stavros Niarchos Foundation-Collaborative Center for Clinical Epidemiology and Outcomes Research (CLEO), University of Athens School of Medicine, Athens, Greece
| | - Alexandros Psarris
- Department of Pediatric Surgery, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Susan Coffin
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA; University of Pennsylvania, Philadelphia, PA, USA
| | - Vasiliki Spoulou
- National Kapodistrian University, Athens, Greece; First Department of Pediatrics, Aghia Sophia" Children's Hospital, Athens, Greece
| | - Theoklis Zaoutis
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| |
Collapse
|
44
|
Kourlaba G, Gkrania-Klotsas E, Kourkouni E, Mavrogeorgos G, Zaoutis TE. Antibiotic prescribing and expenditures in outpatient adults in Greece, 2010 to 2013: evidence from real-world practice. Euro Surveill 2016; 21:30266. [DOI: 10.2807/1560-7917.es.2016.21.26.30266] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 03/30/2016] [Indexed: 11/20/2022] Open
Abstract
We provide a representative analysis of antibiotic prescribing, identify factors associated with broad-spectrum antibiotic prescribing and assess the costs associated with antibiotic use in adult outpatients in Greece. Outpatient antibiotic prescriptions for patients older than 19 years between 2010 and 2013 in Greece were extracted from the IMS Health Xponent database. Prescribing rate and total cost for prescribed antibiotics were calculated. Multivariate logistic regression was used to identify factors related to broad-spectrum antibiotic prescribing. More than 20 million antibiotics were prescribed during the study period, an annual rate of 768 prescribed antibiotics per 1,000 adults. Overall, 33.5% of antibiotics were prescribed for acute respiratory tract infections (ARTIs) for which antibiotics are often not indicated. Macrolides (29.9%), cephalosporins (26.9%) and fluoroquinolones (21.0%) were the most commonly prescribed antibiotic classes. The majority (89.0%) of antibiotics were broad-spectrum. Antibiotic expenditures were approximately EUR 185 million during the study period. Factors associated with broad-spectrum prescribing included older patient age, specialty pulmonologists or otorhinolaryngologists, training in eastern Europe, diagnosis of ARTI, acute diagnosis, and first episode of disease. Broad-spectrum antibiotic prescribing for ARTIs is common in adult Greek outpatients and frequently inappropriate. These data indicate the need for initiatives aiming to control antibiotic prescribing.
Collapse
Affiliation(s)
- Georgia Kourlaba
- Collaborative Center for Clinical Epidemiology and Outcomes Research (CLEO), Athens, Greece
| | - Effrossyni Gkrania-Klotsas
- Medical Research Council Epidemiology Unit, Department of Infectious Diseases and the Clinical School, University of Cambridge, Cambridge, United Kingdom
| | - Eleni Kourkouni
- Collaborative Center for Clinical Epidemiology and Outcomes Research (CLEO), Athens, Greece
| | - Georgios Mavrogeorgos
- Collaborative Center for Clinical Epidemiology and Outcomes Research (CLEO), Athens, Greece
| | - Theoklis E Zaoutis
- Division of Infectious Diseases, Children's Hospital of Philadelphia, UPENN School of Medicine, Philadelphia, United States
- Collaborative Center for Clinical Epidemiology and Outcomes Research (CLEO), Athens, Greece
| |
Collapse
|
45
|
Kourlaba G, Gialama F, Tsioufis K, Maniadakis N. A literature review to evaluate the clinical and economic value of olmesartan for the treatment of hypertensive patients. Int J Cardiol 2016; 221:60-74. [PMID: 27404671 DOI: 10.1016/j.ijcard.2016.06.115] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 05/19/2016] [Accepted: 06/21/2016] [Indexed: 12/15/2022]
Abstract
The objective of the present study was to systematically review the clinical and economic outcomes of olmesartan as monotherapy or in combination with other antihypertensive agents in the treatment of hypertension. A literature search was performed using PubMed and the Cochrane library until December 2015, with no limit on publication date. Eligible studies were selected using predetermined inclusion and exclusion criteria, limiting articles to those published in the English language. Background information of the study, participants' characteristics and study outcomes were collected. Meta-analysis of data was not performed. Fifty-five studies were included, of which fifty investigated the clinical efficacy of olmesartan and five the cost-effectiveness of olmesartan. In general results from clinical trials evaluating the efficacy of olmesartan as monotherapy and as combination therapy demonstrated that olmesartan provided better antihypertensive blood pressure-lowering efficacy and was generally well tolerated compared with other antihypertensive agents. Results from economic evaluations indicated that olmesartan may be more cost-effective than other ARBs such as losartan, valsartan, irbesartan and candesartan, having the potential of decreasing the overall medical costs of care for patients with hypertension. Evidence from the present systematic review confirms the antihypertensive efficacy and good safety profile of olmesartan both as monotherapy and as combination therapy. Olmesartan was also found to be cost-effective compared with other ARBs, though this area has yet relatively poor evidence and needs to further be explored.
Collapse
Affiliation(s)
- G Kourlaba
- EVROSTON LP, Chatzigianni Mexi 5, 115 28 Athens, Greece; Collaborative Center of Clinical Epidemiology and Outcomes Research (CLEO), Non-Profit Company, Chatzigianni Mexi 5, 115 28 Athens, Greece.
| | - F Gialama
- EVROSTON LP, Chatzigianni Mexi 5, 115 28 Athens, Greece
| | - K Tsioufis
- 1st Depertment of Cardiology, University of Athens, Hippocration Hospital, Vassilisis Sophias 114, 115 27, Greece
| | - N Maniadakis
- Department of Health Services Organization, National School of Public Health, 196 Alexandras Avenue, 115 21 Athens, Greece
| |
Collapse
|
46
|
Dimopoulou A, Papanikolaou Z, Kourlaba G, Kopsidas I, Coffin S, Zaoutis T. Surgical Site Infections and Compliance with Perioperative Antimicrobial Prophylaxis in Greek Children. Infect Control Hosp Epidemiol 2016; 35:1425-7. [DOI: 10.1086/678411] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
|
47
|
Vellopoulou K, Kourlaba G, Maniadakis N, Vardas P. A literature review to evaluate the economic value of ranolazine for the symptomatic treatment of chronic angina pectoris. Int J Cardiol 2016; 211:105-11. [DOI: 10.1016/j.ijcard.2016.02.140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 02/28/2016] [Indexed: 12/19/2022]
|
48
|
Kourlaba G, Relakis J, Mahon R, Kalogeropoulou M, Pantelopoulou G, Kousidou O, Maniadakis N. Cost-utility of ranibizumab versus aflibercept for treating Greek patients with visual impairment due to diabetic macular edema. Cost Eff Resour Alloc 2016; 14:7. [PMID: 27081372 PMCID: PMC4831170 DOI: 10.1186/s12962-016-0056-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 07/22/2015] [Accepted: 04/05/2016] [Indexed: 11/17/2022] Open
Abstract
Background To conduct a cost-utility analysis of ranibizumab versus aflibercept for the treatment of patients with visual impairment due to diabetic macular edema (DME) in the Greek setting. Methods A Markov model was adapted to compare the use of ranibizumab 0.5 mg (pro re nata-PRN and treat and extend-T&E) to aflibercept 2 mg (every 8 weeks after five initial doses) in DME. Patients transitioned at a 3-month cycle among nine specified health states (including death) over a lifetime horizon. Transition probabilities, utilities, as well as DME-related mortality were extracted from relevant clinical trials, a network meta-analysis and other published studies. The analysis was conducted from payer perspective and as such only costs reimbursed by the payer were considered (year 2014). The incremental cost per quality-adjusted life year (QALY) gained and the net monetary benefit was the main outcome measures. Results Τhe use of PRN and T&E ranibizumab regimens were shown to be cost saving comparing to aflibercept (by €2824 and €22, respectively), and more beneficial in terms of QALYs gained (+0.05) and time without visual impairment (0.031 and 0.034 years), thereby dominating aflibercept. Moreover, ranibizumab used as PRN or T&E resulted in a net monetary benefit of €3984 and €1278, respectively. Conclusions Both PRN and T&E ranibizumab regimens were more beneficial and less costly compared to aflibercept for the management of DME. Hence, ranibizumab seems to be a dominant option for the treatment of visual impairment due to DME in the Greek setting. Electronic supplementary material The online version of this article (doi:10.1186/s12962-016-0056-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
| | - John Relakis
- Department of Health Services Organization, National School of Public Health, Athens, Greece
| | | | | | | | | | - Nikos Maniadakis
- Department of Health Services Organization, National School of Public Health, Athens, Greece
| |
Collapse
|
49
|
Fanourgiakis J, Simantirakis E, Maniadakis N, Kanoupakis E, Chrysostomakis S, Kourlaba G, Chlouverakis G, Vardas P. Complications Related to Cardiac Rhythm Management Device Therapy and Their Financial Implication: A Prospective Single-Center TwoYear Survey. Hellenic J Cardiol 2016; 57:33-8. [PMID: 26856199 DOI: 10.1016/s1109-9666(16)30016-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Cardiac rhythm management devices (CRMDs) have proven their clinical effectiveness for patients with heart rhythm disorders. Little is known about safety and complication rates during the implantation of these devices. This study demonstrated the complication rates related to CRMD implantation, and estimated the additional hospital stay and cost associated with the management of complications. METHODS During a period of one year, a total of 464 consecutive recipients underwent CRMD implantation and were followed for 2 years. Finally, data were analyzed for 398 patients who completed the two-year follow up, resulting in a total of 796 patient-years. RESULTS Of the 201 patients with initial pacemaker (PM) implantations, 6 (2.99%) had seven complications (5 patients had lead dislodgement, 1 of them twice), and 1 patient developed pocket infection. Of the 117 PM replacements, 1 (0.85%) patient developed a complication (pocket erosion). Two patients with complications (1 with an initial PM and 1 with a replacement) died before completing the follow up for reasons unrelated to cardiac causes. There were no complications in either initial implantations (69 patients) or replacements (11 patients) of implantable cardioverter-defibrillators. The average prolongation of the hospital stay was 7 days, ranging from 1 to 35 days, resulting in 17,411 of total additional direct hospital costs. CONCLUSION This study found relatively low rates of complications in patients undergoing CRMD implantation, initial or replacement, in our center, compared with other studies. The additional hospitalization days and costs attributable to these complications depend on the nature of the complication.
Collapse
Affiliation(s)
- John Fanourgiakis
- Department of Cardiology, Heraklion University Hospital, Crete, Greece
| | | | | | | | | | | | | | | |
Collapse
|
50
|
Spyridis N, Syridou G, Goossens H, Versporten A, Kopsidas J, Kourlaba G, Bielicki J, Drapier N, Zaoutis T, Tsolia M, Sharland M. Variation in paediatric hospital antibiotic guidelines in Europe. Arch Dis Child 2016; 101:72-6. [PMID: 26416900 DOI: 10.1136/archdischild-2015-308255] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 09/08/2015] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess the availability and source of guidelines for common infections in European paediatric hospitals and determine their content and characteristics. DESIGN Participating hospitals completed an online questionnaire on the availability and characteristics of antibiotic prescribing guidelines and on empirical antibiotic treatment including duration of therapy for 5 common infection syndromes: respiratory tract, urinary tract, skin and soft tissue, osteoarticular and sepsis in neonates and children. RESULTS 84 hospitals from 19 European countries participated in the survey of which 74 confirmed the existence of guidelines. Complete guidelines (existing guidelines for all requested infection syndromes) were reported by 20% of hospitals and the majority (71%) used a range of different sources. Guidelines most commonly available were those for urinary tract infection (UTI) (74%), neonatal sepsis (71%) and sepsis in children (65%). Penicillin and amoxicillin were the antibiotics most commonly recommended for respiratory tract infections (RTIs) (up to 76%), cephalosporin for UTI (up to 50%) and for skin and soft tissue infection (SSTI) and bone infection (20% and 30%, respectively). Antistaphylococcal penicillins were recommended for SSTIs and bone infections in 43% and 36%, respectively. Recommendations for neonatal sepsis included 20 different antibiotic combinations. Duration of therapy guidelines was mostly available for RTI and UTI (82%). A third of hospitals with guidelines for sepsis provided recommendations for length of therapy. CONCLUSIONS Comprehensive antibiotic guideline recommendations are generally lacking from European paediatric hospitals. We documented multiple antibiotics and combinations for most infections. Considerable improvement in the quality of guidelines and their evidence base is required, linking empirical therapy to resistance rates.
Collapse
Affiliation(s)
- N Spyridis
- Department of Paediatric Infectious Diseases, Aglaia Kyriakou Children's Hospital, University of Athens, Athens, Greece
| | - G Syridou
- Department of Paediatric Infectious Diseases, Aglaia Kyriakou Children's Hospital, University of Athens, Athens, Greece
| | - H Goossens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - A Versporten
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - J Kopsidas
- Stavros Niarchos Foundation-Collaborative Center for Clinical Epidemiology and Outcomes Research and Division of Infectious Diseases (CLEO), University of Athens School of Medicine, Athens, Greece
| | - G Kourlaba
- Stavros Niarchos Foundation-Collaborative Center for Clinical Epidemiology and Outcomes Research and Division of Infectious Diseases (CLEO), University of Athens School of Medicine, Athens, Greece
| | - J Bielicki
- Paediatric Infectious Diseases Research Group, St George's University of London, London, UK
| | - N Drapier
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - T Zaoutis
- Stavros Niarchos Foundation-Collaborative Center for Clinical Epidemiology and Outcomes Research and Division of Infectious Diseases (CLEO), University of Athens School of Medicine, Athens, Greece The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - M Tsolia
- Department of Paediatric Infectious Diseases, Aglaia Kyriakou Children's Hospital, University of Athens, Athens, Greece
| | - M Sharland
- Paediatric Infectious Diseases Research Group, St George's University of London, London, UK
| | | |
Collapse
|