The Economic Burden of Chronic Obstructive Pulmonary Disease in Greece.

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.

Cost-Effectiveness Analysis of Rivaroxaban for Treatment of Deep Vein Thrombosis and Pulmonary Embolism in Greece.

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.

The direct and indirect costs of managing chronic obstructive pulmonary disease in Greece.

OBJECTIVE: COPD is associated with significant economic burden. The objective of this study was to explore the direct and indirect costs associated with COPD and identify the key cost drivers of disease management in Greece. METHODS: A Delphi panel of Greek pulmonologists was conducted, which aimed at eliciting local COPD treatment patterns and resource use. Resource use was translated into costs using official health insurance tariffs and Diagnosis-Related Groups (DRGs). In addition, absenteeism and caregiver's costs were recorded in order to quantify indirect COPD costs. RESULTS: The total costs of managing COPD per patient per year were estimated at €4,730, with direct (medical and nonmedical) and indirect costs accounting for 62.5% and 37.5%, respectively. COPD exacerbations were responsible for 32% of total costs (€1,512). Key exacerbation-related cost drivers were hospitalization (€830) and intensive care unit (ICU) admission costs (€454), jointly accounting for 85% of total exacerbation costs. Annual maintenance phase costs were estimated at €835, with pharmaceutical treatment accounting for 77% (€639.9). Patient time costs were estimated at €146 per year. The average number of sick days per year was estimated at 16.9, resulting in productivity losses of €968. Caregiver's costs were estimated at €806 per year. CONCLUSION: The management of COPD in Greece is associated with intensive resource use and significant economic burden. Exacerbations and productivity losses are the key cost drivers. Cost containment policies should focus on prioritizing treatments that increase patient compliance as these can lead to reduction of exacerbations, longer maintenance phases, and thus lower costs.

Direct and Indirect Costs of Asthma Management in Greece: An Expert Panel Approach.

OBJECTIVE: Asthma is a major cause of morbidity and mortality and is associated with significant economic burden worldwide. The objectives of this study were to map current resource use associated with the disease management and to estimate the annual direct and indirect costs per adult patient with asthma. METHODS: A Delphi panel with seven leading pulmonologists was conducted. A semistructured questionnaire was developed to elicit data on resource use and treatment patterns. Unit costs from official, published sources were subsequently assigned to resource use to estimate direct medical costs. Indirect costs were estimated as number of work loss days. Cost base year was 2015, and the perspective adopted was that of the National Organization of Health Care Services Provision, as well as the societal. RESULTS: Patients with asthma are mainly managed by pulmonologists (71.4%) and secondarily by general practitioners and internists (28.6%). The annual cost of managing exacerbations was estimated at €273.1, while maintenance costs were estimated at €1,100.2 per year. Total costs of managing asthma per patient per year were estimated at €2,281.8, 64.4% of which represented direct medical costs. Of the direct costs, pharmaceutical treatment was the key driver, accounting for 63.9 and 41.2% of direct and total costs, respectively. Direct non-medical costs (patient travel and waiting time) were estimated at €152.3. Indirect costs accounted for 28.9% of total costs. CONCLUSION: Asthma is a chronic condition, the management of which constrains the already limited Greek health care resources. The increasing prevalence of the disease raises concerns as it could translate per patient costs into a significant burden for the Greek health care system. Thus, the prevention, self-management, and improved quality of care for asthma should find a place in the health policy agenda in Greece.