Cost-effectiveness of Ingenol Mebutate Gel for the Treatment of Actinic Keratosis in Greece.

PURPOSE: The present study aimed to perform a cost-effectiveness analysis of ingenol mebutate (IM) versus other topical alternatives for the treatment of actinic keratosis (AK). METHODS: The analysis used a decision tree to calculate the clinical effects and costs of AK first-line treatments, IM (2-3 days), diclofenac 3% (for 8 or 12 weeks), imiquimod 5% (for 4 or 8 weeks), during a 24-month horizon, using discrete intervals of 6 months. A hypothetical cohort of immunocompetent adult patients with clinically confirmed AK on the face and scalp or trunk and extremities was considered. Clinical data on the relative efficacy were obtained from a network meta-analysis. Inputs concerning resource use derived from an expert panel. All costs were calculated from a Greek third-party payer perspective. FINDINGS: IM 0.015% and 0.05% were both cost-effective compared with diclofenac and below a willingness-to-pay threshold of €30,000 per quality-adjusted life-year (QALY) (€199 and €167 per QALY, respectively). Comparing IM on the face and scalp AK lesions for 3 days versus imiquimod for 4 weeks resulted in an incremental cost-effectiveness ratio of €10,868 per QALY. IM was dominant during the 8-week imiquimod period. IM use on the trunk and extremities compared with diclofenac (8 or 12 weeks) led to incremental cost-effectiveness ratios estimated at €1584 and €1316 per QALY accordingly. Results remained robust to deterministic and probabilistic sensitivity analyses. IMPLICATIONS: From a social insurance perspective in Greece, IM 0.015% and IM 0.05% could be the most cost-effective first-line topical field treatment options in all cases for AK treatment.

General Practitioners' intention to prescribe and prescribing patterns in selected European settings: The OTCSOCIOMED project.

The aim of this paper is to explore general practitioners' (GPs) prescribing intentions and patterns across different European regions using the Theory of Planned Behavior (TPB). A cross-sectional study was undertaken in selected geographically defined Primary Health Care areas in Cyprus, Czech Republic (CZ), France, Greece, Malta, Sweden and Turkey. Face-to-face interviews were conducted using a TPB-based questionnaire. The number of GP participants ranged from 39 to 145 per country. Possible associations between TPB direct measures (attitudes, subjective norms (SN) and perceived behavioral control (PBC)) and intention to prescribe were assessed by country. On average, GPs thought positively of, and claimed to be in control of, prescribing. Correlations between TPB explanatory measures and prescribing intention were weak, with TPB direct measures explaining about 25% of the variance in intention to prescribe in Malta and CZ but only between 3% and 5% in Greece, Sweden and Turkey. SN appeared influential in GPs from Malta; attitude and PBC were statistically significant in GPs from CZ. GPs' prescribing intentions and patterns differed across participating countries, indicating that country-specific interventions are likely to be appropriate. Irrational prescribing behaviors were more apparent in the countries where an integrated primary care system has still not been fully developed and policies promoting the rational use of medicines are lacking. Demand-side measures aimed at modifying GPs prescribing behavior are deemed necessary.

Irrational prescribing of over-the-counter (OTC) medicines in general practice: testing the feasibility of an educational intervention among physicians in five European countries.

BACKGROUND: Irrational prescribing of over-the-counter (OTC) medicines in general practice is common in Southern Europe. Recent findings from a research project funded by the European Commission (FP7), the "OTC SOCIOMED", conducted in seven European countries, indicate that physicians in countries in the Mediterranean Europe region prescribe medicines to a higher degree in comparison to physicians in other participating European countries. In light of these findings, a feasibility study has been designed to explore the acceptance of a pilot educational intervention targeting physicians in general practice in various settings in the Mediterranean Europe region. METHODS: This feasibility study utilized an educational intervention was designed using the Theory of Planned Behaviour (TPB). It took place in geographically-defined primary care areas in Cyprus, France, Greece, Malta, and Turkey. General Practitioners (GPs) were recruited in each country and randomly assigned into two study groups in each of the participating countries. The intervention included a one-day intensive training programme, a poster presentation, and regular visits of trained professionals to the workplaces of participants. Reminder messages and email messages were, also, sent to participants over a 4-week period. A pre- and post-test evaluation study design with quantitative and qualitative data was employed. The primary outcome of this feasibility pilot intervention was to reduce GPs' intention to provide medicines following the educational intervention, and its secondary outcomes included a reduction of prescribed medicines following the intervention, as well as an assessment of its practicality and acceptance by the participating GPs. RESULTS: Median intention scores in the intervention groups were reduced, following the educational intervention, in comparison to the control group. Descriptive analysis of related questions indicated a high overall acceptance and perceived practicality of the intervention programme by GPs, with median scores above 5 on a 7-point Likert scale. CONCLUSIONS: Evidence from this intervention will estimate the parameters required to design a larger study aimed at assessing the effectiveness of such educational interventions. In addition, it could also help inform health policy makers and decision makers regarding the management of behavioural changes in the prescribing patterns of physicians in Mediterranean Europe, particularly in Southern European countries.

Impact of economic crisis and other demographic and socio-economic factors on self-rated health in Greece.

BACKGROUND: Financial crisis and worsened socio-economic conditions are associated with greater morbidity, less utilization of health services and deteriorated population's health status. The aim of the present study was to investigate the determinants of self-rated health in Greece. METHODS: Two national cross-sectional surveys conducted in 2006 and 2011 were combined, and their data were pooled giving information for 10 572 individuals. The sample in both studies was random and stratified by gender, age, degree of urbanization and geographic region. Logistic regression analysis was used to determine the impact of several factors on self-rated health. RESULTS: Poor self-rated health was most common in older people, unemployed, pensioners, housewives and those suffering from chronic disease. Men, individuals with higher education and those with higher income have higher probability to report better self-rated health. Furthermore, the probability of reporting poor self-rated health is higher at times of economic crisis. CONCLUSION: Our findings confirm the association of self-rated health with economic crisis and certain demographic and socio-economic factors. Given that the economic recession in Greece deepens, immediate and effective actions targeting health inequalities and improvements in health status are deemed necessary.

Cost-effectiveness analysis of ranibizumab versus verteporfin photodynamic therapy, pegaptanib sodium, and best supportive care for the treatment of age-related macular degeneration in Greece.

BACKGROUND: Age-related macular degeneration (AMD) is a progressive disease that results in loss of central vision, significant functional impairment, and a subsequent heavy socioeconomic burden. AMD treatments delay disease progression, improve patient outcomes, and reduce resource use associated with visual impairment, however, in a varying way concerning costs and effects. OBJECTIVE: The purpose of this study was to investigate the cost effectiveness of ranibizumab compared with verteporfin photodynamic therapy, pegaptanib sodium, and best supportive care for the treatment of AMD in Greece. METHODS: A 6-state Markov model was constructed according to patient visual acuity in the better-seeing eye. Data on effectiveness were derived from randomized controlled trials evaluating the outcomes of ranibizumab versus alternative AMD treatments. Resource utilization reflected the Greek health care setting and was defined by a panel of experts. All treatments were administered for a 2-year period and evaluated during a 10-year time frame from a third-party payer perspective and discounted at 3.5% per annum. RESULTS: Estimated mean 10-year direct costs of treatment in the ranibizumab arm ranged from €23,733 to €31,795 (2011 Euros), with a projected gain of 4.50 to 4.74 quality-adjusted life years (QALYs) or 2.97 to 4.47 vision years, depending on type of lesion. For predominantly classic lesions, the cost per QALY gained with ranibizumab was estimated at €6444/QALY (95% uncertainty interval [UI], €-30,403/QALY to €44,524/QALY), €15,344 (95% UI, €-11,433 to €53,554) and dominant relative to photodynamic therapy, best supportive care, and pegaptanib, respectively. Corresponding ratios for patients with minimally classic lesions were €24,580/QALY (95% UI, €-5580/QALY to €76,229/QALY) and €13,112/QALY (95% UI, €-3839/QALY to €37,527/QALY) for ranibizumab relative to best supportive care and pegaptanib, and for patients with occult lesions were estimated at €19,407/QALY (95% UI, €-1486 to €46,434) and €28,561/QALY (95% UI, €6143 to 73,431), respectively. Sensitivity analysis provided robust results in all cases. CONCLUSION: Ranibizumab can be a cost-effective option for the treatment of AMD compared with selected alternatives in the Greek health care setting.

Pharmacoeconomic considerations in the treatment of breast cancer.

Breast cancer is the most common malignancy in women worldwide and causes great economic burden. The aim of this paper is to present the available clinical and pharmacoeconomic evidence associated with different therapies for breast cancer. As significant progress was made in recent years and there are many alternative treatments, which are indicated according to the stage and the type of the disease, the age and health status of patient, and vary from surgery to hormonal treatment and chemotherapy. A broad literature review was undertaken and the paper presents the evidence available regarding the effectiveness and cost-effectiveness of the alternative options. Despite the high cost of most therapies and perceptions that treatments in this area may not be cost-effective, due to a combination of high costs and short survival, based on the literature review treatment options for breast cancer are in general deemed to be cost-effective. Time horizon, stage of the disease, patient age, therapy onset, benefit duration and time to recurrence may influence the results. Pharmacoeconomic analyses of alternative therapy options will improve decision-making and will help to optimize the use of scarce health care resources allocated to the care of breast cancer patients.

Factors influencing prescribing behaviour of physicians in Greece and Cyprus: results from a questionnaire based survey.

BACKGROUND: Over the past few decades, drug and overall healthcare expenditure have risen rapidly in most countries. The present study investigates the attitudes and the factors which influence physician prescribing decisions and practice in Greece and Cyprus. METHODS: A postal questionnaire was developed by researchers at the Department of Health Economics at the National School of Public Health in Greece, specifically for the purposes of the study. This was then administered to a sample of 1,463 physicians in Greece and 240 physicians in Cyprus, stratified by sex, specialty and geographic region. RESULTS: The response rate was 82.3% in Greece and 80.4% in Cyprus. There were similarities but also many differences between the countries. Clinical effectiveness is the most important factor considered in drug prescription choice in both countries. Greek physicians were significantly more likely to take additional criteria under consideration, such as the drug form and recommended daily dose and the individual patient preferences. The list of main sources of information for physicians includes: peer-reviewed medical journals, medical textbooks, proceedings of conferences and pharmaceutical sales representatives. Only half of prescribers considered the cost carried by their patients. The majority of doctors in both countries agreed that the effectiveness, safety and efficacy of generic drugs may not be excellent but it is acceptable. However, only Cypriot physicians actually prescribe them. Physicians believe that new drugs are not always better and their higher prices are not necessarily justified. Finally, doctors get information regarding adverse drug reactions primarily from the National Organisation for Medicines. However, it is notable that the majority of them do not inform the authorities on such reactions. CONCLUSION: The present study highlights the attitudes and the factors influencing physician behaviour in the two countries and may be used for developing policies to improve their choices and hence to increase clinical and economic effectiveness and efficiency.