Individuals' personal characteristics associated with private health insurance policy possession in Greece.

BACKGROUND: Possession of private health insurance has been associated with personal and socioeconomic characteristics, such as income and age. The objective of the present study is to assess the individuals' personal characteristics associated with private health insurance possession in Greece. METHODS: The data used in the present analysis derived from the 'Health and Welfare' survey conducted by the Hellenic National School of Public Health in Greece and refer to year 2017. The sample of the analysis consisted of 1,932 adults aged 18 years or older. Α binary logistic regression model was conducted, in order to investigate the factors associated with private health insurance possession. RESULTS: The factors that were found to be associated with private health insurance possession were: area of residence; Attica, family income level; 1,501€-2,000€, 2,001€+, absence of chronic condition, occupation; employer/self-employed, absence of public insurance, time since last health check-up; less than or equal to 5 and more than 1 years ago, more than 5 years or never and level of education; secondary, tertiary. CONCLUSIONS: Private health insurance covers a low percent of the Greek population and has a low contribution to private health spending, compared with other countries. The personal characteristics that were found to be associated with private health insurance possession in Greece by the present study are in line with previous studies in other countries. These results are expected to provide policy advice on how to enhance coverage in order to reduce out-of-pocket expenditure, which is considered high in Greece.

Community acquired pneumonia: a cost-of-illness analysis in Greece.

INTRODUCTION: Community acquired pneumonia (CAP) is an acute respiratory infection with high clinical and economic burden, especially when hospitalisation is required. The present study aimed to assess the mean direct cost per CAP outpatient and inpatient care in Greece, in the absence of previous estimates. METHODS: A retrospective analysis of patients at a tertiary hospital, treated between October 2015 and March 2016, was conducted. Resource use data for inpatients and outpatients were collected (diagnostic tests, medication, physician visits and length of hospitalisation, where applicable). Cost calculations followed a third party payer perspective. Additionally, two regression models were employed to identify the determinants of hospitalisation and the main drivers of inpatient and outpatient cost. RESULTS: Overall, 149 inpatients and 100 outpatients were included in the analysis. Mean hospitalisation duration was 11.35 days (standard deviation (SD)=9.71 days). Mean direct cost per patient was €110.64 (SD=€58.23) and €7406.56 (SD=€12,124.93) for outpatient and inpatient cases respectively. (At the time period for the study, €1.00 was approximately A$1.50.) The main inpatient cost driver was hospitalisation (94.97%), followed by medication (3.30%) and diagnostic tests (0.87%). For outpatients, key cost drivers, in order of magnitude, were prescribed medication (38.84%), diagnostic tests (33.51%) and physician visits (17.54%). The regression analyses showed that the probability of hospitalisation increases with age and number of symptoms, whereas average cost is mainly influenced by gender, duration and number of symptoms, and the presence of comorbidities. CONCLUSION: The results indicate that, in Greece, CAP is accompanied by a significant economic burden, mainly attributable to hospitalisation. Interventions toward reducing the influence of contributors to the incidence and probability of hospitalisation are essential from a clinical and policy perspective. Also, the association of symptoms - in terms of number and duration - and age with hospitalisation probability and costs highlights that special attention should be given to the high risk groups of the population, such as the elderly and the rural residents, both in terms of preventive and therapeutic services.

A cohort of children with type 1 diabetes in Greece: predictors of direct costs of care.

AIM: To examine the predictors of direct costs of pediatric type 1 diabetes (T1D) in a hospital-based outpatient clinic in Greece. METHODS: The outpatient records of 89 children and adolescents (mean age: 12.05 ± 5.15 y) with T1D followed in the Second Department of Pediatrics, University of Athens Medical School, were analyzed. RESULTS: The mean ± SD diabetes duration was 4.9 ± 3.88 y (range: 0.25-17) and glycated hemoglobin (HbA1c) was 8.2 ± 1.09% (66 ± 11.9 mmol/mol). A total of 80% of patients were on multiple daily injections regimen, 10% on pump therapy, and 10% on conventional regimen. Total direct costs per patient-year (ppy) were estimated at €2.712 [95% confidence interval (CI): 2.468-2.956]. Supply costs accounted for 73.7% of total costs and were the highest for pump therapy (P < .001). Multivariate linear regression analysis showed that costs were significantly higher for children (1) on multiple daily injections or pump therapy (r = 0.364, P < .001), (2) of older age (r = 0.25, P < .001) and (3) higher daily insulin dose (r = 0.46, P < .001). Patients on pump therapy had significantly higher costs €5.538 (95%CI 4480-6597) compared with patients on multiple daily injections €2.447 (95% CI 2320-2574) and conventional regimen €1.978.5 (95%CI 1682-2275) (P = .0001). Patients on pump therapy had better glycemic control compared with all other patients [HbA1c (mean ± SD): 7.2% ± 1.0 vs 8.3% ±1.5, P = .039]. CONCLUSION: The total T1D cost in this cohort of Greek children was €2712 ppy. The main factor that predicted direct cost was the use of pump. However, pump therapy was associated with better glycaemic control, which may decrease the risk of total long-term diabetes care cost.

Subjective social status, social network and health disparities: empirical evidence from Greece.

BACKGROUND: Several studies suggest that socioeconomic status affects (SES) affects self-rated health (SRH), both in Greece and internationally. However, prior research mainly uses objective measures of SES, instead of subjective evaluations of individuals' social status. Based on this, this paper aims to examine (a) the impact of the economic dowturn on SRH in Greece and (b) the relationship between subjective social status (SSS), social network and SRH. METHODS: The descriptive analysis is based on four cross-sectional surveys conducted by the National School of Public Health, Athens, Greece (2002, 2006, 2011, 2015), while the data for the empirical investigation were derived from the 2015 survey (Health + Welfare Survey GR). The empirical strategy is based on an ordinal logistic regression model, aiming to examine how several variables affect SRH. Size of social network and SSS are among the independent variables employed for the empirical analysis RESULTS: According to our findings, average SRH has deteriorated, and the percentage of the population that reports very good/good SRH has also decreased. Moreover, our empirical analysis suggests that age, existence of a chronic disease, size of social network and SSS affect SRH in Greece. CONCLUSION: Our findings are consistent with the existing literature and confirm a social gradient in health. According to our analysis, health disparities can be largely attributed to socioeconomic inequalities. The adverse economic climate has impact on socioeconomic differences which in turn affect health disparities. Based on these, policy initiatives are necessasy in order to mitigate the negative impact on health and the disparities caused by economic dowturn and the occuring socioeconomic inequalities.

Treatment with the first TNF inhibitor in rheumatoid arthritis patients in the Hellenic Registry of Biologic Therapies improves quality of life especially in young patients with better baseline functional status.

OBJECTIVES: To assess in daily practice in patients with rheumatoid arthritis (RA) the effect of treatment with first tumour necrosis factor-α inhibitor (TNFi) in quality of life (Qol), disease activity and depict possible baseline predictors for gains in Qol. METHODS: Patients followed prospectively by the Hellenic Registry of Biologic Therapies were analysed. Demographics were recorded at baseline, while RA-related characteristics at baseline and every 6 months. Paired t-tests were used to detect divergences between patient-reported (Health Assessment Questionnaire (HAQ), EuroQol (EQ-5D)) and clinical tools (Disease Activity Score-28 joints (DAS28)). Clinical versus self-reported outcomes were examined via cross-tabulation analysis. Multiple regression analysis was performed for identifying baseline predictors of improvements in QALYs. RESULTS: We analysed 255 patients (age (mean±SD) 57.1±13.0, disease duration 9.2±9.1 years, prior non-biologic disease-modifying anti-rheumatic drugs 2.3±1.2). Baseline EQ-5D, HAQ and DAS28 were 0.36 (0.28), 1.01 (0.72) and 5.9 (1.3), respectively, and were all significantly improved after 12 months (0.77 (0.35), 0.50 (0.66), 3.9 (1.5), respectively, p<0.05 for all). 90% of patients who improved from high to a lower DAS28 status (low-remission or moderate) had clinically important improvement in Qol (phi-coefficient=0.531,p<0.05). Independent predictors of gains in Qol were lower baseline HAQ, VAS global and younger age (adjusted R2=0.27). CONCLUSIONS: In daily practice TNFi improve both disease activity and Qol for the first 12 months of therapy. 90% of patients who improved from high to a lower DAS28 status had clinically important improvement in Qol. Younger patients starting with lower HAQ and VAS global are more likely to benefit.

Measuring the efficiency of the Greek rural primary health care using a restricted DEA model; the case of southern and western Greece.

This is a study to measure the efficiency of the rural Health Centres (HCs) and their Regional Surgeries (RSs) of the 6th Health Prefecture (HP) of Greece, which covers Southern and Western Greece. Data Envelopment Analysis (DEA) was applied under Constant and Variable Returns to Scale, using a weight-restricted, output-oriented model, to calculate pure technical efficiency (PΤΕ), scale efficiency (SE) and total technical efficiency (TE). The selection of inputs, outputs and their relative weights in the model was based on two consecutive consensus panels of experts on Primary Health Care (PHC). Medical personnel, nursing personnel and technological equipment were chosen as inputs and were attributed appropriate weight restrictions. Acute, chronic and preventive consultations where chosen as outputs; each output was constructed by smaller subcategories of different relative importance. Data were collected through a questionnaire sent to all HCs of the covered area. From the 42 HCs which provided complete data, the study identified 9 as technical efficient, 5 as scale efficient and 2 as total efficient. The mean TE, PTE and SE scores of the HCs of the 6th Health Prefecture were 0.57, 0.67 and 0.87, respectively. The results demonstrate noteworthy variation in efficiency in the productive process of the HCs of Southern and Western Greece. The dominant form of inefficiency was technical inefficiency. The HCs of the 6th HP can theoretically produce 33 % more output on average, using their current production factors. These results indicated potential for considerable efficiency improvement in most rural health care units. Emphasis on prevention and chronic disease management, as well as wider structural and organisational reforms, are discussed from the viewpoint of how to increase efficiency.

Economic crisis, austerity and unmet healthcare needs: the case of Greece.

BACKGROUND: The programme for fiscal consolidation in Greece has led to income decrease and several changes in health policy. In this context, this study aims to assess how economic crisis affected unmet healthcare needs in Greece. METHODS: Time series analysis was performed for the years 2004 through 2011 using the EU-SILC database. The dependent variable was the percentage of people who had medical needs but did not use healthcare services. Median income, unemployment and time period were used as independent variables. We also compared self-reported unmet healthcare needs drawn from a national survey conducted in pre-crisis 2006 with a similar survey from 2011 (after the onset of the crisis). A common questionnaire was used in both years to assess unmet healthcare needs, including year of survey, gender, age, health status, chronic disease, educational level, income, employment, health insurance status, and prefecture. The outcome of interest was unmet healthcare needs due to financial reasons. Ordinary least squares, as well as logistic regression analysis were conducted to analyze the results. RESULTS: Unmet healthcare needs increased after the enactment of austerity measures, while the year of participation in the survey was significantly associated with unmet healthcare needs. Income, educational level, employment status, and having insurance, private or public, were also significant determinants of unmet healthcare needs due to financial reasons. CONCLUSIONS: The adverse economic environment has significantly affected unmet health needs. Therefore health policy actions and social policy measures are essential in order to mitigate the negative impact on access to healthcare services and health status.

Cost-utility analysis of tocilizumab monotherapy in first line versus standard of care for the treatment of rheumatoid arthritis in Greece.

The study aims to evaluate the cost-effectiveness of adding tocilizumab (TCZ) first line to a treatment sequence for patients with active rheumatoid arthritis (RA), who had an inadequate response to one or more traditional synthetic disease-modifying antirheumatic drugs (DMARDs) and are intolerant to methotrexate (MTX), or in whom continued treatment with MTX is considered inappropriate. An individual simulation model was applied to project lifetime costs and outcomes for 10,000 patients from a payer's perspective. The analysis compared the standard treatment pathway (STP) with a similar pathway, where treatment was initiated with TCZ. QALYs were used as primary efficacy outcomes. Efficacy data were obtained from the ADACTA trial and a network meta-analysis. Clinical practice standards were derived from an expert panel of Greek rheumatologists. Results indicate that a treatment sequence starting with TCZ yields 1.17 more QALYs (9.38 vs. 8.21) at an additional cost of €3,744 (€119,840 vs. €86,096) compared with the STP. The incremental cost-effectiveness ratio was €28,837/QALY gained. Probabilistic sensitivity analysis confirms robustness of these findings as consistently below a threshold of €45,000. The results of the analysis suggest that TCZ, when used as a first-line biologic monotherapy, can be a cost-effective treatment option for the management of active RA in patients in need of biologic monotherapy.

Quantifying the economic benefits of prevention in a healthcare setting with severe financial constraints: the case of hypertension control.

Hypertension significantly contributes to the increased cardiovascular morbidity and mortality, thus leading to rising healthcare costs. The objective of this study was to quantify the clinical and economic benefits of optimal systolic blood pressure (SBP), in a setting under severe financial constraints, as in the case of Greece. Hence, a Markov model projecting 10-year outcomes and costs was adopted, in order to compare two scenarios. The first one depicted the "current setting", where all hypertensives in Greece presented an average SBP of 164 mmHg, while the second scenario namely "optimal SBP control" represented a hypothesis in which the whole population of hypertensives would achieve optimal SBP (i.e. <140 mmHg). Cardiovascular events' occurrence was estimated for four sub-models (according to gender and smoking status). Costs were calculated from the Greek healthcare system's perspective (discounted at a 3% annual rate). Findings showed that compared to the "current setting", universal "optimal SBP control" could, within a 10-year period, reduce the occurrence of non-fatal events and deaths, by 80 and 61 cases/1000 male smokers; 59 and 37 cases/1000 men non-smokers; whereas the respective figures for women were 69 and 57 cases/1000 women smokers; and accordingly, 52 and 28 cases/1000 women non-smokers. Considering health expenditures, they could be reduced by approximately €83 million per year. Therefore, prevention of cardiovascular events through BP control could result in reduced morbidity, thereby in substantial cost savings. Based on clinical and economic outcomes, interventions that promote BP control should be a health policy priority.

Barriers in access to healthcare services for chronic patients in times of austerity: an empirical approach in Greece.

OBJECTIVES: To investigate the magnitude of barriers in access to health services for chronic patients and the socioeconomic and demographic characteristics that affect them. METHODS: A cross-sectional study was conducted in 1,594 chronic patients suffering from diabetes, hypertension, COPD and Alzheimer. Logistic regression analyses were carried out in order to explore the factors related to economic and geographical barriers in access, as well as the determinants of barriers due to waiting lists. RESULTS: A total of 25% of chronic patients face geographical barriers while 63.5% and 58.5% of them are in front of economic and waiting list barriers, respectively. Unemployed, low-income and low-educated are more likely to face economic barriers in access. Moreover, women, low-income patients, and patients with lower health status are more likely to be in front of geographical barriers. In addition, the probability of waiting lists occurrence is greater for unemployed, employees and low income patients. CONCLUSIONS: Barriers in access can be mainly attributed to income decrease and unemployment. In this context, health policy measures are essential for removing barriers in access. Otherwise, inequalities may increase and chronic patients' health status will be deteriorated. These consequences imply adverse effects on health expenditure.

Health technology assessment of medicines in Greece: pharmaceutical industry executives' views.

OBJECTIVES: The aim of this study was to investigate originator pharmaceutical companies' practices in relation to health technology assessment (HTA) and the views and perceptions of their executives on the importance of HTA in pricing and reimbursement of medicines in Greece. METHODS: A qualitative study was performed, using individual semi-structured interviews based on an interview schedule with open-ended questions. The target population was market access departments' executives of originator pharmaceutical companies. Our target sample consisted of sixteen executives, of whom ten agreed to participate. Saturation point was reached after eight interviews. Data were audio recorded, transcribed verbatim, and analyzed using content analysis. RESULTS: Participants considered HTA as a very important complementary tool for decision making in health policy, particularly in the field of pharmaceuticals and medical devices. They believed that, in Greece, HTA could be institutionalized for the reimbursement mechanism of medicines under certain conditions relating to current health policy-making attitudes and conditions pertaining in the country. They considered that there are many constraints which must be overcome as well as opportunities to be exploited. CONCLUSIONS: Decisions in pharmaceutical policy should be scientifically substantiated and HTA should be institutionalized primarily for reimbursement decisions. Development of guidelines for conducting pharmaco-economic evaluation, change in health policy goals, recording of cost and epidemiological data, and broader participation of all stakeholders in HTA decision-making processes are suggested as prerequisites for a successful implementation of HTA in Greece.

Pregabalin versus gabapentin in the management of peripheral neuropathic pain associated with post-herpetic neuralgia and diabetic neuropathy: a cost effectiveness analysis for the Greek healthcare setting.

BACKGROUND: The anticonvulsants pregabalin and gabapentin are both indicated for the treatment of peripheral neuropathic pain. The decision on which treatment provides the best alternative, should take into account all aspects of costs and outcomes associated with the two therapeutic options. The objective of this study was to examine the cost - effectiveness of the two agents in the management of patients with painful diabetic neuropathy or post - herpetic neuralgia, under the third party payer perspective in Greece. METHODS: The analysis was based on a dynamic simulation model which estimated and compared the costs and outcomes of pregabalin and gabapentin in a hypothetical cohort of 1,000 patients suffering from painful Diabetic Peripheral Neuropathy (DPN) or Post-Herpetic Neuralgia (PHN). In the model, each patient was randomly allocated an average pretreatment pain score, measured using an eleven-point visual analogue scale (0 - 10) and was "run through" the model, simulating their daily pain intensity and allowing for stochastic calculation of outcomes, taking into account medical interventions and the effectiveness of each treatment. RESULTS: Pregabalin demonstrated a reduction in days with moderate to severe pain when compared to gabapentin. During the 12 weeks the pregabalin arm demonstrated a 0.1178 (SE 0.0002) QALY gain, which proved to be 0.0063 (SE 0.0003) higher than that in the gabapentin arm. The mean medication cost per patient was higher for the pregabalin arm when compared to the gabapentin arm (i.e. €134.40) over the 12 week treatment period. However, this higher cost was partially offset by the reduced direct medical costs (i.e. the cost of specialist visits, the cost of diagnostic tests and the other applied interventions). Comparing costs with respective outcomes, the ICERs for pregabalin versus gabapentin were €13 (95%CI: 8 - 18) per additional day with no or mild pain and €19,320 (95%CI: 11,743 - 26,755) per QALY gained. CONCLUSIONS: Neuropathic pain carries a great disease burden for patients and society and, is also, associated with a significant economic burden. The treatment of pain associated with DPN and PHN with pregabalin is a cost-effective intervention for the social security in Greece compared to gabapentin. Thus, these findings need to be taken into consideration in the decision - making process when considering which therapy to use for the treatment of neuropathic pain.

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.

Inequalities in access to cancer treatment: an analysis of cross-regional patient mobility in Greece.

PURPOSE: The quest of specialized oncology services represents an inelastic need for cancer patients that often leads to traveling in order to receive adequate care. The present survey assesses patient geographic mobility to access services for the prevention and treatment of neoplasmatic diseases in Greece, a country where the National Health System is characterized by severe misdistribution of oncology-specific resources. METHODS: Based on data from the National Statistical Service for 1999-2005 (last available), we estimated geographic mobility as the difference between oncology patients residing in a specific region and those receiving care in National Health System (NHS) facilities located in the region, for the ten administrative districts of Greece. Especially for Attica, we performed a sub-analysis according to cancer diagnosis. RESULTS: The most significant mobility is towards Attica, where patients receiving care within the region outnumber the patients actually residing by 48.9% annually, on average. Positive flows are also observed towards Macedonia (8.4%) and Epirus (7.8%). Negative flows are recorded in all remaining regions, the highest noticed in Sterea (-76.2%), Ionian Islands (-63.3%), Aegean Islands (-45.2%), and Thessaly (-37.3%). The largest flow towards Attica is for cases of malignant neoplasms of the skin, uterus, male genital organs, and for Hodgkin's lymphomas. CONCLUSIONS: Misallocation of oncology-specific resources creates "two-tier" cancer patients based on ability to pay for traveling/accommodation. The severity and the consequences of the disease necessitate a bold approach to resource allocation and the establishment of integrated patient support networks that ensure all cancer patients are offered equal opportunities to effective treatment.

Greek NHS capacity constraints regarding intravenous treatment for rheumatoid arthritis patients.

Intravenous (iv) infusion of biologic agents is a highly effective therapeutic option for active rheumatoid arthritis (RA). In Greece, it is mandatory that all infusions are administered in a hospital setting; therefore, they are strongly correlated with the system's capacity in terms of resources. The objective of this paper was to assess the capacity of the Greek National Health System (NHS) hospitals to meet current/projected demand for iv treatment of RA patients. Semi-qualitative interviews on the basis of a strictly structured questionnaire were conducted with the Heads of all NHS RA infusion sites to record available resources, service utilization and ability to meet current/projected demand. Out of 31 NHS infusion sites, 28 responded (90.3%). On average, 41.6% of Greek NHS RA patients are treated with a biologic agent and 61.5% of respondents stated that available resources are insufficient to meet current demand. The most important constraints in selection order were as follows: space (93%), staff (89.5%), equipment (61.5%) and working hours (57%). Fifty-six percent of respondents stated that they may decline treatment to patients due to constraints. Overall, respondents estimated that the number of iv patients could be increased by 104%, were there no capacity constraints. An important proportion of the estimated 40.000 RA patients in Greece, for whom iv biologic treatment in the hospital setting is essential for disease control, may be declined treatment due to constraints in RA-specific resources. Rationalization and reallocation of NHS resources is required to ensure equity in access to effective treatment for all RA patients.

Knowledge, Perceptions and Attitudes Toward HPV Vaccination: A Survey on Parents of Girls Aged 11-18 Years Old in Greece.

Objective: To investigate knowledge, perceptions and practices of parents of girls aged 11-18 years old in Greece toward HPV vaccination, and determine which factors are associated with parents' decision to vaccinate their daughters. Methods: A close-end questionnaire was constructed and telephone interviews were conducted upon informed consent. The sample was random, national, stratified by geographic region and representative of the general population of parents of girls aged 11-18. The data collected include: general knowledge, attitudes and perceptions concerning HPV and HPV vaccine, information regarding their daughters' HPV vaccination, and sociodemographic characteristics. Statistical analysis included descriptives and a logistic regression model to investigate which factors are associated with HPV vaccination. Results: Overall, 1,000 parents participated in the study, 99.4% of which knew what HPV is and 98.8% knew there is a vaccine available against HPV. Furthermore, 47% of the parents stated that their daughters had been vaccinated against HPV, while further analysis revealed that only 35% had received all the recommended doses. In the logistic regression analysis, the following variables had a statistically significant association with HPV vaccination: perceived ease of contracting HPV (OR = 1.105), level of trust in medical profession regarding information on prevention (OR = 1.205), overall perception regarding importance of children's vaccination (OR = 0.618), internet/social media as a source of parent information regarding HPV (OR = 0.886), participant (parent) age (OR = 1.125), and daughter's treating physician's recommendation for HPV vaccination (OR = 7.319). Conclusions: HPV vaccination coverage is still suboptimal. Comprehension of the obstacles toward this goal is important and the role of healthcare professionals is crucial to increase acceptance.

A 10-year economic analysis of HIV management in Greece: evidence of efficient resource allocation.

OBJECTIVE: Human Immunodeficiency Virus (HIV) prevalence has substantially increased over the years, leading to increased direct medical costs. The aim of the present study was to assess the long-term cost of HIV care in Greece incurred over the last decade. METHODS: In order to assess the long-term cost of HIV care, a cost analysis was undertaken for three discrete time points (which reflect major changes in the HIV treatment paradigm), incorporating the evolution of the cost of pharmaceuticals, hospitalization, primary care visits and diagnostic tests. The cost per life year gained (LYG) was also estimated. RESULTS: Total cost of HIV care increased by 57% over the last decade (€53.7 million in 2010 vs €84.5 million in 2019), which can be mainly attributed to a 107% (5084 in 2010 vs. 10,523 in 2019) increase observed in the number of people living with HIV (PLWH) under care. As a result, the cost per person on treatment has decreased by 24.0% (€10,567 in 2010 vs €8032 in 2019). Lifetime cost was lower and life expectancy higher in 2019 compared to 2010, leading to a - €711 cost per LYG, suggesting that the current treatment paradigm produces better health outcomes at a lower cost compared to a decade ago, implying that resources are used in a more efficient way. CONCLUSION: The paper presents some evidence towards the direction that HIV management in Greece can be considered efficient in both clinical and financial terms, as it offers measurable clinical outcomes at well-controlled, almost inelastic spending.

Surveying the ashes: experience from the 2007 Peloponnese wildfires six months after the disaster.

INTRODUCTION: Major disasters disrupt the infrastructure of communities and have lasting psychological, economic, and environmental effects on the affected areas. The psychological status and community effects of the devastating 2007 wildfires on the Peloponnese Peninsula of Greece were assessed six months following the disaster. METHODS: Adult inhabitants, 18-65 years of age, living in villages affected by the wildfires were selected randomly and compared with a demographically similar group living in neighboring villages that were unaffected by the fires. Regions were chosen based on the extent of fire damage in that area. There were 409 participants in the fire group, and 391 in the control group. Participants completed a questionnaire that included the SCL-90-R symptom checklist, a subjective perception of health status, and a series of items assessing views about current problems, personal values, and trust in different institutions. RESULTS: The fire group scored significantly higher on psychological distress compared to the control group. Both groups viewed their health status in the previous year as better than at the present time. There were few significant differences between groups in the designation of regional problems, attitudes, and values. In the total sample, 41.6% listed unemployment, and 15.0% listed poverty as the most important problem in their region. The Church was indicated as the most trusted institution by 36.7% of the group and the Government by 13.3%. A total of 30.2% did not have a trusted institution. CONCLUSIONS: The hardiness and resilience of the fire-impacted group was evident. However, an improvement in economic conditions is needed to maintain the health and enhance the quality of life of the population living in the Peloponnese region. This improvement likely would have a positive effect on the attitude of trust in government institutions.

Can We Incorporate Societal Values in Resource Allocation Decisions Among Disease Categories? An Empirical Approach.

OBJECTIVES: Historically, resource allocation decisions in healthcare are based on univariate approaches, inevitably overlooking value dimensions that are essential from a societal welfare maximization perspective. This article aims to present a wider perspective on decision making that incorporates societal values when prioritizing future resource allocation among disease areas. METHODS: Sociotechnical application of multiple-criteria decision analysis with a set of criteria (value judgments) that are based on positive as well as normative dimensions of resource allocation. We use Greece as a case study. Societal value judgments were sourced via a multidisciplinary panel of experts who collectively provided criteria weights and scores for each alternative (16 disease categories, classified according to the Global Burden of Disease study) against each criterion. An additive value function provided the total value in priority preference for each alternative. RESULTS: The criteria that were deemed relevant to the decision-making process and their respective relative weights were burden of disease (0.245), capacity to benefit (0.190), direct cost and projected changes in the next 5 years (0.160), indirect cost (0.132), intensity of unmet needs (0.109), incidence of catastrophic expenditure (0.091), and caring externalities (0.073). The additive value function revealed that the top 5 priorities in highest total value scores were neoplasms, circulatory diseases, injuries, neurologic diseases, and musculoskeletal diseases. CONCLUSIONS: Incorporation of societal value criteria in resource allocation decisions can highlight priorities and lead to different sets of planning decisions than solely demand-driven allocation.

Two Sides of the Same Coin? A Dual Multiple Criteria Decision Analysis of Novel Treatments Against Rheumatoid Arthritis in Physicians and Patients.

PURPOSE: Available treatment options for rheumatoid arthritis (RA) differ in important aspects. In this sense, each RA treatment option is accompanied by a spectrum of characteristics that collectively constitute its comprehensive "value," as viewed from the physician's or the patient's perspective. The objective of this study was to perform a multiple criteria decision analysis of different RA treatments from the perspective of physicians and patients and to outline the respective aspects of value for each treatment METHODS: A literature review was performed for constructing a set of criteria (N = 8) for the multiple criteria decision analysis. Workshops for the elicitation of preferences occurred separately for physicians and patients. A performance matrix was populated via 2 network meta-analyses plus converged clinical opinion. Criteria were hierarchically classified by application of pairwise comparisons, and criteria weights were attributed by point allocation through convergence of opinions. Performances in both panels were scored by using a 100-point scale. A linear additive value function was used for the calculation of total value estimates. FINDINGS: Both panels provided their consensus. The hierarchical classification of attributes from the physician perspective placed the highest values on the criteria of severe adverse events, clinical efficacy, route of administration, and cost per year for the third-party payer. From the patient perspective, the highest ranking criteria were clinical efficacy, severe adverse events, percentage of patients remaining with the same targeted immune modulator for 1 year ("drug survival"), and cost per year for the third-party payer. IMPLICATIONS: In an era of multiple options and varying preferences, RA treatments must be evaluated by taking into consideration patients' preferences as well, as to cover the full spectrum of value elements rather than simply clinical outcomes. The results of this analysis show that physicians and patients share similarities but also marked differences in terms of the aspects of treatment that they perceive as more valuable.