Costs and effects of paliperidone extended release compared with alternative oral antipsychotic agents in patients with schizophrenia in Greece: A cost effectiveness study

Correction to Geitona M, Kousoulakou H, Ollandezos M, Athanasakis K, Papanicolaou S and Kyriopoulos I: Costs and effects of paliperidone extended release compared with alternative oral antipsychotic agents in patients with schizophrenia in Greece: a cost effectiveness study. Annals of General Psychiatry 2008, 7:16. This correction reports changes in the values listed for Ziprasidone and Aripiprazole in Table Ten

Cost effectiveness of vildagliptin versus glimepiride as add-on treatment to metformin for the treatment of diabetes mellitus type 2 patients in Greece

Abstract Objectives This study was designed to assess the cost-effectiveness of vildagliptin versus glimepiride as add-on to metformin in the management of type 2 diabetes mellitus (T2DM) patients in the Greek healthcare setting. Methods A cost-effectiveness model was designed, using MS Excel, to compare two treatment strategies. Strategy 1 consisted of first-line metformin, followed by metformin + vildagliptin in second-line, while strategy 2 consisted of first line metformin, followed by metformin + glimepiride in second line. Subsequent lines were the same in both strategies and consisted of metformin + basal insulin and metformin + basal + rapid insulin. Clinical data and utility decrements relating to diabetes complications were taken from the published literature. Only direct medical costs were included in the analysis (cost base year 2014), and consisted of drug, adverse events and comorbidity costs (taken from local officially published sources and the literature). The perspective adopted was that of the Social Insurance Fund. The time horizon was lifetime, and future costs and outcomes were discounted at 3.5% per annum. Results Adding vildagliptin to metformin increased drug costs compared with adding glimepiride to metformin (€2853 vs. €2427, respectively). However, this increase was offset by a decrease in the costs of associated comorbidities (€4393 vs. €4539) and adverse events (€2757 vs. €3111), resulting in a lower total cost of €74 in strategy 1 compared with strategy 2. Comorbidities were the largest cost component in both strategies, accounting for 43.9 and 45.0% in strategies 1 and 2, respectively. Strategy 1 was also associated with increased life-years (LYs, 0.11) and quality-adjusted life-years (QALYs, 0.11) compared with strategy 2. Strategy 1 is therefore dominant, as it is associated with both lower overall costs and increased effectiveness. Conclusions Vildagliptin as add-on treatment to metformin in the management of T2DM in Greece appears to be dominant versus. glimepiride in terms of both cost per LY and cost per QALY gained

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 semi-structured 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 (sic)273.1, while maintenance costs were estimated at (sic)1,100.2 per year. Total costs of managing asthma per patient per year were estimated at (sic)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 (sic)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

The use of PESTEL as a change management tool to inform change management of polypharmacy and adherence within SIMPATHY program

Introduction: Polypharmacy and medication adherence in the older populationwith multiple chronic conditionsare significant public health issues across all the European Union (EU) countries. SIMPATHY (Stimulating Innovation Management of Polypharmacy and Adherence in The Elderly) is a consortium of 10 organizations representing 8 EU countriesaiming to provide to EU policy makers the evidence and tools, including Change Management methodologies, to support to formulate and introduce new policies.Methods: The selection the Change management approach, in SIMPATHY, aimed to provide the analytical tool to identify the impact of various factors affecting polypharmacy, not only currently but also in the short and long run. The approach selected is the PESTEL analysis, it has been deployed in three steps andis expected to provide projection of the estimated impact of the factors up to 10 years. First step aimed to create a PESTEL analysis framework and to prepare guide to help the partners to conduct the analysis; a pilot testing performed in three of the partner countries for assessing the specificity, objectivity and robustness of the multidimensional content, before the finalization of the relevant Handbook. The second step focused to conduct the analysis -through interviews and workshopsamong the stakeholders, decision makers and focus groups across all eight countries.The third step refers to the interpretation of the results in order the evident drivers and barriers to change polypharmacy landscape to be identified and to be taken into consideration for future strategy development.Process and preliminary results: The change management approach stimulated a dynamic process within SIMPATHY. The first and second step of the entire PESTEL process is about to be completed. The PESTEL frameworkhasbeen formulated incorporating economic, political, legaland cultural contextas well as alternative interventionsrelated to the health system structure and attributes in health and social care delivery process among EU countries.Pilot analyses results mainly focused on the comprehensiveness and objectivity of the factors included in the PESTEL framework and contributed to the Handbook’s improvement and finalization. Finally, the analysis conducted by each country is expected to provide interesting results about the differences, particularities and similarities among the countries, especiallyregarding the attributes of health care delivery, medication prescribing and dispensing, controlling mechanisms, the role of payers as well as doctors’, pharmacists’ and patients’ behaviour. These will create a rich picture of the drivers and barriers for change in each country but also in all countries and potentially provide a clear understanding of the measures necessary to be taken and the policies to be implemented in the future.Conclusion: SIMPATHY preliminary Change Management results support the formulation of a strategy of introducing changes over a 10 years’ time horizon and give evidence to EU to develop a policy framework to address inappropriate polypharmacy and improve adherence, by involving decision makers, health professionals, stakeholders and by supporting the enhancement of the integration in all levels of health and social care.Funding: This poster is part of the SIMPATHY project (663082) which has received funding from the European Union’s Health Programme (2014-2020)

Patient-reportedimpact of myasthenia gravis in the real world: protocol for a digital observational study (MyRealWorld MG)

International audienceDownload PDFPDFNeurologyProtocolPatient-reportedimpact of myasthenia gravis in the real world: protocol for a digital observational study (MyRealWorld MG) Sonia Berrih-Aknin1, Kristl G Claeys2,3, Nancy Law4, Renato Mantegazza5,6, Hiroyuki Murai7, Francesco Saccà8, Sarah Dewilde9, Mathieu F Janssen10, http://orcid.org/0000-0001-7208-1303Emma Bagshaw11, Hara Kousoulakou11, Mark Larkin11, Jon Beauchamp12, Trevor Leighton12, Sandra Paci12 INSERM, Institute of Myology, Center of Research in Myology, Sorbonne Université, Paris, France Department of Neurology, University Hospitals Leuven, Leuven, Belgium Laboratory for Muscle Diseases and Neuropathies, Department of Neurosciences, KU Leuven, Leuven, Belgium Myasthenia Gravis Foundation of America Inc, Westborough, Massachusetts, USA Fondazione IRCCS, Istituto Nazionale Neurologico Carlo Besta, Milan, Italy Associazione Italiana Miastenia e Malattie Immunodegenerative, Milan, Italy Department of Neurology, International University of Health and Welfare, Narita, Japan DNSRO Department, University of Naples Federico II, Naples, Italy Services in Health Economics, Brussels, Belgium Section Medical Psychology and Psychotherapy, Department of Psychiatry, Erasmus MC, Rotterdam, Netherlands Vitaccess Limited, London, UK argenx BV, Ghent, BelgiumIntroduction Myasthenia gravis (MG) is a rare, chronic, autoimmune disease, mediated by immunoglobulin G antibodies, which causes debilitating muscle weakness. As with most rare diseases, there is little patient-reported data with which to understand and address patient needs. This study explores the impact of MG in the real world from the patient perspective.Methods and analysis This is a 2-year prospective, observational, digital, longitudinal study of adults with MG, resident in the following countries: the USA, Japan, Germany, France, the UK, Italy, Spain, Canada and Belgium. The planned sample size is 2000. Recruitment will be community based, via patient advocacy groups, social media and word of mouth. Participants will use a smartphone application (app) to check eligibility, provide consent and contribute data. Planned data entry is as follows: (1) personal profile on enrollment—covering demographics, MG characteristics and previous care; (2) monthly event tracker—current treatments, healthcare visits, treatment-related adverse events, productivity losses; (3) monthly selection of validated generic and disease-specific patient-reported outcomes instruments: EQ-5D-5L, Myasthenia Gravis Activities of Daily Living, Myasthenia Gravis Quality of Life 15-item revised scale, Hospital Anxiety and Depression Scale and Health Utilities Index III. Analyses are planned for when the study has been running in most countries for approximately 6, 12, 18 and 24 months.Ethics and dissemination The study protocol has been reviewed and granted ethics approval by Salus IRB for participants resident in the following countries: Germany, the UK and the US. Local ethics approval is being sought for the following study countries: Belgium, Canada, France, Italy, Japan and Spain. Study results will be communicated to the public and participants via conference presentations and journal publications, as well as regular email, social media and in-application communication

Patient-reported impact of myasthenia gravis in the real world: Protocol for a digital observational study (MyRealWorld MG)

Introduction Myasthenia gravis (MG) is a rare, chronic, autoimmune disease, mediated by immunoglobulin G antibodies, which causes debilitating muscle weakness. As with most rare diseases, there is little patient-reported data with which to understand and address patient needs. This study explores the impact of MG in the real world from the patient perspective. Methods and analysis This is a 2-year prospective, observational, digital, longitudinal study of adults with MG, resident in the following countries: the USA, Japan, Germany, France, the UK, Italy, Spain, Canada and Belgium. The planned sample size is 2000. Recruitment will be community based, via patient advocacy groups, social media and word of mouth. Participants will use a smartphone application (app) to check eligibility, provide consent and contribute data. Planned data entry is as follows: (1) personal profile on enrollment - covering demographics, MG characteristics and previous care; (2) monthly event tracker - current treatments, healthcare visits, treatment-related adverse events, productivity losses; (3) monthly selection of validated generic and disease-specific patient-reported outcomes instruments: EQ-5D-5L, Myasthenia Gravis Activities of Daily Living, Myasthenia Gravis Quality of Life 15-item revised scale, Hospital Anxiety and Depression Scale and Health Utilities Index III. Analyses are planned for when the study has been running in most countries for approximately 6, 12, 18 and 24 months. Ethics and dissemination The study protocol has been reviewed and granted ethics approval by Salus IRB for participants resident in the following countries: Germany, the UK and the US. Local ethics approval is being sought for the following study countries: Belgium, Canada, France, Italy, Japan and Spain. Study results will be communicated to the public and participants via conference presentations and journal publications, as well as regular email, social media and in-application communication. Trial registration number NCT04176211