The economic burden of treating neonates in Intensive Care Units (ICUs) in Greece

<p>Abstract</p> <p>Background</p> <p>In a period when a public-private mix in Greece is under consideration and hospital budgets become restrained, economic assessment is important for rational decision making. The study aimed to estimate the hospitalization cost of neonates admitted to the ICUs and demonstrate discrepancies with reimbursement.</p> <p>Methods</p> <p>Chosen methodology was based on the selection of medical records of all NICUs and intermediate care admissions within February to April 2004. Neonates (n = 99) were classified according to birthweight and gestational age.</p> <p>Results</p> <p>Mean cost per infant was estimated at €5.485 while reimbursement from social funds arises to €3.952. Costs per birthweight or gestational age show an inverse relationship. Personnel costs accounted for 59.9%, followed by enteral/parenteral feeding (16.14%) and pharmaceuticals expenses (11.10%) of all resources consumed. Sensitivity analysis increases the robustness of the results</p> <p>Conclusion</p> <p>Neonatal intensive care in Greece is associated with significant costs that exceed reimbursement from social funds. Reimbursement should be adjusted to make neonatal intensive care economically viable to private hospitals and thus, increase capacity of the services provided.</p

Comparative Analysis of Legislative Requirements About Patients' Access to Biotechnological Drugs for Rare Diseases in Central and Eastern European Countries

Objectives: The aim of the study was to compare the access of patients with rare diseases (RDs) to biotechnological drugs in several Central and Eastern European countries (CEECs). We focused on the legislative pricing and reimbursement requirements, availability of biotechnological orphan medicinal products (BOMPs) for RDs, and reimbursement expenditures. Methods: A questionnaire-based survey was conducted among experts from 10 CEECs: Bulgaria, Croatia, Estonia, Greece, Hungary, Poland, Romania, Slovakia, Serbia, and Macedonia. The legal requirements for reimbursement and pricing of BOMPs were collected. All BOMPs and medicines without prior orphan designations were extracted from the European list of orphan medicinal products, 2017. The reimbursement status of these medicinal products in 2017 in the public coverage of the included CEECs as well as the share of their costs in relation to the total public pharmaceutical spending for the period from 2014 to 2016 were defined. Results: Our survey revealed that some differences in the legal requirements for pricing and reimbursement of BOMPs amongst the countries included in the study. All European Union countries have developed and implemented pharmacoeconomic guidelines with or without some specific reimbursement requirements for orphan medicinal products. Cost-effectiveness analysis, cost-utility analysis, Markov models, meta-analysis, and discount levels of costs and results were required only in Bulgaria, Poland and Hungary. The number of reimbursed BOMPs and biotechnological medicinal products for RDs without prior orphan designation was the highest in Hungary (17 and 40, respectively). Patient-based reimbursement schemes were available only in Hungary for 11 out of 17 BOMPs. Poland and Greece have the highest pharmaceutical expenditure of reimbursed BOMPs with are similar to 214 million and 180 million EUR, respectively in the observed period from 2014 to 2016. High proportion of the pharmaceutical expenditure on the reimbursed biotechnological medicinal products for RDs for the observed period 2014-2016 is presented in Bulgaria and Slovakia. Conclusions: The non-European Union CEECs face a significant delay in the legal implementation of pharmacoeconomic guideline for assessment of BOMPs. The access to BOMPs is similar among the observed CEECs and the countries with the best access are Hungary and Greece. The influence of BOMP expenditures on the budget in the individual countries is significant

Economic evaluation of neonatal intensive care units in Greece

Introduction: Neonatal Intensive Care Units (NICUs) are one of the most expensive hospital sectors, absorbing between 20%-35% of hospital budgets. Valuing costs without measuring effectiveness cannot be considered an efficient indicator in modern health systems.Objective: To identify the cost of preterm babies hospitalized in Neonatal Intensive Care Units and the outcomes based on life years gained indicator.Method: In order to calculate the costs of neonatal hospitalization, a micro-costing was carried out in the neonatal intensive care units of the two public maternity hospitals of Attica and compared with the costs resulting from a costing study of the MENN pediatric hospitals in 1989 separated into birth weight categories of the newborns. Effectiveness is assessed by avoidable perinatal mortality attributable to neonatal intensive care units. To implement the cost-effectiveness analysis, the following parameters were used:• The cost of newborns hospitalized in NICUs of pediatric hospitals 1989• Perinatal mortality in 1989• The cost of newborns hospitalized in NICUs of pediatric hospitals 2004• Life expectancy in 1989• Perinatal mortality in 2004• Consumer Price Index year 1989, 2004 & 2008• Life expectancy in 2004• Discount Rate 3.5% & 5%Results: In the category of newborns with birth weight 2500 g amounts to €565.07. The results were discounted with interest rates of 3.5% and 5% in order to show the reliability (robustness) of the results.Πρόλογος: Οι Μονάδες Εντατικής Νοσηλείας Νεογνών αποτελούν έναν από τους ακριβότερους νοσοκομειακούς τομείς, απορροφώντας ποσοστό μεταξύ 20%-35% των νοσοκομειακών προϋπολογισμών. Η αποτίμηση του κόστους χωρίς τη μέτρηση της αποτελεσματικότητας δεν μπορεί να αποτελέσει αποδοτικό δείκτη στα σύγχρονα συστήματα υγείας. Σκοπός: Η ανεύρεση του κόστους που συνάγεται στην κοινωνία η λειτουργία των Μονάδων Εντατικής Νοσηλείας Νεογνών και τα οφέλη που αυτές επιφέρουν αποδιδόμενα σε κερδισμένα έτη ζωής.Μέθοδος: Για τον υπολισμό του κόστους νοσηλείας νεογνών, πραγματοποιήθηκε μίκρο-κοστολόγηση σε μονάδες εντατικής νοσηλείας νεογνών των δύο δημόσιων μαιευτικών νοσοκομείων της Αττικής και συγκρίθηκε με το κόστος που προέκυψε από μελέτη κοστολόγησης των ΜΕΝΝ μαιευτικών νοσοκομείων το 1989 διαχωρισμένο σε κατηγορίες βάρους γέννησης των νεογνών. Η αποτελεσματικότητα αποτιμάται από την αποφευχθείσα περιγεννητική θνησιμότητα που οφείλεται στις μονάδες εντατικής νοσηλείας νεογνών. Για την υλοποίηση της ανάλυσης κόστους αποτελεσματικότητας χρησιμοποιήθηκαν:•Το κόστος νεογνών νοσηλευθέντων σε παιδιατρικά νοσοκομεία 1989•Περιγεννητική θνησιμότητα το 1989•Το κόστος νεογνών νοσηλευθέντων σε παιδιατρικά νοσοκομεία 2004•Προσδόκιμο επιβίωσης το 1989•Περιγεννητική θνησιμότητα το 2004•Δείκτης Τιμών Καταναλωτή έτους 1989, 2004 & 2008•Προσδόκιμο Επιβίωσης το 2004•Προεξοφλητικό Επιτόκιο 3,5% & 5%Αποτελέσματα: Στην κατηγορία νεογνών βάρους γέννησης 2500 γραμ. ανέρχεται στα €565,07. Πραγματοποιήθηκε προεξόφληση των αποτελεσμάτων με επιτόκια 3,5% και 5% ώστε να διαφανεί η αξιοπιστία (robustness) των αποτελεσμάτων

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

Treatment Compliance with Fixed-Dose Combination of Vildagliptin/Metformin in Patients with Type 2 Diabetes Mellitus Inadequately Controlled with Metformin Monotherapy: A 24-Week Observational Study

Objective. To evaluate the differences in treatment compliance with vildagliptin/metformin fixed-dose versus free-dose combination therapy in patients with type 2 diabetes mellitus (T2DM) in Greece. Design. Adult patients with T2DM, inadequately controlled with metformin monotherapy, (850 mg bid), participated in this 24-week, multicenter, observational study. Patients were enrolled in two cohorts: vildagliptin/metformin fixed-dose combination (group A) and vildagliptin metformin free-dose combination (group B). Results. 659 patients were enrolled, 360 were male, with mean BMI 30.1, mean T2DM duration 59.6 months, and mean HbA1c at baseline 8%; 366 patients were assigned to group A and 293 to group B; data for 3 patients was missing. In group A, 98.9% of patients were compliant with their treatment compared to 84.6% of group B. The odds ratio for compliance in group A versus B was (OR) 18.9 (95% CI: 6.2, 57.7; P<0.001). In group A mean HbA1c decreased from 8.1% at baseline to 6.9% (P<0.001) at the study end and from 7.9% to 6.8% (P<0.001) in group B. Conclusions. Patients in group A were more compliant than patients in group B. These results are in accordance with international literature suggesting that fixed-dose combination therapies lead to increased compliance to treatment

The Cost of Managing Type 2 Diabetes Mellitus in Greece: A Retrospective Analysis of 10-Year Patient Level Data “The HERCULES Study”

Objective. This study aimed to estimate the mean annual cost of treating type 2 diabetes mellitus patients (T2DM) including complications and comorbidities in Greece. Design. A noninterventional retrospective study was based on patient level data analysis (bottom-up approach) from medical records, with at least 10-year-follow-up data. Results. The total annual cost per patient for managing diabetes in Greece was estimated at € 7,111 and was, statistically significantly, higher for patients with inadequate glycemic control (Hba1c>7%) versus patients with adequate control (Hba1c=7%) (€ 7,783 versus € 6,366, resp.;   P=0.017). This was mainly attributed to difference in CV hospitalizations between groups 14/111 versus 4/100, respectively, OR=3.46 (95% CI: 1.10–10.9) for inadequately controlled patients. The largest component of cost was management of comorbidities, accounting for 48% of costs, and pharmaceutical treatment at 35.9% while only 14.9% was attributed to diabetes treatment per se. Obese men and patients with poor education are the groups with higher treatment costs. Conclusions. This is the first study to capture all cost components and the real burden of diabetes in Greece. Comorbidities were found to account for almost half of total cost, significantly higher in nonoptimally controlled diabetes patients

The cost of COPD exacerbations: A university hospital – based study in Greece

SummaryBackgroundHospitalization attributed to severe exacerbations is the major cost driver of Chronic Obstructive Pulmonary Disease (COPD). Given that in Greece no previous studies have addressed the economic burden of COPD, the aim of the study was to examine the hospitalization cost of COPD patients with severe exacerbations in the region of Thrace.MethodsSample consisted of 142 COPD patients with severe exacerbations who were admitted to the pneumonology department of the University Teaching Hospital of Alexandroupolis (UTHA) in 2006 and 2007. Data collection was performed retrospectively and resource utilization was derived from patients’ files. General Linear Model univariate analysis was applied in order to test the influence of disease severity on costs.ResultsMean actual cost per severe exacerbation was €1711; the amount of €621 is reimbursed by social security funds. Price discrepancies are observed between the actual and the nominal cost per patient in all disease stage categories. Mean hospitalization cost per COPD patient increases slightly with the severity of the disease. However, in the very severe stage it greatly increases mainly due to Intensive Care Unit (ICU) admission. In multivariate analysis the length of stay and the stage of the disease were both related to significantly increased costs, while the existence of co-morbidities exhibited marginal significant relation to increased cost.ConclusionsThe cost estimation of severe exacerbations is important as it could trigger further research and also provide the opportunity of creating national epidemiological and economic data. Such data could contribute to the estimation of the total economic and societal burden of COPD in the country