This study to assess the incidence rates and risk factors of hypoglycemia in a wide real-life sam... more This study to assess the incidence rates and risk factors of hypoglycemia in a wide real-life sample of patients with insulin-treated type 2 diabetes mellitus. In a prospective epidemiological study, data from 817 subjects were collected from medical records and via interviews. Over a 3-month period, hypoglycemic episodes were recorded via self-measurement of glucose levels at least twice daily. Cox proportional and negative binomial multivariable models were applied to estimate adjusted and unadjusted hazard ratios and incidence rate ratios of hypoglycemic events. Of the 817 patients, 52.9% experienced hypoglycemia, 38.1% had only nonsevere episodes, and 14.8% had at least 1 severe episode. Total events per patient-year were estimated at 13.3 (±24.8), with 11.8 (±21.6) and 1.4 (±4.7) being nonsevere and severe, respectively. History of hypoglycemia and severe hypoglycemia were consistent risk factors of hypoglycemia. Intensification of therapy was associated with higher incidence rates, whereas the effect on the hazard rates was more moderate. Longer duration of insulin therapy and the presence of congestive heart failure were associated with a higher risk of developing and frequency of hypoglycemia. Hypoglycemia awareness was found to independently affect only mild hypoglycemia. Hypoglycemia is a common complication in patients with insulin-treated type 2 diabetes mellitus. The risk factors of developing hypoglycemia are to some extent different from those of the frequency of hypoglycemic episodes. Particular attention is required for patients with recurrent hypoglycemic events and on intensive antidiabetic therapy.
Objective To evaluate the impact of multiple comorbidities/complications on health-related qualit... more Objective To evaluate the impact of multiple comorbidities/complications on health-related quality of life (HRQoL) and health utilities in insulin-treated type 2 diabetes (T2DM). Methods In a non-interventional, epidemiological study, data were collected from medical records and via interviews for 938 subjects from various geographical areas of Greece. HRQoL and health utilities were explored with the EQ-5D-5L. Univariate associations were evaluated with the Mann–Whitney and Kruskal–Wallis tests for continuous and Chi-squared tests for nominal variables, and binary logistic regressions were employed to obtain marginal effects. Employing a split sample approach, various specifications of ordinary least squares regression models were evaluated in terms of goodness of fit, model specification, shrinkage and predictive and discriminative performance, to select the best model for mapping health utilities using the whole dataset. Results Overall, the most important factors of impaired HRQoL and health utilities were higher age, female gender, obesity, poor glycemic control and increased duration of insulin treatment. History and increasing concurrence of all complications assessed were associated with exacerbated HRQoL problems, decreased health utilities and diminished health state, although it was not always statistically significant. The highest disutilities were associated with stroke (− 0.082), diabetic retinopathy (− 0.066), diabetic neuropathy (− 0.051) and severe hypoglycemia (− 0.050). Conclusions The deleterious impact of comorbidities on insulin-dependent T2DM subjects’ HRQoL has been confirmed and clinicians should adapt the priorities of disease management accordingly. The derived health utility estimates may be valuable for conducting economic evaluations of interventions in the area of T2DM when data are not available.
During the past two or three decades there has been a growing interest among social scientists in... more During the past two or three decades there has been a growing interest among social scientists in investigation of the social organization, control, and functioning of alternative forms of psychiatric care. A wider approach has been promoted, which is based on the search for an interdisciplinary methodology. The complexity of sociopsychiatric problems confronted by the modern societies could not be solved by the medical profession alone, or by the administrators, planners, psychologists, economists, and other social scientists. The inexplicity of the social problems and the increasing need for reforms require harmonic collaboration between the above professions.
SummaryIn the WHO–EURO region, around 28 million people are currently living with chronic viral h... more SummaryIn the WHO–EURO region, around 28 million people are currently living with chronic viral hepatitis, and 120 000 people die every year because of it. Lack of awareness and understanding combined with the social stigma and discrimination exacerbate barriers related to access to prevention, diagnosis and treatment services for those most in need. In addition, the persisting economic crisis has impacted on public health spending, thus posing challenges on the sustainable investment in promotion, primary and secondary prevention, diagnosis and treatment of viral hepatitis across European countries. The Hepatitis B and C Public Policy Association in cooperation with the Hellenic Center for Disease Prevention and Control together with 10 partner organizations discussed at the Athens High Level Meeting held in June 2014 recent policy developments, persisting and emerging challenges related to the prevention and management of viral hepatitis and the need for a de minimis framework of urgent priorities for action, reflected in a Call to Action (Appendix S1). The discussion confirmed that persisting barriers do not allow the full realisation of the public health potential of diagnosing and preventing hepatitis B and C, treating hepatitis B and curing hepatitis C. Such barriers are related to (a) lack of evidence‐based knowledge of hepatitis B and C, (b) limited access to prevention, diagnosis and treatment services with poor patient pathways, (c) declining resources and (d) the presence of social stigma and discrimination. The discussion also confirmed the emerging importance of fiscal constraints on the ability of policymakers to adequately address viral hepatitis challenges, particularly through increasing coverage of newer therapies. In Europe, it is critical that public policy bodies urgently agree on a conceptual framework for addressing the existing and emerging barriers to managing viral hepatitis. Such a framework would ensure all health systems share a common understanding of definitions and indicators and look to integrate their responses to manage policy spillovers in the most cost‐effective manner, while forging wide partnerships to sustainably and successfully address viral hepatitis.
OBJECTIVES: The objective of this study was to study cost containment and cost reallocation and t... more OBJECTIVES: The objective of this study was to study cost containment and cost reallocation and to discern how they burden households and the pharmaceutical industry. METHODS: For the period 2010-2020, we implemented content analysis on 377 statutes that concerned pharmaceutical expenditure. These measures were classified firstly with reference to their character as cost containing or rationing and, secondly, with respect to cost reallocation. RESULTS: The proportion of measures shifting healthcare costs to consumers was 31% and 48.5% to industry. Mean equivalized total consumption between 2008 and 2018 decreased by 31.5% while mean equivalized total health expenditure decreased by 20.5%. During the same period mean equivalized pharmaceutical expenditure increased by 25.56% and the proportion of households with positive expenditure increased by 31 %. Meanwhile pharmaceutical industry’s direct contribution to the total pharmaceutical expenditure increased from 1.5% in 2010 to 30.1% i...
The COVID-19 pandemic has been challenging and testing of public health systems across the globe,... more The COVID-19 pandemic has been challenging and testing of public health systems across the globe, engaging them in a prolonged scrutinization of their functions, capacity and resources. While in theory, this process can yield invaluable insights for future policy design and mitigate future adversity, it demands a suitable mode of evaluation. Often, innovative and ambitious legislative frames are a far cry from policymaking realities plagued with institutional and operational deficiencies. As a result, we decide to move past assessments of the de jure status quo and examine the de facto modus operandi through the eyes of the systems' participating agents. We focus on the case of Greece, a country which boasts a modern public health systemic design, aligned with contemporary public health thought and international trends. We develop a new framework iteration for public health system performance evaluation, founded on prominent templates. We rely on elite surveying insights from 26...
Although stringent containment strategies are generally effective in slowing COVID-19 transmissio... more Although stringent containment strategies are generally effective in slowing COVID-19 transmission, they also entail severe socioeconomic implications. This study uses aggregated data from Eurostat and the Oxford COVID-19 Government Response Tracker (OxCGRT) to quantify changes in GDP and their association with the stringency index. We examine the evolution of Covid-19 cases and deaths per 100.000 thousand inhabitants in Europe and discuss the impact on the economy. On average, EU member states witnessed an 11.4% reduction in their GDP, due to the COVID-19 crisis. The impact on the southern member states was even greater. We use OxCGRT methodology to rank the European countries on their performance against COVID-19 on the base of four aggregate indices referring to: i) the overall government response, ii) containment and health measures, iii) the stringency index and iv) economic support measures. It is shown that the southern European states and Ireland, top the rankings in terms o...
This study to assess the incidence rates and risk factors of hypoglycemia in a wide real-life sam... more This study to assess the incidence rates and risk factors of hypoglycemia in a wide real-life sample of patients with insulin-treated type 2 diabetes mellitus. In a prospective epidemiological study, data from 817 subjects were collected from medical records and via interviews. Over a 3-month period, hypoglycemic episodes were recorded via self-measurement of glucose levels at least twice daily. Cox proportional and negative binomial multivariable models were applied to estimate adjusted and unadjusted hazard ratios and incidence rate ratios of hypoglycemic events. Of the 817 patients, 52.9% experienced hypoglycemia, 38.1% had only nonsevere episodes, and 14.8% had at least 1 severe episode. Total events per patient-year were estimated at 13.3 (±24.8), with 11.8 (±21.6) and 1.4 (±4.7) being nonsevere and severe, respectively. History of hypoglycemia and severe hypoglycemia were consistent risk factors of hypoglycemia. Intensification of therapy was associated with higher incidence rates, whereas the effect on the hazard rates was more moderate. Longer duration of insulin therapy and the presence of congestive heart failure were associated with a higher risk of developing and frequency of hypoglycemia. Hypoglycemia awareness was found to independently affect only mild hypoglycemia. Hypoglycemia is a common complication in patients with insulin-treated type 2 diabetes mellitus. The risk factors of developing hypoglycemia are to some extent different from those of the frequency of hypoglycemic episodes. Particular attention is required for patients with recurrent hypoglycemic events and on intensive antidiabetic therapy.
Objective To evaluate the impact of multiple comorbidities/complications on health-related qualit... more Objective To evaluate the impact of multiple comorbidities/complications on health-related quality of life (HRQoL) and health utilities in insulin-treated type 2 diabetes (T2DM). Methods In a non-interventional, epidemiological study, data were collected from medical records and via interviews for 938 subjects from various geographical areas of Greece. HRQoL and health utilities were explored with the EQ-5D-5L. Univariate associations were evaluated with the Mann–Whitney and Kruskal–Wallis tests for continuous and Chi-squared tests for nominal variables, and binary logistic regressions were employed to obtain marginal effects. Employing a split sample approach, various specifications of ordinary least squares regression models were evaluated in terms of goodness of fit, model specification, shrinkage and predictive and discriminative performance, to select the best model for mapping health utilities using the whole dataset. Results Overall, the most important factors of impaired HRQoL and health utilities were higher age, female gender, obesity, poor glycemic control and increased duration of insulin treatment. History and increasing concurrence of all complications assessed were associated with exacerbated HRQoL problems, decreased health utilities and diminished health state, although it was not always statistically significant. The highest disutilities were associated with stroke (− 0.082), diabetic retinopathy (− 0.066), diabetic neuropathy (− 0.051) and severe hypoglycemia (− 0.050). Conclusions The deleterious impact of comorbidities on insulin-dependent T2DM subjects’ HRQoL has been confirmed and clinicians should adapt the priorities of disease management accordingly. The derived health utility estimates may be valuable for conducting economic evaluations of interventions in the area of T2DM when data are not available.
During the past two or three decades there has been a growing interest among social scientists in... more During the past two or three decades there has been a growing interest among social scientists in investigation of the social organization, control, and functioning of alternative forms of psychiatric care. A wider approach has been promoted, which is based on the search for an interdisciplinary methodology. The complexity of sociopsychiatric problems confronted by the modern societies could not be solved by the medical profession alone, or by the administrators, planners, psychologists, economists, and other social scientists. The inexplicity of the social problems and the increasing need for reforms require harmonic collaboration between the above professions.
SummaryIn the WHO–EURO region, around 28 million people are currently living with chronic viral h... more SummaryIn the WHO–EURO region, around 28 million people are currently living with chronic viral hepatitis, and 120 000 people die every year because of it. Lack of awareness and understanding combined with the social stigma and discrimination exacerbate barriers related to access to prevention, diagnosis and treatment services for those most in need. In addition, the persisting economic crisis has impacted on public health spending, thus posing challenges on the sustainable investment in promotion, primary and secondary prevention, diagnosis and treatment of viral hepatitis across European countries. The Hepatitis B and C Public Policy Association in cooperation with the Hellenic Center for Disease Prevention and Control together with 10 partner organizations discussed at the Athens High Level Meeting held in June 2014 recent policy developments, persisting and emerging challenges related to the prevention and management of viral hepatitis and the need for a de minimis framework of urgent priorities for action, reflected in a Call to Action (Appendix S1). The discussion confirmed that persisting barriers do not allow the full realisation of the public health potential of diagnosing and preventing hepatitis B and C, treating hepatitis B and curing hepatitis C. Such barriers are related to (a) lack of evidence‐based knowledge of hepatitis B and C, (b) limited access to prevention, diagnosis and treatment services with poor patient pathways, (c) declining resources and (d) the presence of social stigma and discrimination. The discussion also confirmed the emerging importance of fiscal constraints on the ability of policymakers to adequately address viral hepatitis challenges, particularly through increasing coverage of newer therapies. In Europe, it is critical that public policy bodies urgently agree on a conceptual framework for addressing the existing and emerging barriers to managing viral hepatitis. Such a framework would ensure all health systems share a common understanding of definitions and indicators and look to integrate their responses to manage policy spillovers in the most cost‐effective manner, while forging wide partnerships to sustainably and successfully address viral hepatitis.
OBJECTIVES: The objective of this study was to study cost containment and cost reallocation and t... more OBJECTIVES: The objective of this study was to study cost containment and cost reallocation and to discern how they burden households and the pharmaceutical industry. METHODS: For the period 2010-2020, we implemented content analysis on 377 statutes that concerned pharmaceutical expenditure. These measures were classified firstly with reference to their character as cost containing or rationing and, secondly, with respect to cost reallocation. RESULTS: The proportion of measures shifting healthcare costs to consumers was 31% and 48.5% to industry. Mean equivalized total consumption between 2008 and 2018 decreased by 31.5% while mean equivalized total health expenditure decreased by 20.5%. During the same period mean equivalized pharmaceutical expenditure increased by 25.56% and the proportion of households with positive expenditure increased by 31 %. Meanwhile pharmaceutical industry’s direct contribution to the total pharmaceutical expenditure increased from 1.5% in 2010 to 30.1% i...
The COVID-19 pandemic has been challenging and testing of public health systems across the globe,... more The COVID-19 pandemic has been challenging and testing of public health systems across the globe, engaging them in a prolonged scrutinization of their functions, capacity and resources. While in theory, this process can yield invaluable insights for future policy design and mitigate future adversity, it demands a suitable mode of evaluation. Often, innovative and ambitious legislative frames are a far cry from policymaking realities plagued with institutional and operational deficiencies. As a result, we decide to move past assessments of the de jure status quo and examine the de facto modus operandi through the eyes of the systems' participating agents. We focus on the case of Greece, a country which boasts a modern public health systemic design, aligned with contemporary public health thought and international trends. We develop a new framework iteration for public health system performance evaluation, founded on prominent templates. We rely on elite surveying insights from 26...
Although stringent containment strategies are generally effective in slowing COVID-19 transmissio... more Although stringent containment strategies are generally effective in slowing COVID-19 transmission, they also entail severe socioeconomic implications. This study uses aggregated data from Eurostat and the Oxford COVID-19 Government Response Tracker (OxCGRT) to quantify changes in GDP and their association with the stringency index. We examine the evolution of Covid-19 cases and deaths per 100.000 thousand inhabitants in Europe and discuss the impact on the economy. On average, EU member states witnessed an 11.4% reduction in their GDP, due to the COVID-19 crisis. The impact on the southern member states was even greater. We use OxCGRT methodology to rank the European countries on their performance against COVID-19 on the base of four aggregate indices referring to: i) the overall government response, ii) containment and health measures, iii) the stringency index and iv) economic support measures. It is shown that the southern European states and Ireland, top the rankings in terms o...
Objectives: A plethora of measures has been implemented for the purpose of public pharmaceutical ... more Objectives: A plethora of measures has been implemented for the purpose of public pharmaceutical cost containment during the recent years in Greece. The main objective of this study was to disaggregate the nature of these policy reforms in terms of cost containment and cost reallocation Methods: For the period 2010- May 2017, 319 statutes and regulations (FEK) that concerned directly or indirectly pharmaceutical care were retrieved from the Government Gazette. A content analysis was performed on these documents to identify unique pharmaceutical policy reforms. These measures were classified firstly with reference to their character as cost containment (white area) or rationing (black area) or a mixture of those (grey area), and, secondly, with respect to cost reallocation to the tax-funded National Health System (NHS) or the social security funds or health consumers. Results: 84 FEK encompassed 115 measures, which were categorised as 82.6% belonging in the white area, 16.5% in the grey area, and 0.9% in the black area. Of those, 51.3% concerned price regulations, 17.4% prescription control, 13.9% cash limits, volume restrictions and benefit caps, 6.1% co-payments, 6.1% waste avoidance, 2.6% exclusion from reimbursement, 1.7% elimination of surplus resources and 0.9% scarcity of resources. 64 FEK were identified to contain 92 unique measures of cost reallocation. 17.4% of them transferred pharmaceutical cost to the NHS, 22.8% to the social security funds, and 59.8% (35.9% directly, 23.9% indirectly) to consumers. Conclusions: Pharmaceutical reforms during the recent years present a clear tendency to reallocate pharmaceutical cost to consumers. Considering the economic challenges the Greek citizens are facing and the already privatised nature of the Greek health system, policies should focus more on improving health system’s efficiency and effectiveness, instead of increasing out-of-pocket payments, which may exacerbate barriers to pharmaceutical access, especially for the more vulnerable groups.
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Papers by John Yfantopoulos
Methods: For the period 2010- May 2017, 319 statutes and regulations (FEK) that concerned directly or indirectly pharmaceutical care were retrieved from the Government Gazette. A content analysis was performed on these documents to identify unique pharmaceutical policy
reforms. These measures were classified firstly with reference to their character as cost containment (white area) or rationing (black area) or a mixture of those (grey area), and, secondly, with respect to cost reallocation to the tax-funded National Health System (NHS) or the social security funds or health consumers.
Results: 84 FEK encompassed 115 measures, which were categorised as 82.6% belonging in the white area, 16.5% in the grey area, and 0.9% in the black area. Of those, 51.3% concerned price regulations, 17.4% prescription control, 13.9% cash limits, volume restrictions and benefit caps, 6.1% co-payments, 6.1% waste avoidance, 2.6% exclusion from reimbursement, 1.7% elimination of surplus resources and 0.9% scarcity of resources. 64 FEK were identified to contain 92 unique measures of cost reallocation. 17.4% of them transferred pharmaceutical cost to the NHS, 22.8% to the social security funds, and 59.8% (35.9% directly, 23.9% indirectly) to consumers.
Conclusions:
Pharmaceutical reforms during the recent years present a clear tendency to reallocate pharmaceutical cost to consumers. Considering the economic challenges the Greek citizens are facing and the already privatised nature of the Greek health system, policies should focus more on improving health system’s efficiency and effectiveness, instead of increasing out-of-pocket payments, which may exacerbate barriers to pharmaceutical access, especially for the more vulnerable groups.