@article{Athanasakis2022-dw,

title = {'Inclusive' health systems increase healthy life expectancy},

author = {Kostas Athanasakis},

year  = {2022},

date = {2022-05-01},

journal = {Rural Remote Health},

volume = {22},

number = {2},

pages = {7014},

address = {Australia},

abstract = {INTRODUCTION: This article attempts to investigate whether 

 inclusive health systems increase societal welfare, with the 

 latter expressed through estimates of healthy life expectancy 

 (HLE). METHODS: The analysis uses publicly available data by the 

 Organisation for Economic Co-operation and Development and 

 explores the relationship of HLE at the age of 65 years (HLE_65) 

 with four variables that are representative of institutional 

 inclusivity or extractiveness of health systems. RESULTS: Results 

 indicate that HLE_65 is positively associated with healthcare 

 system institutional inclusivity as expressed in terms of the 

 share of public healthcare expenditure and the spending on 

 preventive care. HLE_65 is inversely associated with the 

 strength of extracting characteristics of the system, such as the 

 market power of physicians and the share of specialists in the 

 total number of physicians. CONCLUSION: In this light, the 

 development of health policies that aim to strengthen inclusive 

 institutions, such as the focus on prevention, financial 

 protection and primary care, could have a significant positive 

 impact in collective welfare and social cohesion - especially for 

 populations in rural, remote and less developed parts of the 

 world.},

keywords = {extractiveness; health system performance; healthy life   expectancy; inclusivity; collective welfare},

pubstate = {published},

tppubtype = {article}

}

@article{Garani-Papadatos2022-il,

title = {Ethical Principles in Digital Palliative Care for Children: The 

 MyPal Project and Experiences Made in Designing a Trustworthy 

 Approach},

author = {Tina Garani-Papadatos and Pantelis Natsiavas and Marcel Meyerheim and Stefan Hoffmann and Christina Karamanidou and Sheila A Payne},

year  = {2022},

date = {2022-03-01},

journal = {Front Digit Health},

volume = {4},

pages = {730430},

abstract = {This paper explores the ethical dimension of the opportunity to 

 offer improved electronic patient-reported outcome (ePRO) systems 

 addressing personal needs of pediatric cancer patients, their 

 parents and caregivers, with regard to technological advance of 

 digital health. This opportunity has been explored in the MyPal 

 research project, which aims to assess a patient-centered service 

 for palliative care relying on the adaptation and extension of 

 digital health tools and concepts available from previous 

 projects. Development and implementation of ePROs need to take 

 place in a safe, secure and responsible manner, preventing any 

 possible harm and safeguarding the integrity of humans. To that 

 end, although the final results will be published at the end of 

 the project, this paper aims to increase awareness of the ethical 

 ramifications we had to address in the design and testing of new 

 technologies and to show the essentiality of protection and 

 promotion of privacy, safety and ethical standards. We have thus 

 reached a final design complying with the following principles: 

 (a) respect for the autonomy of participants, especially 

 children, (b) data protection and transparency, (c) fairness and 

 non-discrimination, (d) individual wellbeing of participants in 

 relation to their physical and psychological health status and e) 

 accessibility and acceptability of digital health technologies 

 for better user-engagement. These principles are adapted from the 

 Ethics Guidelines for a trustworthy Artificial Intelligence (AI) 

 which provide the framework for similar interventions to be 

 lawful, complying with all applicable laws and regulations, 

 ethical, ensuring compliance to ethical principles and values and 

 robust, both from a technical and social perspective.},

keywords = {acceptability; cancer; children; digital health; palliative care;   research ethics; trustworthiness},

pubstate = {published},

tppubtype = {article}

}

@article{Polaris_Observatory_HCV_Collaborators2022-ib,

title = {Global change in hepatitis C virus prevalence and cascade of  care between 2015 and 2020: a modelling study},

author = {Polaris Observatory HCV Collaborators (Kostas Athanasakis)},

year  = {2022},

date = {2022-02-01},

urldate = {2022-02-01},

journal = {Lancet Gastroenterol Hepatol},

volume = {7},

number = {5},

pages = {396--415},

address = {Netherlands},

abstract = {BACKGROUND: Since the release of the first global hepatitis 

 elimination targets in 2016, and until the COVID-19 pandemic 

 started in early 2020, many countries and territories were making 

 progress toward hepatitis C virus (HCV) elimination. This study 

 aims to evaluate HCV burden in 2020, and forecast HCV burden by 

 2030 given current trends. METHODS: This analysis includes a 

 literature review, Delphi process, and mathematical modelling to 

 estimate HCV prevalence (viraemic infection, defined as HCV 

 RNA-positive cases) and the cascade of care among people of all 

 ages (age $geq$0 years from birth) for the period between Jan 1, 

 2015, and Dec 31, 2030. Epidemiological data were collected from 

 published sources and grey literature (including government 

 reports and personal communications) and were validated among 

 country and territory experts. A Markov model was used to 

 forecast disease burden and cascade of care from 1950 to 2050 for 

 countries and territories with data. Model outcomes were 

 extracted from 2015 to 2030 to calculate population-weighted 

 regional averages, which were used for countries or territories 

 without data. Regional and global estimates of HCV prevalence, 

 cascade of care, and disease burden were calculated based on 235 

 countries and territories. FINDINGS: Models were built for 110 

 countries or territories: 83 were approved by local experts and 

 27 were based on published data alone. Using data from these 

 models, plus population-weighted regional averages for countries and territories without models (n=125), we estimated a global 

 prevalence of viraemic HCV infection of 0·7% (95% UI 0·7-0·9), 

 corresponding to 56·8 million (95% UI 55·2-67·8) infections, on 

 Jan 1, 2020. This number represents a decrease of 6·8 million 

 viraemic infections from a 2015 (beginning of year) prevalence 

 estimate of 63·6 million (61·8-75·8) infections (0·9% [0·8-1·0] 

 prevalence). By the end of 2020, an estimated 12·9 million 

 (12·5-15·4) people were living with a diagnosed viraemic 

 infection. In 2020, an estimated 641 000 (623 000-765 000) 

 patients initiated treatment. INTERPRETATION: At the beginning of 

 2020, there were an estimated 56·8 million viraemic HCV 

 infections globally. Although this number represents a decrease 

 from 2015, our forecasts suggest we are not currently on track to 

 achieve global elimination targets by 2030. As countries recover 

 from COVID-19, these findings can help refocus efforts aimed at 

 HCV elimination. FUNDING: John C Martin Foundation, Gilead 

 Sciences, AbbVie, ZeShan Foundation, and The Hepatitis Fund.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Pronk2022-pt,

title = {Applying the exposome concept to working life health: The EU 

 EPHOR project},

author = {Anjoeka Pronk and Miranda Loh and Eelco Kuijpers and Maria Albin and Jenny Selander and Lode Godderis and Manosij Ghosh and Roel Vermeulen and Susan Peters and Ingrid Sivesind Mehlum and Michelle C Turner and Vivi Schlünssen and Marcel Goldberg and Manolis Kogevinas and Barbara N Harding and Svetlana Solovieva and Tina Garani-Papadatos and Martie Tongeren and EPHOR Consortium and Rob Stierum},

year  = {2022},

date = {2022-02-01},

journal = {Environ Epidemiol},

volume = {6},

number = {2},

pages = {e185},

abstract = {Exposures at work have a major impact on noncommunicable diseases 

 (NCDs). Current risk reduction policies and strategies are 

 informed by existing scientific evidence, which is limited due to 

 the challenges of studying the complex relationship between 

 exposure at work and outside work and health. We define the 

 working life exposome as all occupational and related 

 nonoccupational exposures. The latter includes nonoccupational 

 exposures that may be directly or indirectly influenced by or 

 interact with the working life of the individual in their 

 relation to health. The Exposome Project for Health and 

 Occupational Research aims to advance knowledge on the complex 

 working life exposures in relation to disease beyond the single 

 high exposure-single health outcome paradigm, mapping and 

 relating interrelated exposures to inherent biological pathways, 

 key body functions, and health. This will be achieved by 

 combining (1) large-scale harmonization and pooling of existing 

 European cohorts systematically looking at multiple exposures and 

 diseases, with (2) the collection of new high-resolution external 

 and internal exposure data. Methods and tools to characterize the 

 working life exposome will be developed and applied, including 

 sensors, wearables, a harmonized job exposure matrix (EuroJEM), 

 noninvasive biomonitoring, omics, data mining, and 

 (bio)statistics. The toolbox of developed methods and knowledge 

 will be made available to policy makers, occupational health 

 practitioners, and scientists. Advanced knowledge on working life 

 exposures in relation to NCDs will serve as a basis for 

 evidence-based and cost-effective preventive policies and 

 actions. The toolbox will also enable future scientists to 

 further expand the working life exposome knowledge base.},

keywords = {Exposome; Noncommunicable disease; Occupational; Working life},

pubstate = {published},

tppubtype = {article}

}

@article{Athanasakis2021-cu,

title = {A 10-year economic analysis of HIV management in Greece: 

 evidence of efficient resource allocation},

author = {Kostas Athanasakis and Vasiliki Naoum and Panagiota Naoum and Nikos Nomikos and Dorina Theodoratou and John Kyriopoulos},

year  = {2021},

date = {2021-12-01},

journal = {Curr Med Res Opin},

volume = {38},

number = {2},

pages = {265--271},

address = {England},

abstract = {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.},

keywords = {HIV; HIV care; HIV cost; cost analysis; disease management;   efficiency},

pubstate = {published},

tppubtype = {article}

}

@article{Naoum2021-xa,

title = {Self-medication in Greece: the financial impact from expanding 

 the OTC market},

author = {Vasiliki Naoum and Nikos Nomikos and Panagiota Naoum and Kostas Athanasakis and John Kyriopoulos},

year  = {2021},

date = {2021-12-01},

journal = {Int J Pharm Pract},

volume = {29},

number = {6},

pages = {541--547},

address = {England},

abstract = {OBJECTIVES: To assess the financial impact of self-medication 

 enhancement through a potential expansion of the over-the-counter 

 (OTC) drug list in Greece. METHODS: An analysis consisting of two 

 scenarios was conducted. The first scenario estimated the 

 financial effects of hypothetically switching 5% of the volume 

 of the total sales of reimbursed drugs in Greece to OTC, while 

 the second scenario estimated the effects of switching to OTC the 

 total sales volume of a set of active substances (which are 

 currently reimbursed), facilitated by a consensus panel meeting. 

 The analysis was conducted from the third-party payer, individual 

 and societal perspectives. Data and costs refer to the year 2019. 

 KEY FINDINGS: Switching 5% of the volume of the total sales of 

 reimbursed drugs to OTC was estimated to lead to total annual 

 savings of 227.57 million euros. The annual savings from the 

 third-party payer, individual and societal perspectives were 

 estimated at 97.06 million euros, 91.81 million euros and 38.69 

 million euros, respectively. Switching the total sales volume of 

 the reimbursed drugs of the active substances which emerged from 

 the consensus panel meeting was estimated to lead to total annual 

 savings of 567.57 million euros. The annual savings for the 

 third-party payer, individuals and society were estimated at 

 232.91 million euros, 241.01 million euros and 93.65 million 

 euros, respectively. CONCLUSIONS: Although the present analysis 

 is model-based, and thus did not incorporate some potentially 

 significant parameters, it demonstrated the financial savings 

 which a potential expansion of the OTC drug list could produce 

 for the third-party payer, individuals and society in Greece.},

keywords = {OTC; financial effects; self-medication; switch},

pubstate = {published},

tppubtype = {article}

}

@article{nokey,

title = {COVID-19 vaccination certificates and lifting public health and social measures: ethical considerations},

author = {Teck Chuan Voo and Maxwell J. Smith and Ignacio Mastroleo and Angus Dawson and WHO Ethics & COVID-19 Working Group},

doi = {http://doi.org/10.26719/emhj.22.023},

year  = {2021},

date = {2021-11-29},

urldate = {2021-06-01},

journal = {Eastern Mediterranean Health Journal},

abstract = {Background: To reopen society, various countries are planning or have implemented differential public health and social measures (PHSMs) for COVID-19-vaccinated individuals, by exempting these individuals from some of these measures or restricting access to specific activities or services to them.},

keywords = {COVID-19, ethics, pandemic, vaccination, vaccination certificates},

pubstate = {published},

tppubtype = {article}

}

@article{Scarfo2021-jm,

title = {MyPal ADULT study protocol: a randomised clinical trial of 

 the MyPal ePRO-based early palliative care system in adult 

 patients with haematological malignancies},

author = {Lydia Scarf`o and Christina Karamanidou and Michael Doubek and Tina Garani-Papadatos and Jana Didi and Charalampos Pontikoglou and Julie Ling and Cathy Payne and Helen $A$ Papadaki and Richard Rosenquist and Niki Stavroyianni and Sheila Payne and Paolo Ghia and Pantelis Natsiavas and Christos Maramis and Kostas Stamatopoulos},

year  = {2021},

date = {2021-11-01},

journal = {BMJ Open},

volume = {11},

number = {11},

pages = {e050256},

abstract = {INTRODUCTION: The systematic collection of electronic 

 patient-reported outcome (ePRO) in the routine care of patients 

 with chronic haematological malignancies such as chronic 

 lymphocytic leukaemia (CLL) and myelodysplasia syndromes (MDS) 

 can constitute a very ambitious but worthwhile challenge. MyPal 

 is a Horizon 2020 Research & Innovation Action aiming to meet 

 this challenge and foster palliative care for patients with CLL 

 or MDS by leveraging ePRO systems to adapt to the personal needs 

 of patients and caregiver(s). METHODS AND ANALYSIS: In this 

 interventional randomised trial, 300 patients with CLL or MDS 

 will be recruited across Europe. Patients will be randomly allocated to early palliative care using the MyPal system (n=150) 

 versus standard care including general palliative care if needed (n=150). Patients in the experimental arm will be given access to 

 the MyPal digital health platform which consists of purposely 

 designed software available on smartphones and/or tablets. The 

 platform entails different functionalities including physical and 

 psychoemotional symptom reporting via regular questionnaire 

 completion, spontaneous self-reporting, motivational messages, 

 medication management and a personalised search engine for health 

 information. Data on patients' activity (daily steps and sleep 

 quality) will be automatically collected via wearable devices. 

 ETHICS AND DISSEMINATION: The integration of ePROs via mobile 

 applications has raised ethical concerns regarding inclusion 

 criteria, information provided to participants, free and 

 voluntary consent, and respect for their autonomy. These have 

 been carefully addressed by a multidisciplinary team. Data 

 processing, dissemination and exploitation of the study findings 

 will take place in full compliance with European Union data 

 protection law. A participatory design was adopted in the 

 development of the digital platform involving focus groups and 

 discussions with patients to identify needs and preferences. The 

 protocol was approved by the ethics committees of San Raffaele 

 (8/2020), Thessaloniki 'George Papanikolaou' Hospital (849), 

 Karolinska Institutet (20.10.2020), University General Hospital 

 of Heraklion (07/15.4.2020) and University of Brno 

 (01-120220/EK). TRIAL REGISTRATION NUMBER: NCT04370457.},

keywords = {adult palliative care; health informatics; leukaemia},

pubstate = {published},

tppubtype = {article}

}

@article{Koulierakis2021,

title = {Determinants of healthy diet choices during austerity in Greece},

author = {George Koulierakis and Anastasia Dermatis and Nair-Tonia Vassilakou and Elpida Pavi and Dimitris Zavras and John Kyriopoulos},

url = {https://doi.org/10.1108/bfj-10-2020-0883},

doi = {10.1108/bfj-10-2020-0883},

year  = {2021},

date = {2021-11-01},

journal = {British Food Journal},

publisher = {Emerald},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Naoum2021-ih,

title = {Economic Evaluation of Digital Health Interventions in Palliative 

 Care: A Systematic Review of the Literature},

author = {Panagiota Naoum and Elpida Pavi and Kostas Athanasakis},

year  = {2021},

date = {2021-11-01},

journal = {Front Digit Health},

volume = {3},

pages = {730755},

abstract = {Introduction: Digital health interventions can facilitate the 

 provision of palliative care. However, the economic evaluation of 

 such interventions has not yet been a standard practice. The 

 present study aimed to identify the existing literature on the 

 particular subject. Methods: A systematic search was conducted in 

 six literature databases between 2010 and 2021: PubMed, Scopus, 

 DARE, NHS EED, Cochrane Database of Systematic Reviews, and 

 Cochrane Central Register of Controlled Trials. Methodological 

 quality was assessed with the Drummond Checklist. Results: The 

 search identified 423 publications, 66 of which were removed as 

 duplicates, resulting in 357 records to be screened by title and 

 abstract. Ten studies were subjected to full-text review and 3 

 were included in the analysis. The interventions of these studies 

 referred to video consultations and eHealth interventions for 

 symptom management. Overall, the digital health interventions 

 incurred lower costs compared with usual care or no intervention 

 and were considered cost saving and cost-effective. The 

 methodological quality of the studies was considered good. 

 Conclusion: The results of this systematic review indicate that 

 the use of digital health interventions has the potential to be 

 cost-effective in palliative care. However, applicability and 

 generalizability of the evidence is uncertain, mainly due to 

 methodological heterogeneity and scarcity of research.},

keywords = {costs and outcomes; digital health; economic evaluation;   palliative care; systematic review},

pubstate = {published},

tppubtype = {article}

}

@article{Meyerheim2021-qw,

title = {Challenges and Pitfalls for Implementing Digital Health Solutions 

 in Clinical Studies in Europe},

author = {Marcel Meyerheim and Anna Burns-Gebhart and Kasra Mirzaie and Tina Garani-Papadatos and Yvonne Braun and Norbert Graf},

year  = {2021},

date = {2021-09-01},

journal = {Front Digit Health},

volume = {3},

pages = {730680},

abstract = {The increasing number of digital solutions developed for use in 

 clinical health care settings is accompanied by new challenges to 

 develop and conduct clinical studies that include eHealth 

 technologies. Clinical study implementation plans often disregard 

 or underestimate the necessity of additional administrative and 

 logistic tasks required at clinical sites as well as ethical 

 aspects to test digital solutions. Experiences made in the run-up 

 of an observational clinical feasibility study at three 

 international clinical sites in the framework of the MyPal 

 project (https://mypal-project.eu/) result in recommendations to 

 avoid delays and barriers in the planning of such prospective 

 studies in clinical and also palliative care for increased 

 efficiency.},

keywords = {digital health; digital health platform; digital technology;   e-health; health care},

pubstate = {published},

tppubtype = {article}

}

@article{Nomikos2021-dk,

title = {Individuals' personal characteristics associated with private 

 health insurance policy possession in Greece},

author = {Nikos Nomikos and Panagiota Naoum and Vasiliki Naoum and Kostas Athanasakis and John Kyriopoulos and Elpida Pavi},

year  = {2021},

date = {2021-09-01},

journal = {Int J Health Plann Manage},

volume = {37},

number = {1},

pages = {361--371},

address = {England},

abstract = {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. $A$ 

 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.},

keywords = {private health insurance; voluntary health insurance},

pubstate = {published},

tppubtype = {article}

}

@article{Athanasakis2021-je,

title = {Two Sides of the Same Coin? A Dual Multiple Criteria Decision 

 Analysis of Novel Treatments Against Rheumatoid Arthritis in 

 Physicians and Patients},

author = {Kostas Athanasakis and Michael Igoumenidis and Nadia Boubouchairopoulou and Elli Vitsou and John Kyriopoulos},

year  = {2021},

date = {2021-08-01},

journal = {Clin Ther},

volume = {43},

number = {9},

pages = {1547--1557},

address = {United States},

abstract = {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.},

keywords = {multiple criteria decision analysis; rheumatoid arthritis; shared   decision-making; targeted immune modulators},

pubstate = {published},

tppubtype = {article}

}

@article{Ubalde-Lopez2021-ml,

title = {Working life, health and well-being of parents: a joint effort to 

 uncover hidden treasures in European birth cohorts},

author = {Monica Ubalde-Lopez and Tina Garani-Papadatos and Ghislaine Scelo and Maribel Casas and Claudia Lissåker and Susan Peters and Ellen Aagaard Nohr and Maria Albin and Raquel Lucas and Kyriaki Papantoniou and Kinga Pola'nska and Cecilia H Ramlau-Hansen and Jelena Sarac and Jenny Selander and Helena Skröder and Elena Vasileiou and Manolis Kogevinas and Ute Bültmann and Ingrid Sivesind Mehlum and Milena Maule},

year  = {2021},

date = {2021-08-01},

journal = {Scand J Work Environ Health},

volume = {47},

number = {7},

pages = {550--560},

abstract = {OBJECTIVE: Birth cohorts collect valuable and under-utilized 

 information on employment and health of parents before and during 

 pregnancy, at birth, and sometimes after birth. In this 

 discussion paper, we examine how these data could be exploited to 

 study the complex relationships and interactions between 

 parenthood, work, and health among parents themselves. METHODS: 

 Using a web-based database of birth cohorts, we summarize 

 information on maternal employment and health conditions and 

 other potentially related variables in cohorts spread throughout 

 Europe. This provided information on what data are available and 

 could be used in future studies, and what was missing if specific 

 questions are to be addressed, exploiting the opportunity to 

 explore work-health associations across heterogenous geographical 

 and social contexts. RESULTS: We highlight the many 

 potentialities provided by birth cohorts and identify gaps that 

 need to be addressed to adopt a life-course approach and 

 investigate topics specific to the peri-pregnancy period, such as 

 psychosocial aspects. We address the technical difficulties 

 implied by data harmonization and the ethical challenges related 

 to the repurposing of data, and provide scientific, ecological 

 and economic arguments in favor of improving the value of data 

 already available as a result of a serious investment in human 

 and material resources. CONCLUSIONS: There is a hidden treasure 

 in birth cohorts that deserves to be brought out to study the 

 relationships between employment and health among working parents 

 in a time when the boundaries between work and life are being 

 stretched more than ever before.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Zavras2021,

title = {Feeling Uncertainty during the Lockdown That Commenced in March 2020 in Greece},

author = {Dimitris Zavras},

url = {https://doi.org/10.3390/ijerph18105105},

doi = {10.3390/ijerph18105105},

year  = {2021},

date = {2021-05-01},

journal = {International Journal of Environmental Research and Public Health},

volume = {18},

number = {10},

pages = {5105},

publisher = {MDPI AG},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Naoum2021-zj,

title = {Cost-Benefit Analysis of Single versus Repeated Use of 

 Single-Use Devices in Cataract Surgery},

author = {Panagiota Naoum and Sotiria Palioura and Vasiliki Naoum and Nikos Nomikos and Konstantina Bachtalia and Konstantinos Zisis and Kostas Athanasakis and John Kyriopoulos},

year  = {2021},

date = {2021-04-01},

journal = {Clin Ophthalmol},

volume = {15},

pages = {1491--1501},

abstract = {PURPOSE: To estimate the net cost effect associated with the 

 real-world practice of repeated use of designated single-use 

 medical devices (SUDs) versus their proper single use in cataract 

 surgery in Greece. DESIGN: A cost-benefit analysis model was 

 constructed in the form of a decision tree. METHODS: A digital 

 expert panel was assembled in order to estimate the probabilities 

 of intraoperative and postoperative complications associated with 

 single and repeated use of SUDs. Unit costs for the management of 

 each complication were obtained from the official Greek 

 bulletins. A Monte Carlo-type sensitivity analysis was performed 

 to assess the robustness of the results. RESULTS: Based on the 

 probabilities of complications attained from the expert panel, 

 repeated use of SUDs is associated with a higher chance of 

 complications compared to single use, which results in higher 

 cost of complication management. Under the healthcare sector 

 perspective, the total expected cost per cataract surgery is 

 1,403.98€ (1,244.20€ the initial cost of cataract surgery plus 

 159.78€ the cost of adverse events) in the case of single use, 

 while for repeated use the total cost is 1,486.29€ (1,146.86€ + 

 339.43€, respectively) and, thus, repeated use of SUDs in 

 cataract surgery results in 82.31€ higher expected cost per 

 patient compared to their single use. Moreover, the societal 

 perspective analysis indicated even higher additional costs in 

 the case of SUD reuse (108.24€). CONCLUSION: Repeated use of SUDs 

 in cataract surgery is not appropriate, it jeopardizes patient 

 safety and carries a legal liability for the reuser. The present 

 study, which is the first to attach a monetary value to the 

 common yet questionable practice of SUD reuse, shows that it is 

 not cost beneficial. Therefore, it is expected that the results 

 will have implications in policy formulations to improve the 

 delivery of cataract healthcare.},

keywords = {SUDs; cataract; cataract surgery; single-use devices},

pubstate = {published},

tppubtype = {article}

}

@article{Vardavas2021-do,

title = {Cost-effectiveness of emergency preparedness measures in response  to infectious respiratory disease outbreaks: a systematic review  and econometric analysis},

author = {Constantine Vardavas and Katerina Nikitara and Konstantinos Zisis and Kostas Athanasakis and Revati Phalkey and Jo Leonardi-Bee and Helen Johnson and Svetla Tsolova and Massimo Ciotti and Jonathan E Suk},

year  = {2021},

date = {2021-04-01},

urldate = {2021-04-01},

journal = {BMJ Open},

volume = {11},

number = {4},

pages = {e045113},

abstract = {OBJECTIVES: Respiratory infectious disease outbreaks pose a 

 threat for loss of life, economic instability and social 

 disruption. We conducted a systematic review of published 

 econometric analyses to assess the direct and indirect costs of 

 infectious respiratory disease outbreaks that occurred between 

 2003 and 2019. SETTING: Respiratory infectious disease outbreaks 

 or public health preparedness measures or interventions 

 responding to respiratory outbreaks in OECD countries (excluding 

 South Korea and Japan) so as to assess studies relevant to the 

 European context. The cost-effectiveness of interventions was 

 assessed through a dominance ranking matrix approach. All cost 

 data were adjusted to the 2017 Euro, with interventions compared 

 with the null. We included data from 17 econometric studies. 

 PRIMARY AND SECONDARY OUTCOME MEASURES: Direct and indirect costs 

 for disease and preparedness and/or response or cost-benefit and 

 cost-utility were measured. RESULTS: Overall, the economic burden 

 of infectious respiratory disease outbreaks was found to be 

 significant to healthcare systems and society. Indirect costs 

 were greater than direct costs mainly due to losses of 

 productivity. With regard to non-pharmaceutical strategies, 

 prehospitalisation screening and the use of protective masks were 

 identified as both an effective strategy and cost-saving. 

 Community contact reduction was effective but had ambiguous 

 results for cost saving. School closure was an effective measure, 

 but not cost-saving in the long term. Targeted antiviral 

 prophylaxis was the most cost-saving and effective pharmaceutical 

 intervention. CONCLUSIONS: Our cost analysis results provide 

 evidence to policymakers on the cost-effectiveness of 

 pharmaceutical and non-pharmaceutical intervention strategies 

 which may be applied to mitigate or respond to infectious 

 respiratory disease outbreaks.},

keywords = {health economics; health policy; infection control; infectious   diseases; public health},

pubstate = {published},

tppubtype = {article}

}

@article{Meyerheim2021-nz,

title = {MyPal-Child study protocol: an observational prospective 

 clinical feasibility study of the MyPal ePRO-based early 

 palliative care digital system in paediatric oncology patients},

author = {Marcel Meyerheim and Christina Karamanidou and Sheila Payne and Tina Garani-Papadatos and Annette Sander and Julia Downing and Kostas Stamatopoulos and J Ling and Cathy Payne and Lydia Scarf`o and Petr Lokaj and Christos Maramis and Norbert Graf},

year  = {2021},

date = {2021-04-01},

journal = {BMJ Open},

volume = {11},

number = {4},

pages = {e045226},

abstract = {INTRODUCTION: Electronic patient-reported outcomes (ePROs) have 

 tremendous potential to optimise palliative and supportive care 

 for children with cancer, their families and healthcare 

 providers. Particularly, these children and their families are 

 subjected to multiple strains caused by the disease and its 

 treatment. The MyPal digital health platform is designed to 

 address these complex demands by offering pursuant ePRO-based 

 functionalities via two mobile applications, one developed for 

 children and the other for their parents. METHODS AND ANALYSIS: 

 In this observational prospective feasibility study, 100 

 paediatric oncology patients aged between 6 and 17 years and at 

 least one of their parents/legal guardians will be recruited at 

 three clinical sites in two European countries (Germany and Czech 

 Republic). They will use the mobile applications which are part 

 of the novel digital health platform. During a 6-month study 

 period, participants will complete various ePROs via the 

 applications addressing quality of life, satisfaction with care 

 and impact of the disease on the family at monthly intervals. 

 Additionally, priority-based symptom reporting is integrated into 

 a serious game for children. Outcomes that will be assessed 

 concern the feasibility and the evaluation of the newly designed 

 digital health platform to contribute to the evidence base of 

 clinical ePRO use in paediatric oncology and palliative care 

 process. ETHICS AND DISSEMINATION: The MyPal-Child study obtained 

 ethical approval from the Ethics Committee responsible for the 

 University of Saarland, that is, the Ärztekammer des 

 Saarlandes, the Ethics Committee of the Medical School Hannover 

 and the Ethics Committee of the University of Brno. Study results 

 will be disseminated through scientific publications, 

 presentations at international conferences, congresses and a 

 final report to the European Commission. General publicly 

 accessible information can be found on the project website 

 (www.mypal-project.eu) and social media. TRIAL REGISTRATION 

 NUMBERS: U1111-1251-0043, DRKS00021458, NCT04381221.},

keywords = {health informatics; paediatric oncology; paediatric palliative   care},

pubstate = {published},

tppubtype = {article}

}

@article{Athanasakis2021-qb,

title = {Can We Incorporate Societal Values in Resource Allocation 

 Decisions Among Disease Categories? An Empirical Approach},

author = {Kostas Athanasakis and Ilias Kyriopoulos and John Kyriopoulos},

year  = {2021},

date = {2021-02-01},

journal = {Value Health Reg Issues},

volume = {25},

pages = {29--36},

address = {United States},

abstract = {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.},

keywords = {MCDA; disease categories; health prioritization; resource   allocation},

pubstate = {published},

tppubtype = {article}

}

@article{Smith2021-dz,

title = {Top five ethical lessons of COVID-19 that the world must learn},

author = {Maxwell J Smith and Aasim Ahmad and Thalia Arawi and Angus Dawson and Ezekiel J Emanuel and Tina Garani-Papadatos and Prakash Ghimire and Zubairu Iliyasu and Ruipeng Lei and Ignacio Mastroleo and Roli Mathur and Joseph Okeibunor and Michael Parker and Carla Saenz and Beatriz Thomé and Ross E G Upshur and Teck Chuan Voo},

year  = {2021},

date = {2021-01-01},

urldate = {2021-01-01},

journal = {Wellcome Open Res},

volume = {6},

pages = {17},

abstract = {As the world reflects upon one year since the first cases of 

 coronavirus disease 2019 (COVID-19) and prepare for and 

 experience surges in cases, it is important to identify the most 

 crucial ethical issues that might lie ahead so that countries are 

 able to plan accordingly. Some ethical issues are rather obvious 

 to predict, such as the ethical issues surrounding the use of 

 immunity certificates, contact tracing, and the fair allocation 

 of vaccines globally. Yet, the most significant ethical challenge 

 that the world must address in the next year and beyond is to 

 ensure that we learn the ethical lessons of the first year of 

 this pandemic. Learning from our collective experiences thus far 

 constitutes our greatest moral obligation. Appreciating that 

 decision-making in the context of a pandemic is constrained by 

 unprecedented complexity and uncertainty, beginning in June 2020, 

 an international group of 17 experts in bioethics spanning 15 

 countries (including low-, middle-, and high-income countries) 

 met virtually to identify what we considered to be the most 

 significant ethical challenges and accompanying lessons faced 

 thus far in the COVID-19 pandemic. Once collected, the group met 

 over the course of several virtual meetings to identify 

 challenges and lessons that are analytically distinct in order to 

 identify common ethical themes under which different challenges 

 and lessons could be grouped. The result, described in this 

 paper, is what this expert group consider to be the top five 

 ethical lessons from the initial experience with COVID-19 that 

 must be learned.},

keywords = {COVID-19; Ethics},

pubstate = {published},

tppubtype = {article}

}

@article{10.1093/jphsr/rmab050,

title = {Giving patients a voice in Health Technology Assessment decision-making in Greece: a patient advocacy group consensus analysis},

author = {Kostas Athanasakis and Vasiliki Naoum and Eleftheria Karampli and Panagiota Naoum and Elpida Pavi and John Kyriopoulos},

url = {https://doi.org/10.1093/jphsr/rmab050},

doi = {10.1093/jphsr/rmab050},

issn = {1759-8893},

year  = {2021},

date = {2021-01-01},

journal = {Journal of Pharmaceutical Health Services Research},

volume = {12},

number = {4},

pages = {583-586},

abstract = {This analysis aimed to assess patient advocacy groups’ (PAGs) perspectives on patients’ and PAGs’ potential role in Health Technology Assessment (HTA) decision-making in Greece.In total, 22 representatives of PAGs participated in a consensus panel meeting. Participants’ views were elicited via a consensus panel meeting, through a televoting procedure, based on a structured questionnaire with close-ended questions. Voting was anonymous, to avoid the influence of the dominant personality. After voting, the results were presented to the participants and televoting was repeated to achieve consensus.The majority of participants (94.8%) believe that valid information on the developments regarding HTA in Greece is not conveyed to them by the official national regulatory sources. Key sources of valid information on developments regarding HTA were: conferences (95.2%), international PAGs (85.7%) and HTA experts/scientists (76.2%). About 76.2% of participants evaluated PAGs’ competence to participate in policy-making concerning HTA scheme formation as moderate or higher. Regarding patients’ effective participation in HTA decision-making, greater importance (points 4 and 5 on a 5-point scale) was given to their education on treatment effects in terms of quality of life (100.0%), basic principles of health economics and pharmaceutical policy (95.5%) and ethical aspects of HTA (95.0%). About 55.0% strongly agree that patients should formally express their opinion on HTA issues, while 72.7% believe that patients’ opinions on HTA issues should be expressed through participation in the process and right to vote.The participation of patients in HTA decision-making is an issue not only of justice but also of essence. For a productive participation, PAGs training is essential.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Koulierakis2021DeterminantsOH,

title = {Determinants of healthy diet choices during austerity in Greece},

author = {George Koulierakis and Anastasia Dermatis and Nair-Tonia Vassilakou and Elpida Pavi and Dimitris Zavras and John Kyriopoulos},

year  = {2021},

date = {2021-01-01},

urldate = {2021-01-01},

journal = {British Food Journal},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{world2030024,

title = {Studying Satisfaction with the Restriction Measures Implemented in Greece during the First COVID-19 Pandemic Wave},

author = {Dimitris Zavras},

url = {https://www.mdpi.com/2673-4060/2/3/24},

doi = {10.3390/world2030024},

issn = {2673-4060},

year  = {2021},

date = {2021-01-01},

journal = {World},

volume = {2},

number = {3},

pages = {379--390},

abstract = {There is an ongoing debate regarding the effectiveness of policy responses to the coronavirus disease 2019 (COVID-19) pandemic. As satisfaction with such measures is a function of their effectiveness, the main objective of this study was to identify the factors driving satisfaction with the measures implemented in Greece during the first pandemic wave. The study used data from the first round of the “Public Opinion in the European Union (EU) in Time of Coronavirus Crisis” survey. The sample consisted of 1050 individuals aged between 16 and 54 years. The results of the analysis, which was based on an adjacent category logistic model, indicate that materially deprived individuals were less likely to be satisfied with the restriction measures, while those considering that the health benefits were greater than the economic damage, those concerned for their own health and those concerned for the health of their family and friends were more likely to be satisfied with the restriction measures. The results confirm the existence of uncertainty regarding the effectiveness and impacts of the restriction measures.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Zisis2020-ej,

title = {Qualitative comparative analysis of health economic evaluation 

 guidelines for health technology assessment in European countries},

author = {Konstantinos Zisis and Panagiota Naoum and Kostas Athanasakis},

year  = {2020},

date = {2020-12-01},

journal = {Int J Technol Assess Health Care},

volume = {37},

pages = {e2},

address = {England},

abstract = {OBJECTIVE: To classify, analyze, and compare published guidelines 

 for economic evaluation within health technology assessment (HTA) 

 in European countries and highlight differences and similarities. 

 METHODS: We performed a literature review to identify published 

 guidance for the conduct and assessment of economic evaluation 

 studies that are undertaken within the context of HTA processes 

 in European countries. Organizations and working groups were 

 identified via the ISPOR, INAHTA, and EUnetHTA databases. 

 Following the identification of official documents, we performed 

 a qualitative content analysis to highlight discrepancies or 

 common practices under the following categories: comparator, 

 perspective on costs/benefits, time horizon, economic evaluation 

 method, instrument used for utility measurement, outcome measure, 

 source for efficacy, modeling, sensitivity analysis, discounting, 

 and incremental cost-effectiveness ratio. RESULTS: A total of 

 nineteen guidance documents were identified (in English) 

 providing data for the analysis in nineteen countries. The 

 comparative content analysis identified common practices in most 

 countries regarding the approaches to the choice of comparator, 

 source of data, the preferred economic evaluation method, the 

 option for a lifetime analytical horizon, discounting, and the 

 choice of key outcome measure-for which, most countries recommend 

 the use of the EQ-5D instrument. Differences were mainly found in 

 the choice of perspective, dealing with uncertainty and 

 sensitivity analysis, the use of end points, and the required use 

 of modeling. CONCLUSIONS: The use of economic evaluation 

 constitutes one of the key pillars of the HTA process in Europe. 

 Although a methodological convergence has occurred during the 

 last few years, notable differences still remain.},

keywords = {Economic evaluation; European Union; Guidelines; Health   technology assessment},

pubstate = {published},

tppubtype = {article}

}

@article{Zavras2020,

title = {Studying Healthcare Affordability during an Economic Recession: The Case of Greece},

author = {Dimitris Zavras},

url = {https://doi.org/10.3390/ijerph17217790},

doi = {10.3390/ijerph17217790},

year  = {2020},

date = {2020-10-01},

journal = {International Journal of Environmental Research and Public Health},

volume = {17},

number = {21},

pages = {7790},

publisher = {MDPI AG},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Naoum2020-uo,

title = {Idiopathic Pulmonary Fibrosis: Utilization of Health Services and 

 Out-Of-Pocket Health Expenditures in Greece},

author = {Panagiota Naoum and Kostas Athanasakis and Anastasis Skroumpelos and John Kyriopoulos},

year  = {2020},

date = {2020-08-01},

journal = {Value Health Reg Issues},

volume = {22},

pages = {44--48},

address = {United States},

abstract = {OBJECTIVES: Idiopathic pulmonary fibrosis (IPF) is a severe 

 progressive disease with poor prognosis. Patients show an 

 increased healthcare utilization pattern consisting of regular 

 physician consultations and monitoring tests. The aim of the 

 present study was to estimate healthcare resource utilization and 

 out-of-pocket expenditures for IPF patients in Greece. METHODS: 

 An IPF-specific questionnaire was constructed, which focused on 

 retrospective healthcare resource utilization and out-of-pocket 

 expenditures within a 6-month period. Upon informed consent, the 

 questionnaires were completed anonymously. RESULTS: The study 

 sample included 123 IPF patients. Within a 6-month period, 85.4% 

 of the patients visited their treating physician (mean, 2.35; 

 standard deviation [SD], 1.400), 29.4% visited other physicians 

 for IPF-related reasons (mean, 1.90; SD, 1.595), 42.9% visited a 

 healthcare setting, and 10.6% required hospitalization (mean 

 duration, 2.86 days; SD, 3.338). Spirometry (98.1%) and blood 

 tests (88.5%) were the most common tests for IPF monitoring. 

 Almost half of the respondents (48.6%) stated they had private 

 expenditures for IPF medication, physician visits, hospital 

 services, medical tests, or other IPF-related reasons. 

 CONCLUSIONS: IPF management requires regular contact with 

 healthcare services and uptake of specific medical tests. 

 Considering the high proportion of patients bearing out-of-pocket 

 costs, along with the decline of incomes in Greece, improvement 

 of the disease management is important, and action should be 

 taken to lower the financial burden imposed on patients.},

keywords = {IPF idiopathic pulmonary fibrosis; healthcare use; private   expenditure},

pubstate = {published},

tppubtype = {article}

}

@article{Konerding2020-gw,

title = {The impact of accessibility and service quality on the frequency 

 of patient visits to the primary diabetes care provider: results 

 from a cross-sectional survey performed in six European countries},

author = {Uwe Konerding and Tom Bowen and Sylvia G Elkhuizen and Raquel Faubel and Paul Forte and Eleftheria Karampli and Tomi Malmström and Elpida Pavi and Paulus Torkki},

year  = {2020},

date = {2020-08-01},

journal = {BMC Health Serv Res},

volume = {20},

number = {1},

pages = {800},

abstract = {BACKGROUND: Visits to the primary diabetes care provider play a 

 central role in diabetes care. Therefore, patients should attend 

 their primary diabetes care providers whenever a visit is 

 necessary. Parameters that might affect whether this condition is 

 fulfilled include accessibility (in terms of travel distance and 

 travel time to the practice), as well as aspects of service 

 quality (for example in-practice waiting time and quality of the 

 provider's communication with the patient). The relationships of 

 these variables with the frequency of visits to the primary 

 diabetes care provider are investigated. METHODS: The 

 investigation is performed with questionnaire data of 1086 type 2 

 diabetes patients from study regions in England (213), Finland 

 (135), Germany (218), Greece (153), the Netherlands (296) and 

 Spain (71). Data were collected between October 2011 and March 

 2012. Data were analysed using log-linear Poisson regression 

 models with self-reported numbers of visits in a year to the 

 primary diabetes care provider as the criterion variable. 

 Predictor variables of the core model were: country; gender; age; 

 education; stage of diabetes; heart problems; previous stroke; 

 problems with lower extremities; problems with sight; kidney 

 problems; travel distance and travel time; in-practice waiting 

 time; and quality of communication. To test region-specific 

 characteristics, the interaction between the latter four 

 predictor variables and study region was also investigated. 

 RESULTS: When study regions are merged, travel distance and 

 in-practice waiting time have a negative effect, travel time no 

 effect and quality of communication a positive effect on visit 

 frequency (with the latter effect being by far largest). When 

 region specific effects are considered, there are strong 

 interaction effects shown for travel distance, in-practice 

 waiting time and quality of communication. For travel distance, 

 as well as for in-practice waiting time, there are 

 region-specific effects in opposite directions. For quality of 

 communication, there are only differences in the strength with 

 which visit frequency increases with this variable. CONCLUSIONS: 

 The impact of quality of communication on visit frequency is the 

 largest and is stable across all study regions. Hence, increasing 

 quality of communication seems to be the best approach for 

 increasing visit frequency.},

keywords = {Accessibility to care; Health care provider; In-practice waiting   time; Provider-patient communication; Travel distance; Travel   time; Type 2 diabetes; Visit},

pubstate = {published},

tppubtype = {article}

}

@article{Naoum2020-ef,

title = {Community acquired pneumonia: a cost-of-illness analysis in 

 Greece},

author = {Panagiota Naoum and Kostas Athanasakis and Ilias Kyriopoulos and Adamantia Liapikou and Michail Toumbis and John Kyriopoulos},

year  = {2020},

date = {2020-06-01},

journal = {Rural Remote Health},

volume = {20},

number = {2},

pages = {5400},

address = {Australia},

abstract = {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.},

keywords = {Greece; community acquired pneumonia; cost of illness; economic   burden; CAP},

pubstate = {published},

tppubtype = {article}

}

@article{nokey,

title = {A futures literacy application in health care: The managed outcomes project case study},

author = {Paul Forte and R. (Riel) Miller and Tom Bowen and Jan Vissers and Raquel Faubel and Elpida Pavi and Tomi Malmström},

doi = {10.6531/JFS.20200324(3).0004},

year  = {2020},

date = {2020-03-01},

urldate = {2020-03-01},

journal = {Journal of Futures Studies},

volume = {24},

number = {3},

pages = {51-61},

abstract = {A Futures Literacy application to a major healthcare project is described. Funded under the EU FP7 framework, the 'Man-aged Outcomes' project modelled resource usage across four different medical conditions and linked this with patient health outcomes. A Futures Literacy approach was undertaken to explore scenarios for future care provision in 18 workshops, and five languages. Facilitator training, workshop preparation, delivery and outcomes are described. The process provided a consistent framework for generating relevant outputs from local care professionals and indicated potential operational process developments to improve patient outcomes.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Athanasakis2020-bu,

title = {Twenty-year trends in the prescription costs of Type 2 diabetes: 

 Real world data and empirical analysis in Greece},

author = {Kostas Athanasakis and Elisavet Prodromiadou and Athanasia Papazafiropoulou and Anastasios Koutsovasilis and Stamatina Driva and Maria Ziori and Elias Georgopoulos and Dimitris Gougourelas and Alexios Sotiropoulos and Stauros Bousboulas and Andreas Melidonis and Stauros Liatis},

year  = {2020},

date = {2020-02-01},

journal = {Diabetes Res Clin Pract},

volume = {162},

pages = {108095},

address = {Ireland},

abstract = {AIMS: To estimate and compare the prescription costs for the 

 management of patients with diabetes over a period of 20 years in 

 Greece, based on real world data. METHODS: The records of 

 outpatients with T2D, monitored at three diabetes centres, were 

 examined in four cross-sections (1998, 2006, 2012, 2018). 

 Prescribed medicines per patient, along with a set of clinical 

 indicators were recorded. Annual costs of pharmaceutical 

 treatment per patient were calculated by using each year's 

 nominal retail prices, as well as by adjusting for 2018 price 

 levels, in order to account for price differences over time. 

 RESULTS: 4066 patients were included in the analysis. 

 Prescription patterns indicate a quick uptake of the new classes 

 of glucose-lowering drugs and a reduction in the proportional use 

 of sulfonylurea and glitazone. Adjusting for 2018 prices, the 

 average total annual prescription cost per patient was 381.54 

 Euros (s.d. 297.44) in 1998 and 1147.21 Euros (s.d. 814.39) in 

 2018. Glucose-lowering drug costs per patient increase from 1998 

 onwards, whereas the costs of antihypertensive, antiplatelet and 

 lipid-lowering treatment declined gradually, especially after 

 2006. CONCLUSIONS: Per patient prescription costs for 

 glucose-lowering drugs present a steep increase, in Greece over 

 the last 20 years. Real-world evidence studies that compare this 

 increase with the changes in patient outcomes are essential in 

 order to examine whether a costs-vs-outcomes balance is optimal.},

keywords = {Economic analysis; Glucose-lowering drugs cost; Prescription   costs; Real world data},

pubstate = {published},

tppubtype = {article}

}

@article{article,

title = {What Influences Self-Perceived Quality of Life During an Economic Recession? The Case of Greece},

author = {Dimitris Zavras and Ilias-Ioannis Kyriopoulos and Kostas Athanasakis and John Kyriopoulos and Mohamed Buheji},

doi = {10.5923/j.ijire.20200402.01},

year  = {2020},

date = {2020-01-01},

urldate = {2021-01-01},

volume = {5},

pages = {41-49},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Athanasakis2020-nj,

title = {A cost of illness analysis of hepatocellular carcinoma for the 

 Greek healthcare setting},

author = {Kostas Athanasakis and Fani Pliarchopoulou and Vasiliki Naoum and Christos Psarrakis and Nikolaos Tziolos and Theodoros Marantos and Christina Damoulari and Athina Chounta},

year  = {2020},

date = {2020-01-01},

journal = {Gastroenterol Hepatol Bed Bench},

volume = {13},

number = {3},

pages = {219--222},

abstract = {AIM: To estimate the cost per patient for hepatocellular 

 carcinoma in Greece, a setting that is currently facing financial 

 constraints. BACKGROUND: Hepatocellular carcinoma patient 

 management strategies are associated with significant costs. 

 Despite this, patient level data on healthcare resource use and 

 cost-of-illness analyses of hepatocellular carcinoma remain 

 rather scarce in the international literature. METHODS: 123 

 patients diagnosed with hepatocellular carcinoma and followed in 

 a specialised clinic of a tertiary hospital in Greece formed the 

 basis of the analysis. Detailed resource use data were derived 

 from the medical records of each patient. Data were recorded from 

 the first encounter of the patient with the facility until a 

 fatal endpoint or until the last day of follow up. Patients that 

 were lost to follow-up were excluded from the analysis. 

 Calculations follow a third-party payer perspective, according to 

 official prices and tariffs. RESULTS: The average cost per 

 patient was estimated at 12,119.1 Euros (SD: 14,670.3) (21,375.1 

 PPP USD) for the average follow-up period and 10,241.5 Euros 

 (18,063.5 PPP USD) per year. Median costs per month of follow-up 

 according to underlying disease were 1,218.1, 1,376.8, 1,521.3 

 and 686.9 Euros (2,148.4, 2,428.3, 2,683.2 and 1,211.5 PPP USD) 

 for patients with alcoholic steatohepatitis, hepatitis B, 

 hepatitis C and non-alcoholic fatty liver disease, respectively. 

 CONCLUSION: Hepatocellular carcinoma represents a heavy toll, 

 both from the clinical as well as from the economic perspective, 

 especially for a setting in ``dire straits''. Interventions 

 towards reducing the incidence and, subsequently, the cost of HCC 

 are imperative.},

keywords = {Cost-of-illness; Economic evaluation; Hepatocellular cancer},

pubstate = {published},

tppubtype = {article}

}

@article{Zawati2019-le,

title = {Country Reports},

author = {Ma'n H Zawati and Don Chalmers and Sueli G Dallari and Marina Neiva Borba and Miriam Pinkesz and Yann Joly and Haidan Chen and Mette Hartlev and Liis Leitsalu and Sirpa Soini and Emmanuelle Rial-Sebbag and Nils Hoppe and Tina Garani-Papadatos and Panagiotis Vidalis and Krishna Ravi Srinivas and Gil Siegal and Stefania Negri and Ryoko Hatanaka and Maysa Al-Hussaini and Amal Al-Tabba' and Lourdes Motta-Murg'ia and Laura Estela Torres Moran and Aart Hendriks and Obiajulu Nnamuchi and Rosario Isasi and Dorota Krekora-Zajac and Eman Sadoun and Calvin Ho and Pamela Andanda and Won Bok Lee and Pilar Nicolás and Titti Mattsson and Vladislava Talanova and Alexandre Dosch and Dominique Sprumont and Chien-Te Fan and Tzu-Hsun Hung and Obiajulu Nnamuchi and Jane Kaye and Andelka Phillips and Heather Gowans and Nisha Shah and James W Hazel},

year  = {2019},

date = {2019-12-01},

journal = {J Law Med Ethics},

volume = {47},

number = {4},

pages = {582--704},

address = {England},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Maltezou2019-vz,

title = {Costs associated with measles in healthcare personnel during the  2017-2018 epidemic in Greece: a real-world data cost-of-illness  analysis},

author = {H C Maltezou and X Dedoukou and Elpida Pavi and M Theodoridou and Kostas Athanasakis},

year  = {2019},

date = {2019-12-01},

urldate = {2019-12-01},

journal = {J Hosp Infect},

volume = {105},

number = {1},

pages = {91--94},

address = {England},

abstract = {Measles represents an occupational risk for healthcare personnel 

 (HCP). A total of 117 cases of measles among HCP were notified in 

 Greece during 2017-2018. We were able to contact 46 of them. Most 

 of those contacted had a serious clinical course with 

 complications, necessitating hospitalization in 67% of cases. 

 All HCP reported absenteeism, for a mean duration of 21.2 working 

 days (range: 3-60 days); 54.3% of HCP reported being at work 

 while symptomatic for a mean duration of 2.3 working days (range: 

 1-7 days). The average total cost-of-illness was €4,739 per HCP. 

 The total direct and indirect costs of the 117 notified cases 

 among HCP amount to €554,494, which is likely to be an 

 underestimate of the true cost.},

keywords = {Absenteeism; Cost; Healthcare personnel; Measles; Presenteeism;   Vaccination},

pubstate = {published},

tppubtype = {article}

}

@article{Mahdavi2019-xl,

title = {Correction: The relationship between context, structure, and 

 processes with outcomes of 6 regional diabetes networks in Europe},

author = {Mahdi Mahdavi and Jan Vissers and Sylvia Elkhuizen and Mattees Dijk and Antero Vanhala and Eleftheria Karampli and Raquel Faubel and Paul Forte and Elena Coroian and Joris Klundert},

year  = {2019},

date = {2019-11-01},

journal = {PLoS One},

volume = {14},

number = {11},

pages = {e0225619},

abstract = {[This corrects the article DOI: 10.1371/journal.pone.0192599.].},

keywords = {},

pubstate = {published},

tppubtype = {article}

}