Publications by authors named "Theodoros V Giannouchos"

15 Publications

  • Page 1 of 1

Mandatory vaccination support and intentions to get vaccinated for COVID-19: Results from a nationally representative general population survey in October 2020 in Greece.

J Eval Clin Pract 2021 Jun 1. Epub 2021 Jun 1.

Department of Social and Education Policy, University of Peloponnese, Corinth, Greece.

Objectives: To explore rates and factors associated with mandatory vaccination support overall and intentions to get vaccinated specifically for COVID-19 among individuals in Greece.

Methods: Using data from a nationally representative cross-sectional survey conducted in October 2020 among 855 adults (≥18 years) in Greece, we estimated support rates for mandatory vaccination and respondents' intention to get vaccinated for COVID-19 as well as associations thereof with individual sociodemographic, clinical and contextual characteristics.

Results: About 74% of respondents supported mandatory vaccination and 62% intended to get vaccinated for COVID-19. The most prevalent reasons against COVID-19 vaccination were safety concerns related to the duration of clinical trials and potential side effects. Individuals who reported increased trust in healthcare authorities' recommendations, who revealed that their trust in the State increased due to the way the COVID-19 pandemic was handled, who used preventive services more often, and those with higher income were more likely to both support mandatory vaccination and to indicate intention to get vaccinated for COVID-19. Participants with worse or better self-reported health status (compared to average), younger adults, and females were less likely to intend to get vaccinated for COVID-19.

Conclusion: The survey revealed that the majority of the Greek citizens favour mandatory vaccination overall and intend to get vaccinated for COVID-19, driven mostly by utilization of preventive services and trust in healthcare authorities. However, intention to get vaccinated for COVID-19 was lower relative to mandatory vaccination support. This suggests a need to intensify evidence-based yet simplified messaging by esteemed healthcare providers to inform the public on the risks and benefits of vaccines.
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http://dx.doi.org/10.1111/jep.13588DOI Listing
June 2021

"Public Health Behaviors during the COVID-19 Pandemic in Greece and Associated Factors: A Nationwide Cross-sectional Survey".

Inquiry 2021 Jan-Dec;58:469580211022913

First Department of Psychiatry, Medical School, Aiginition Hospital, National & Kapodistrian University of Athens, Athens, Greece.

The objective of this cross-sectional survey was to estimate the association between multiple socioeconomic, and health-related characteristics, COVID-19 related attitudes and adoption of public health preventive behaviors. A national cross-sectional survey among 1205 adults was conducted in April 2020 in Greece. Multivariable ordered logistic regression models were used to estimate the association between COVID-19 related attitudes and knowledge and adoption of preventive behaviors, controlling for socioeconomic and health-related characteristics. A total of 923 individuals fully completed the survey. Individuals who believed that the virus is out of control, is transmitted through the air, and is not similar to the common flu were more likely to adopt public health preventive behaviors more frequently, particularly wearing masks in public spaces, washing their hands, and spending fewer hours out of their homes. Uncertainty about the virus symptomatology was associated with less frequent mask-wearing and handwashing. Increased social support, frequent media use for COVID-19 updates, trust to authorities, older age, worse health status, female gender and being a healthcare professional were also associated with uptake of some preventive health behaviors. Attitudinal and socioeconomic determinants critically affect public engagement in preventive behaviors. Health policy initiatives should focus on community outreach approaches to raise awareness and to strengthen social support mechanisms by integrating multiple stakeholders.
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http://dx.doi.org/10.1177/00469580211022913DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8170349PMC
June 2021

Identifying and prioritizing benefits and risks of using privacy-enhancing software through participatory design: a nominal group technique study with patients living with chronic conditions.

J Am Med Inform Assoc 2021 May 19. Epub 2021 May 19.

Population Informatics Lab, School of Public Health, Texas A&M University, College Station, Texas, USA.

Objective: While patients often contribute data for research, they want researchers to protect their data. As part of a participatory design of privacy-enhancing software, this study explored patients' perceptions of privacy protection in research using their healthcare data.

Materials And Methods: We conducted 4 focus groups with 27 patients on privacy-enhancing software using the nominal group technique. We provided participants with an open source software prototype to demonstrate privacy-enhancing features and elicit privacy concerns. Participants generated ideas on benefits, risks, and needed additional information. Following a thematic analysis of the results, we deployed an online questionnaire to identify consensus across all 4 groups. Participants were asked to rank-order benefits and risks. Themes around "needed additional information" were rated by perceived importance on a 5-point Likert scale.

Results: Participants considered "allowance for minimum disclosure" and "comprehensive privacy protection that is not currently available" as the most important benefits when using the privacy-enhancing prototype software. The most concerning perceived risks were "additional checks needed beyond the software to ensure privacy protection" and the "potential of misuse by authorized users." Participants indicated a desire for additional information with 6 of the 11 themes receiving a median participant rating of "very necessary" and rated "information on the data custodian" as "essential."

Conclusions: Patients recognize not only the benefits of privacy-enhancing software, but also inherent risks. Patients desire information about how their data are used and protected. Effective patient engagement, communication, and transparency in research may improve patients' comfort levels, alleviate patients' concerns, and thus promote ethical research.
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http://dx.doi.org/10.1093/jamia/ocab073DOI Listing
May 2021

The effect of expanded insurance coverage under the Affordable Care Act on emergency department utilization in New York.

Am J Emerg Med 2021 Apr 30;48:183-190. Epub 2021 Apr 30.

Population Informatics Lab, Texas A&M University, College Station, TX, USA; Texas A&M University, School of Public Health, Department of Health Policy & Management, College Station, TX, USA.

Background: One of the proposed benefits of expanding insurance coverage under the Affordable Care Act (ACA) was a reduction in emergency department (ED) utilization for non-urgent visits related to lack of health insurance coverage and access to primary care providers. The objective of this study was to estimate the effect of the 2014 ACA implementation on ED use in New York.

Methods: We used the Healthcare Cost and Utilization Project State Emergency Department and State Inpatient Databases for all outpatient and all inpatient visits for patients admitted through an ED from 2011 to 2016. We focused on in-state residents aged 18 to 64, who were covered under Medicaid, private insurance, or were uninsured prior to the 2014 expansion. We estimated the effect of the expanded insurance coverage on average monthly ED visits volumes and visits per 1000 residents (rates) using interrupted time-series regression analyses.

Results: After ACA implementation, overall average monthly ED visits increased by around 3.0%, both in volume (9362; 95% Confidence Intervals [CI]: 1681-17,522) and in rates (0.80, 95% CI:0.12-1.49). Medicaid covered ED visits volume increased by 23,972 visits (95% CI: 16,240 -31,704) while ED visits by the uninsured declined by 13,297 (95% CI:-15,856 - -10,737), and by 1453 (95% CI:-4027-1121) for the privately insured. Medicaid ED visits rates per 1000 residents increased by 0.77 (95% CI:-1.96-3.51) and by 2.18 (95% CI:-0.55-4.92) for those remaining uninsured, while private insurance visits rates decreased by 0.48 (95% CI:-0.79 - -0.18). We observed increases in primary-care treatable ED visits and in visits related to mental health and alcohol disorders, substance use, diabetes, and hypertension. All estimated changes in monthly ED visits after the expansion were statistically significant, except for ED visit rates among Medicaid beneficiaries.

Conclusion: Net ED visits by adults 18 to 64 years of age increased in New York after the implementation of the ACA. Large increases in ED use by Medicaid beneficiaries were partially offset by reductions among the uninsured and those with private coverage. Our results suggest that efforts to expand health insurance coverage only will be unlikely to reverse the increase in ED use.
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http://dx.doi.org/10.1016/j.ajem.2021.04.076DOI Listing
April 2021

Costs associated with COVID-19 in healthcare personnel in Greece: a cost-of-illness analysis.

J Hosp Infect 2021 Apr 21. Epub 2021 Apr 21.

Faculty of Social and Political Sciences, University of Peloponnese, Corinth, Greece; Health Policy Institute, Athens, Greece.

Background: Healthcare personnel (HCP) are at increased risk for SARS-CoV-2 infection.

Aim: To estimate the costs related to COVID-19 exposure and infection among HCP in Greece.

Methods: Data were retrieved from the national database of SARS-CoV-2 infections and from the database of HCP exposed to COVID-19. A cost-of-illness analysis was performed to estimate total, direct and indirect, costs.

Results: We studied 254 HCP with COVID-19 and 3,332 HCP exposed to COVID-19 during the first epidemic wave. Of the 254 HCP with COVID-19, 49 (19.3%) were hospitalized (mean hospitalization: 11.6 days) and four were admitted to intensive care unit (mean duration: 10.8 days). Overall, 1,332 (40%) exposed HCP had a mean duration of absenteeism of 7.5 days while 252 (99.2%) HCP with COVID-19 had a mean duration of absenteeism of 25.8 days. The total costs for the management of the two groups were estimated at 1,735,830 Euros (772,890 Euros for the HCP with COVID-19 and 962,940 Euros for the exposed HCP). Absenteeism accounted for the large share of total costs (80.4% of all expenditures), followed by costs for RT-PCR and hospitalization costs (10.2% and 6.5% of all expenditures, respectively).

Conclusion: Our study confirms that COVID-19 is associated with increased rates and duration of absenteeism among HCP. Indirect costs and particularly absenteeism is the major driver of total costs among exposed to and infected with COVID-19 HCP. The estimated total costs are underestimated. Studies are needed to explore the impact of COVID-19 vaccination of HCP on absenteeism and COVID-19-associated costs.
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http://dx.doi.org/10.1016/j.jhin.2021.04.018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8061082PMC
April 2021

Informal out-of-pocket payments experience and individuals' willingness-to-pay for healthcare services in Greece.

Health Policy 2021 Jun 3;125(6):693-700. Epub 2021 Apr 3.

Department of Social and Education Policy, University of Peloponnese, Damaskinou & Kolokotroni Str., 20100, Corinth, Greece.

Background: Informal out-of-pocket payments to healthcare providers are not uncommon in the Greek health system. We explore individuals' willingness-to-pay (WTP) to secure zero out-of-pocket full coverage for healthcare services and medications and we estimate the impact of past informal payments and individuals' opinion about the legalization of informal payments on WTP.

Methods: We conducted a survey of 2841 participants from November 2016 to February 2017. We obtained information on WTP using the contingent valuation method. A two-part regression model was used to estimate the association between WTP, informal payments, and respondents' opinion about legalizing such payments.

Results: About 80% of the respondents were willing to pay an average of €95 per month to obtain free access to full healthcare coverage and medications. About 65% of the respondents were involved in an informal payment at least once during the past four months with an average payment of €247. Higher informal payments and supportive opinions towards the legalization of informal payments increased the likelihood of WTP and were also positively associated with increased WTP amounts overall (p < 0.001).

Conclusions: This survey reveals that individuals' WTP is critically affected by previous experiences and attitudes towards informal payments. Our results imply that the potential introduction of official fees might not suffice to limit informal payments and suggest the need for stricter regulatory policies.
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http://dx.doi.org/10.1016/j.healthpol.2021.04.001DOI Listing
June 2021

Should vaccination be mandated? Individuals' perceptions on mandatory vaccination in Greece.

J Eval Clin Pract 2021 Mar 29. Epub 2021 Mar 29.

Department of Social and Education Policy, University of Peloponnese, Corinth, Greece.

Objectives: The aim of this study was to explore factors that influence individuals' attitudes towards mandatory vaccination in Greece.

Methods: A nationally representative cross-sectional telephone survey was conducted via a random multistage selection process in October 2019 in Greece. The survey was designed to obtain information about whether vaccination should be mandated or not among adults 18 years of age or older. A multivariable logistic regression model was used to estimate the association between individuals' sociodemographic, contextual and clinical characteristics, utilization, satisfaction, and trust in the healthcare system and providers and their preference over mandatory vaccination.

Results: A total of 901 participants fully completed the survey (response rate 90%-901/1001). About 85% of the respondents supported mandatory vaccination. Individuals who used preventive services more often compared to those who never or rarely used such, those who reported increased trust in official healthcare authorities' guidelines and recommendations compared to those who reported no trust and those who had underage children living in the household were significantly more likely to support mandatory vaccination. No differences were observed for sociodemographic factors and mandatory vaccination support.

Conclusion: This survey revealed that most Greek citizens support mandatory vaccination, which was critically affected by the utilization of preventive services and trust in healthcare authorities. Our results suggest that healthcare policy interventions should promote mandatory vaccination through multi-level initiatives to improve healthcare providers' and the general public's understanding of the value of vaccination.
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http://dx.doi.org/10.1111/jep.13568DOI Listing
March 2021

Emergency Department Utilization by Adolescents Experiencing Homelessness in Massachusetts.

Med Care 2021 Apr;59(Suppl 2):S187-S194

Population Informatics Lab, Texas A&M University, College Station.

Background: Adolescents who experience homelessness rely heavily on emergency departments (EDs) for their health care.

Objectives: This study estimates the relationship between homelessness and ED use and identifies the sociodemographic, clinical, visit-level, and contextual factors associated with multiple ED visits among adolescents experiencing homelessness in Massachusetts.

Research Design: We used the Healthcare Cost and Utilization Project State Emergency Department Databases on all outpatient ED visits in Massachusetts from 2011 to 2016. We included all adolescents who were 11-21 years old. We estimated the association between homelessness and ED utilization and investigated predictors of multiple ED visits among adolescents who experience homelessness using multivariate logistic and negative binomial regressions.

Results: Our study included 1,196,036 adolescents, of whom about 0.8% experienced homelessness and this subset of adolescents accounted for 2.2% of all ED visits. Compared with those with stable housing, adolescents who were homeless were mostly covered through Medicaid (P<0.001), diagnosed with 1 or more comorbidities (P<0.001), and visited the ED at least once for reasons related to mental health; substance and alcohol use; pregnancy; respiratory distress; urinary and sexually transmitted infections; and skin and subcutaneous tissue diseases (P<0.001). Homeless experience was associated with multiple ED visits (incidence rate ratio=1.18; 95% confidence intervals, 1.16-1.19) and frequent ED use (4 or more ED visits) (adjusted odds ratio=2.21; 95% confidence interval, 2.06-2.37). Factors related to clinical complexity and Medicaid compared with lack of coverage were also significant predictors of elevated ED utilization within the cohort experiencing homelessness.

Conclusions: Adolescents who experience homelessness exhibit higher ED use compared with those with stable housing, particularly those with aggravated comorbidities and chronic conditions. Health policy interventions to integrate health care, housing, and social services are essential to transition adolescents experiencing homelessness to more appropriate community-based care.
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http://dx.doi.org/10.1097/MLR.0000000000001436DOI Listing
April 2021

Trends in outpatient emergency department visits during the COVID-19 pandemic at a large, urban, academic hospital system.

Am J Emerg Med 2021 Feb 9;40:20-26. Epub 2020 Dec 9.

Department of Health Policy & Management, School of Public Health, Texas A&M University, College Station, TX, United States of America.

Background: The coronavirus disease 2019 (COVID-19) pandemic has critically affected healthcare delivery in the United States. Little is known on its impact on the utilization of emergency department (ED) services, particularly for conditions that might be medically urgent. The objective of this study was to explore trends in the number of outpatient (treat and release) ED visits during the COVID-19 pandemic.

Methods: We conducted a cross-sectional, retrospective study of outpatient emergency department visits from January 1, 2019 to August 31, 2020 using data from a large, urban, academic hospital system in Utah. Using weekly counts and trend analyses, we explored changes in overall ED visits, by patients' area of residence, by medical urgency, and by specific medical conditions.

Results: While outpatient ED visits were higher (+6.0%) in the first trimester of 2020 relative to the same period in 2019, the overall volume between January and August of 2020 was lower (-8.1%) than in 2019. The largest decrease occurred in April 2020 (-30.4%), followed by the May to August period (-12.8%). The largest declines were observed for visits by out-of-state residents, visits classified as non-emergent, primary care treatable or preventable, and for patients diagnosed with hypertension, diabetes, headaches and migraines, mood and personality disorders, fluid and electrolyte disorders, and abdominal pain. Outpatient ED visits for emergent conditions, such as palpitations and tachycardia, open wounds, syncope and collapse remained relatively unchanged, while lower respiratory disease-related visits were 67.5% higher in 2020 relative to 2019, particularly from March to April 2020. However, almost all types of outpatient ED visits bounced back after May 2020.

Conclusions: Overall outpatient ED visits declined from mid-March to August 2020, particularly for non-medically urgent conditions which can be treated in other more appropriate care settings. Our findings also have implications for insurers, policymakers, and other stakeholders seeking to assist patients in choosing more appropriate setting for their care during and after the pandemic.
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http://dx.doi.org/10.1016/j.ajem.2020.12.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7725055PMC
February 2021

Improved strategies to counter the COVID-19 pandemic: Lockdowns vs. primary and community healthcare.

Toxicol Rep 2021 3;8:1-9. Epub 2020 Dec 3.

Department of Analytical Toxicology, Pharmaceutical Chemistry and Pharmacognosy, Sechenov University, 119991, Moscow, Russia.

COVID-19 pandemic mitigation strategies are mainly based on social distancing measures and healthcare system reinforcement. However, many countries in Europe and elsewhere implemented strict, horizontal lockdowns because of extensive viral spread in the community which challenges the capacity of the healthcare systems. However, strict lockdowns have various untintended adverse social, economic and health effects, which have yet to be fully elucidated, and have not been considered in models examining the effects of various mitigation measures. Unlike commonly suggested, the dilemma is not about health vs wealth because the economic devastation of long-lasting lockdowns will definitely have adverse health effects in the population. Furthermore, they cannot provide a lasting solution in pandemic containment, potentially resulting in a vicious cycle of consecutive lockdowns with in-between breaks. Hospital preparedness has been the main strategy used by governments. However, a major characteristic of the COVID-19 pandemic is the rapid viral transmission in populations with no immunity. Thus, even the best hospital system could not cope with the demand. Primary, community and home care are the only viable strategies that could achieve the goal of pandemic mitigation. We present the case example of Greece, a country which followed a strategy focused on hospital preparedness but failed to reinforce primary and community care. This, along with strategic mistakes in epidemiological surveillance, resulted in Greece implementing a second strict, horizontal lockdown and having one of the highest COVID-19 death rates in Europe during the second wave. We provide recommendations for measures that will reinstate primary and community care at the forefront in managing the current public health crisis by protecting hospitals from unnecessary admissions, providing primary and secondary prevention services in relation to COVID-19 and maintaining population health through treatment of non-COVID-19 conditions. This, together with more selective social distancing measures (instead of horizontal lockdowns), represents the only viable and realistic long-term strategy for COVID-19 pandemic mitigation.
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http://dx.doi.org/10.1016/j.toxrep.2020.12.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7713637PMC
December 2020

Informal out-of-pocket payments for healthcare services in Greece.

Health Policy 2020 07 23;124(7):758-764. Epub 2020 May 23.

Department of Social and Educational Policy, University of Peloponnese, Damaskinou & Kolokotroni Str., 20100, Corinth, Greece.

Background: Informal out-of-pocket (OOP) payments for healthcare services are not unusual in Greece.

Aim: This study estimates the association between respondent and incident-level characteristics and informal payments.

Methods: A survey of 4218 households was conducted from November 2016 to February 2017. We analyzed healthcare incidents by all household members within the past four months. Multivariate negative binomial regression analysis was used to estimate the association between respondents and incident-level characteristics and informal OOP payments to providers.

Results: A total of 3494 healthcare incidents were reported by 3183 household-representatives. More-than-half (63 %) of all incidents involved informal activity (median=€150). About 30 % of those were related to provider requested payments. Using hospital, dental, diagnostic/screening, and emergency department services compared to primary care services and having oncological and surgical conditions were among the strongest predictors of higher rates for informal payments. The use of specific providers for reasons related to trust, reputation, referral, and lack of alternatives was also associated with higher rates of informal payments. Provider requested and skip the line payments were associated with larger OOP amounts compared to gratitude payments.

Conclusion: This survey reveals that informal payments occur for higher-need and less cost-responsive healthcare services particularly in areas where patients lack alternatives. Health policy and regulatory interventions, including stricter control of the financial reporting system are essential to limit informal payments.
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http://dx.doi.org/10.1016/j.healthpol.2020.04.005DOI Listing
July 2020

Frequent emergency department use in the paediatric population: A systematic literature review.

J Eval Clin Pract 2021 Feb 5;27(1):193-203. Epub 2020 Mar 5.

Medical Sciences Library, Texas A&M University, College Station, Texas, USA.

Objective: We systematically reviewed the literature on paediatric frequent emergency department (ED) users to identify and to synthesize characteristics and factors associated with frequent ED utilization among this population in the United States.

Methods: We searched Medline (Ovid), CINAHL (Ebsco), and Embase (Ovid) to identify all relevant studies after 1990. We focused on US studies analysing paediatric frequent ED (PFED) users excluding those focused on specific subgroups. Two reviewers independently selected articles and extracted data on predisposing, enabling, behavioural, need and reinforcing factors.

Results: Fifteen studies met the inclusion criteria. PFED users comprised 3% to 14% of all paediatric ED users and accounted for 9% to 42% of all paediatric ED visits in 11 studies that defined frequent use as four to six ED visits per year. Most PFED users were less than 5 years old who had public insurance coverage and a regular provider. Public insurance compared to private residency in disadvantaged areas, having at least one chronic or complex condition and a history of hospitalization, were associated with frequent use. Children who had a regular primary care provider were less likely to exhibit frequent ED use.

Conclusions: Minimizing unnecessary ED visits by frequent utilizers is a quality improvement and cost-saving priority for health systems. Our findings indicate that many PFED users have greater healthcare needs and face barriers accessing care in a timely manner, even though some have regular providers. To better address the needs of this vulnerable group, health systems should focus on educating caregivers and expanding access to providers in other settings.
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http://dx.doi.org/10.1111/jep.13382DOI Listing
February 2021

Predictors of Multiple Emergency Department Utilization Among Frequent Emergency Department Users in 3 States.

Med Care 2020 02;58(2):137-145

Department of Health Policy & Management, School of Public Health.

Background: Research on frequent emergency department (ED) use shows that a subgroup of patients visits multiple EDs. This study characterizes these individuals.

Objective: The objective of this study was to determine how many frequent ED users seek care at multiple EDs and to identify sociodemographic, clinical, and contextual factors associated with such behavior.

Research Design: We used the 2011-2014 Healthcare Cost and Utilization Project State Emergency Department Databases data on all outpatient ED visits in New York, Massachusetts, and Florida. We studied all adult ED users with ≥5 visits in a year and defined multisite use as visits to ≥3 different sites. We estimated predictors of multisite use with multivariate logistic regressions.

Results: Across all 3 states, 1,033,626 frequent users accounted for 7,613,077 ED visits. Of frequent users, 25% were multisite users, accounting for 30% of the visits studied. Frequent users with at least 1 visit for mental health or substance use-related diagnosis were more likely to use multiple sites. Uninsured frequent users and those with public insurance were associated with less use of multiple EDs than those with private coverage while lacking consistent coverage by the same insurance within each year were associated with using multiple sites.

Conclusions: Health policy interventions to reduce duplicative or unnecessary ED use should apply a population health perspective and engage multiple hospitals. Community-level preventive approaches and a stronger infrastructure for mental health and substance use are essential to mitigate multisite ED use.
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http://dx.doi.org/10.1097/MLR.0000000000001228DOI Listing
February 2020

Cost-Effectiveness Analysis of Erenumab Versus OnabotulinumtoxinA for Patients with Chronic Migraine Attacks in Greece.

Clin Drug Investig 2019 Oct;39(10):979-990

Laboratory of Health Economics and Management, Economics Department, University of Piraeus, Karaoli ke Dimitriou 80, 185 34, Pireas, Greece.

Background: Migraine is a common, chronic neurovascular brain disorder with non-negligible multifaceted economic costs. Existing preventive treatments involve the selective use of onabotulinumtoxinA, which aims at migraine morbidity reduction for patients who have failed initial preventive treatment with oral agents. Erenumab is a new preventive treatment for migraines.

Objective: To evaluate the differences in costs and outcomes of the preventive treatment with erenumab versus onabotulinumtoxinA in patients with chronic migraines (CM) in Greece to assess the economic value of this treatment.

Methods: We conducted a cost-effectiveness analysis from both the payer and the societal perspective using a decision-tree analytic model. Outcomes were expressed in migraines avoided and in quality-adjusted life-years (QALYs). We obtained model inputs from the existing literature. The decision path adjusted for variation in the probability of adherence and the resulting differential effectiveness between the two treatments. Direct costs included the cost of the two drugs and administration costs, the costs of acute drugs used under usual care, and the costs of hospitalization, physician, and emergency department visits. Indirect costs for the societal perspective analyses included wages lost on workdays. The time-horizon of the analysis was 1 year and all costs were calculated in 2019 euros (€). Sensitivity analyses were conducted to control for parameter uncertainty and to evaluate the robustness of the findings.

Results: Our results indicate that treatment of CM with erenumab compared to onabotulinumtoxinA resulted in incremental cost-effectiveness ratios (ICERs) of €218,870 and €231,554 per QALY gained and €620 and €656 per migraine avoided, from the societal and the payer's perspective, respectively. Using a common cost-effectiveness threshold equal to three times the local gross domestic product (GDP) per capita (€49,000), for the erenumab ICERs to fall below this threshold, the erenumab price would have to be no more than €192 (societal perspective) or €173 (payer perspective).

Conclusion: The prophylactic treatment of CM with erenumab in Greece might be cost effective compared to the existing alternative of onabotulinumtoxinA from both the payer and the societal perspective, but only at a highly discounted price. Nevertheless, erenumab could be considered a therapeutic option for patients who fail treatment with onabotulinumtoxinA.
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http://dx.doi.org/10.1007/s40261-019-00827-zDOI Listing
October 2019

Characteristics and predictors of adult frequent emergency department users in the United States: A systematic literature review.

J Eval Clin Pract 2019 Jun 2;25(3):420-433. Epub 2019 May 2.

Department of Health Policy & Management, School of Public Health, Texas A&M University, College Station, TX, USA.

Study Objective: We conducted a systematic literature review to identify and to update patient characteristics and contextual factors for adult frequent emergency department users (FEDUs) compared with non-FEDU in an era where the US health care system underwent substantial changes.

Methods: We searched MEDLINE, CINAHL, and EMBASE to identify all relevant articles after 2010 through July 2018 that describe FEDU. We included US studies on adult FEDU only and excluded studies on specific subgroups of FEDU. We included demographic, clinical, and health care utilization information, and two reviewers independently evaluated the studies using the Joanna Briggs Institute Critical Appraisal tool.

Results: The 11 studies included in the review indicated that FEDU were 4% to 16% of total ED users but accounted for 14% to 47% of ED visits, with six to nine visits per year on average. The majority of FEDU were young or middle-aged adults, females, of low socioeconomic status and high school or less education, with public insurance, multiple primary care provider visits, and chronic conditions. Fair or poor self-perceived health status, unemployment, unmet needs from primary care providers (PCPs), mental health, and substance abuse were predictors of FEDU.

Conclusion: FEDUs are disproportionally sicker and are also heavy users of non-ED health care service providers. The limited data for non-ED health services use in facility-specific studies of FEDU may contribute to findings in such studies that complex and unmet needs from PCPs contributed to ED visits. This suggests the need for more comprehensive data analysis beyond a few sites that can inform systemic management approaches.
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http://dx.doi.org/10.1111/jep.13137DOI Listing
June 2019