Disease In Greece Research Articles

Cost of dementia and the relationship between stage of dementia and cost of care in Greece

Objective The current study attempts to estimate the cost of dementia in relation to the severity of the disease in Greece. Methods A prospective observational study was conducted in Tripoli, Arcadia at the neurological clinic of a secondary hospital. The study included 110 patients and their main caregivers. The total cost of dementia has been calculated as well as its allocation to private and public funding. The results were correlated with three stages of disease severity (mild–moderate–severe) with a multivariate regression model. Results The average total cost of caring for dementia is €819.89 per month: €710.60 of this is the private cost and €109.29 is the public cost. The cost is positively correlated statistically with the progress of the disease in the three stages of severity. Conclusions The cost of caring for people with dementia in the authors' research appears lower than that in developed Western societies and in relation to other developing societies. The Greek economic crisis seems to be a determining factor in this result. However, it is still a high cost, which is mainly paid by the patient and the family.

Q fever in Greece: Findings of a 13 years surveillance study

Q fever is an endemic disease in different parts of Greece. The current study aimed to investigate the prevalence of acute Q fever disease in Greece through the operation of the national reference centre for Q fever.A total of 5397 sera were received from febrile patients under the suspicion of Q fever infection during a 13 years period (2001–20013). A questionnaire was filled in by the clinicians containing certain clinical/epidemiological/demographic information.The diagnosis was based both on IFA (IgG and IgM phase II antibodies against Coxiella burnetii) and on molecular means.A total of 685 (12.7 %) samples were initially tested positive for acute Q fever. The mean (±SD) age of patients was 55.3 years (±18.7). Out of the 489 convalescent samples, 134 (27.4 %) samples indicated a minimum of a four-fold seroconversion and were considered as laboratory confirmed cases of acute Q fever. Pneumonia was the most frequently encountered clinical symptom with presence in 6.8 % of all positive samples. Forty six (46) patients were laboratory confirmed as chronic Q fever cases.Climate seemed to influence the distribution of Q fever cases throughout the years. The findings of the current study comply with past studies carried out elsewhere that had demonstrated a clear relation of the disease with temperature, south winds, etc.This study represents the first large scale attempt to gather a long period information on Q fever infection in Greece. The findings of the current study support the fact that Q fever is an important endemic zoonotic disease in Greece and needs increased awareness by clinical physicians and health care system.

P704 The biennial direct pharmaceutical costs per treatment with biologics for the inflammatory bowel disease in Greece: A comparative calculation study

Abstract Background Inflammatory bowel disease (IBD), as a chronic disease with relatively high prevalence worldwide, has undoubtedly resulted in a notable economic burden on health care systems globally. The IBD treatment with biologics (IBD-BT) seems quite complex with various strategies to induce and maintain remission and balance against long-term complications. IBD-BT costs have never been estimated in detail so far in Greece, especially during such a severe 10-years financial crisis experience. Methods Direct pharmaceutical costs for one and two years, both for induction and maintenance, adult treatment diagnosed with Crohn’s disease (CD-BT) or Ulcerative colitis (UC-BT) were estimated. For intravenous agents, the hospital drug prices and one day admission costs were calculated, whereas for subcutaneous biologics the retail ones. It was taken for granted that all patients were fully responders and after the approved induction scheme continued with the standard maintenance strategy. Prototype and biosimilar drug prices were also assessed where available. More specifically, when considering biosimilars, the most affordable one was included to our analysis. Each drug price was estimated based on the data collected from the 2019 Greek official electronic national publication on drug therapy of the Greek national organisation for medicines. Results Table shows the costs in euros of each IBD-BT scheme. The biosimilar adalimumab was proved as the most affordable choice both for CD- and UC-BT. The second most affordable choice for CD revealed to be the prototype Adalimumab and respectively for UC the recently introduced tofacitinib, in the maintenance dose of 5 mg bid after week 8 (with a slight burden when the more intensive scheme with Tofacitinib 10 mg bid for 16 weeks is necessary). The most expensive strategies include Ustekinumab 90 mg (per 8 weeks for body weight—BW > 55 to ≤85 kg and >85 kg) and the prototype Infliximab 5 mg/kg (per 8 weeks for BW>81 kg), whereas Vedolizumab remains expensive regardless BW. It is worthwhile to mention that the hospitalisation expenditures (563€) raise the costs of intravenous agents when compared with the subcutaneous ones. Conclusion The biennial direct pharmaceutical costs for the approved IBD-BT schemes both for induction and maintenance phases in fully responders were estimated thoroughly for the first time in Greece. These results should motivate Governments and European Union policymakers in order to promote cost-benefit and cost-utility studies to offer the best patients’ benefit by evaluating and deciding the most suitable regimen with respect to biologic prices, adverse effects, hospitalisation expenditures, IBD complications and recurrences.

Epidemiology of hepatitis A in Greece in the last decade: management of reported cases and outbreaks and lessons learned.

Hepatitis A is a mandatory notifiable disease in Greece. Here, we present the epidemiological data for 2009-2018 and the results of outbreak investigations performed, and discuss future public health priorities.Overall, 1193 cases were reported; 320 migrants/refugees, 240 Roma, 112 travellers and 521 from the general population. The median age of the affected general population (37 years) had an increasing trend (from 30.8 years in 2009 to 40.5 in 2018, P < 0.001) and was significantly higher than that among Roma and migrants (7 and 8 years, respectively, P < 0.001). Twenty-two cases (2.2%) were unvaccinated patients with a chronic liver disease. Fifty clusters with 2-12 cases each were recorded; 44 were attributed to person-to-person transmission and six to food consumption. Three outbreaks accounting for 32.3% of the total number of recorded cases were identified; in 2013 among Roma (112 cases), in 2016 among refugees (188 cases) and in 2017 among men having sex with men (96 cases; 33 of them (34.4%) HIV-positive). The epidemiological data depict that improving living conditions and vaccination coverage of deprived populations, and informing adults on the disease focusing at faecal-oral transmission during sexual intercourse and travel should be the future public health priorities.

Sleeping Disorders and Health-Related Quality of Life in Hemodialysis Patients with Chronic Renal Disease in Greece.

Increased life expectancy in patients with end-stage renal failure undergoing dialysis and the high prevalence of the chronic renal disease highlight the need to investigate the patients' quality of life. To investigate sleep disorders and the level of health-related quality of life in hemodialysis patients with chronic renal failure. The sample of the study consisted of 420 hemodialysis patients. The Kidney Disease and Quality of Life™ Short Form questionnaire was used to assess the quality of life of patients, and the Pittsburgh Sleep Quality Index was used to investigate sleep disorders. The physical and mental health of the responders were found to be 36.9 and 39.6, respectively, while the burden and effects of chronic renal disease were found to be 40 and 44.9, respectively. There were strong positive correlations between the overall health assessment and the emotional well-being (r=0.743), the physical function (r=0.730), the burden of renal disease (0.626), the energy/fatigue (0.643), the social function (0.639), and the pain (0.595). The patients' quality of sleep was found poor (7.62). The major correlation was observed between the total score and the dimension of the sleep latency (0.681), followed by the sleep disturbances (0.624). The HRQOL of hemodialysis patients with CKD-FS remains poor, interacting with important functions such as sleep, vitality, cognition, and sexual function.

Sickle-Cell Disease in Greece: Patient Reported Outcomes Related to Clinical Complications, Treatment Choices and Attitudes, Beliefs and Trends Affecting Potential Participation in Clinical Trials - a Greek National Multicentric Study

Background: Sickle cell disease (SCD) is an autosomal recessive disorder caused by a point mutation in the β-globin chain of hemoglobin that forms hemoglobin S. It is clinically characterized by complicated episodes of veno-occlusive crises (VOC), emergency room (ER) visits and uncomplicated inpatient admissions. Aim: We investigated the clinical complications and treatment choices of a large cohort of Greek SCD patients, representative of the whole country. Most importantly, this study aimed to assess patients' attitudes and beliefs regarding their enrollment in clinical trials testing new drugs. We examined the factors influencing such a participation. Patients and Methods: A total of 254 patients from 10 Thalassemia and Sickle Cell Departments across Greece (110 men/144 women), aged 18 - over 65, 210 (82.7%) with β-thalassemia/sickle cell trait and 44 (17.3%) with homozygous SCD participated in the study. The participants had variable educational and socioeconomic background. They all answered an anonymous self-report questionnaire during their medical evaluations between November 2018 and May 2019, including their demographic and clinical characteristics, their current treatment and their opinion regarding a possible participation in a clinical trial for SCD. Descriptive statistical analysis using calculated scale variables and Chi-square test were performed. Results: All participants completed the survey. During the previous year, 64 patients (25.3%) had no admissions for VOC, 128 (50.6%) had 1-5, whereas 21 (8.3%) had 5-10 and 40 (15.8%) more than 10. Except for acute pain crises, the most frequent complications were chronic pain (59%), liver/spleen dysfunction (32.4%), infectious episodes (29.5%), iron overload (23.8%) and pulmonary hypertension (20.1%). In addition to hematological care, patients seeked medical attention from expert physicians for disease complications; 77.6% of the patients reported that they yearly visited a cardiologist, 42.4% an ophthalmologist, 31.9% an orthopedic, 28.4% a pneumonologist, 28.9% a hepatologist, 12.6% an urologist, 14% a nephrologist, 11.9% an infectious disease doctor, 10.1% a pain management specialist and 8.1% a neurologist. The therapeutic approaches included daily folic acid supplementation (86.1%), vaccines (68.3%), hydroxyurea (66.3%), antibiotics (57.1%), simple pain moderators (52.4%), opioids (48.8%) and iron chelators (30.2%). Previous experience in clinical trials was reported by only 17 patients (6.9%). Regarding the patients' attitudes towards a probable clinical trial, 41.3% were positive to try new therapies, 28.3% negative and 30.4% neutral. 67.2% were satisfied with their current treatment, without excluding a potential participation in clinical trials; such treatment satisfaction correlated significantly with older age, lower income and secondary hemochromatosis under chelation treatment (p&lt;0.05). 40% reported that they had been waiting for years for a new treatment, but 43.2% strongly denied becoming an experimental mouse model, whereas 47.3% mentioned that they would trust their doctors' advice correlating positively with male gender and higher income (p&lt;0.05). Lower educational status, prior intake of hydroxyurea and residence/origin in the capital in contrast to the countryside (chi-square, p&lt;0.05) significantly correlated with a potential clinical trial participation. Internet and television information motivated patients to seek more details from their doctor. Concerning the factors rated as the most important for a potential participation in a clinical trial, 7 out of 10 patients of our cohort considered of utmost equal importance the effectiveness of a probable treatment and the relative toxicity. Conclusions: Most SCD patients have chronic complications and visit specialized physicians. Since the participation of larger number of patients in clinical trials is essential for the application of novel drugs, the most important factors of our cohort are the effectiveness of a probable treatment and the relative toxicity, along with the trust to the doctor. These factors are crucial, influencing patients' decision. Even though a proportion of our patients remain skeptical towards clinical trials, an increasing number is willing to participate, which correlates positively with residence in the capital, lower educational status and prior intake of hydroxyurea. Disclosures Kattamis: Apopharma: Honoraria; Vertex: Membership on an entity's Board of Directors or advisory committees; Celgene Corporation: Honoraria, Membership on an entity's Board of Directors or advisory committees; Ionis: Membership on an entity's Board of Directors or advisory committees; ViFOR: Membership on an entity's Board of Directors or advisory committees; Novartis Oncology: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding. Symeonidis:Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Roche: Membership on an entity's Board of Directors or advisory committees, Research Funding; Pfizer: Research Funding; Novartis: Membership on an entity's Board of Directors or advisory committees, Research Funding; MSD: Membership on an entity's Board of Directors or advisory committees, Research Funding; Janssen: Membership on an entity's Board of Directors or advisory committees, Research Funding; Tekeda: Membership on an entity's Board of Directors or advisory committees, Research Funding; Sanofi: Research Funding; Gilead: Membership on an entity's Board of Directors or advisory committees, Research Funding.

PCV67 BUDGET IMPACT OF RIVAROXABAN 2.5MG IN COMBINATION WITH ASPIRIN IN TREATMENT OF PATIENTS WITH CORONARY ARTERY DISEASE (CAD) OR PERIPHERAL ARTERY DISEASE (PAD) IN GREECE

To evaluate the budget impact of introducing rivaroxaban 2.5mg (RIV) in combination with aspirin 100 mg (ASA) in patients with CAD or PAD in order to assess the affordability of this therapy for the Greek public healthcare system over a 5-year time horizon. The populations modelled reflect the overall COMPASS (NCT01776424) population (CAD or PAD). The model considers the Greek National Healthcare Payer perspective and as such, only direct costs were included. Model inputs included: risk of main events and associated mortality (based on COMPASS); epidemiology data; current and future market share projections for treatments; and data on the following cost items based on national reimbursed prices and DRGs tariffs (e.g. Official Price Bulletin, Government Gazettes): treatment costs, administration costs, disease-related costs (physician visits and laboratory tests), the management cost of potential associated main events, such as myocardial infarction, ischaemic stroke, intracranial haemorrhage, cardiovascular death, bleeding death and the management of potential health events, such as acute limb ischemia, minor and major amputation, and venous thrombo-embolism. Introducing rivaroxaban for the treatment of patients with coronary artery disease or peripheral artery disease in Greece would result in €639,957 and €13,558,417 budget impact in the 1st and 5th year, respectively. The treatment of CAD or PAD with RIV+ASA would have a total net budget impact of €41.6m in five years. Drug cost is the key driver of the increasing total cost. The introduction of rivaroxaban reduces the cost of acute main events, post main events, health events and mortality by €5,173,990 over five years. The progressive introduction of rivaroxaban would result in a manageable budget impact for the Greek healthcare system and represent elevated savings in the management of acute main events, post main events, health events and mortality due to rivaroxaban’s clinical benefits and associated costs.

Biopolitics of public health and immigration in times of crisis: The malaria epidemic in Greece (2009–2014)

That crisis and austerity have a negative effect on public health is well documented. Less attention has been paid on the explosive combination of crisis with xenophobia and the ways racist policies and discourses produce vulnerable bodies, blamed then for their own disease. We study here the 2009 outbreak of malaria in the Evrotas region of Peloponnese, first time since the official eradication of the disease in Greece in 1974. We find that a crucial factor for the outbreak was discrimination against undocumented farm workers excluded from channels of support maintained for Greek citizens. Like Agamben’s homo sacer, the state sustains immigrant workers at a threshold of existence, initially invisible then turned into biopolitical targets, scapegoats in a public health emergency. Disease such as malaria is the result of interacting human and non-human ecologies produced in a web of power relations. As such, it can be used symbolically and with political purposes in order to enhance xenophobia and “Othering”. Racism, social vulnerability and disease, we claim, can be mutually reinforcing phenomena particularly during times of socio-economic crisis and austerity.

Epidemiology of invasive meningococcal disease in Greece, 2006-2016.

The present study describes the epidemiology of invasive meningococcal disease (IMD) in Greece for the period 2006-2016. Combined data from notified and laboratory-confirmed IMD cases were obtained from the two involved National Centres (Epidemiology and Reference Laboratory). Laboratory identification and typing was carried out by both conventional (culture) and molecular methods (PCR, MLST, PorA, and FetA typing). A total of 796 IMD cases were notified; of those, 720 (91%) were laboratory confirmed. Overall, a decline on the annual incidence of confirmed cases was observed, ranging from 0.91 (2006) to 0.47 (2016) /100,000. A similar trend was observed in most age groups especially in children 0-4years (7.7 to 2.9/100,000), with the exception of an increase in the incidence rate in adults > 20years (0.21 to 0.32/100,000). The overall case fatality rate was 6.5% (52/796), annual range 2-13%. Among 658 strains which were typed by sero/genogroup, 80% were identified as MenB (annual range 65-92%); however, a decline was observed in MenB incidence from 5.3 (2006) to 2.7 (2016), among infants and toddlers, while MenW (1%), MenY (2%), and MenA (1%) remained low. During the 11years, the annual incidence of IMD declined by 50%, especially in the 0-4-year age group, due mainly to MenB. Continuous surveillance of IMD is important for the development of future vaccination and public health policies.

“Silent” post-menopausal genital tuberculosis with lethal outcome

Female genital Tuberculosis (TB) is a rare disease, that usually affects female patients of reproductive age living in developing countries. The diagnosis of the disease is quite difficult since there is no consensus on the appropriate screening and management needed. Female genital TB can mimic many other pathologies including advanced ovarian cancer. Laboratory findings or blood serum tests usually are not suggestive of the disease. Imaging findings can be misleading. The incidence of the disease in Greece is rare. We present a rare case report of a post-menopausal patient with female genital TB, mimicking malignancy and resulting to a lethal outcome. Laboratory and imaging findings were non-specific for the disease, leading to a false diagnosis of disseminated peritoneal carcinomatosis.

PB2413 HAEMOGLOBIN AGHIA SOPHIA (HBA1:C.187_189DELGTG) IN NORTHERN GREECE. IMPLICATIONS IN CLINICAL PHENOTYPE OF HBH

Background: Alpha-thalassaemia is inherited as an autosomal recessive disorder characterised by a microcytic hypochromic anaemia, and the clinical phenotype varies from almost asymptomatic to a lethal haemolytic anaemia. It is probably the most common monogenic gene disorder in the world. Several mutations have been described that can affect globin gene expression in any step and many of those mutations are rare causes of alpha thalassaemia. Aims: 28 patients have been diagnosed with Hb H disease (14 males and 14 females) from 1986 to 2019 at the regions of Central and Western Macedonia in Northern Greece with a population of around 2.5 million. The most prevalent genotype was the -α 3.7/—med, (5 cases), 2 cases of –α 3,7/-α5,2, 1 case of –med/αPoly A, 1 case of –α 3,7/Hb Adana and 1 case of Hb Aghia Sophia/--med. The phenotype suggests that HbH disease in Greece has in general a moderate presentation. The molecular characterization of the patients with Hb H disease is useful for the prediction of the clinical outcome and the genetic counselling of the couples at risk. Methods: Hb Aghia Sophia carriers are asymptomatic with normal or nearly normal Hb levels and red cell indices similar to α+ thalassaemia carrier as it was shown in 2 members of a family that this mutation was also detected in our region. Haemoglobin (Hb) Aghia Sophia in interaction with deletional α-thalassaemia mutations leads to HbH. We report a case of Hb Aghia Sophia with co-inheritance with the a-thalassaemia – med deletion, a rare double heterozygosity case. Results: The case presented, concerns a 40 year old woman followed in our Thalassemia Clinic who was diagnosed at the age of 8 with Hb H. At diagnosis, totally incidental findings were compatible with a typical phenotype of Hb H, anaemia being mild and growth not having been impaired. As a girl, she retained a mild hypochromic microcytic anaemia until the age of 10 that a splenectomy was decided due to marked splenomegaly and anemia. During the following years her hemoglobin was maintained around 8gr/dl and she had normal growth. At the age of 35 she had an abortion. She was transfused each month during the next two pregnancies. Lately she was complaining for fatigue and her hemoglobin value was 7gr/dl. The investigation of hemoglobin deterioration did not reveal any significant cause. Bone marrow aspiration showed increased erythroid hyperplasia. Molecular examination revealed Aghia Sophia with co-inheritance with the a-thalassaemia – med deletion. As she denied transfusion, erythropoietin therapy was started with good results maintaining Hb level to 9gr/dl. Additionally, she receives deferasirox due to iron overload. Summary/Conclusion: The co-inheritance of Hb Aghia Sophia with –med, is extremely rare and the severity is due to the interaction of a hyper unstable mutant of the a1 gene with an α0-thal determinant. Hb Aghia Sophia causes instability to the polypeptide chain and is rapidly catabolized. Long follow-up of such rare cases is necessary in order to gain as much information as possible, so as to offer the best management to the patients and the most accurate counseling to their families.

Criniviruses associated with cucurbit yellows disease in Greece and Cyprus: an ever‐changing scene

Cucurbit yellow stunting disorder virus (CYSDV), Cucurbit chlorotic yellows virus (CCYV) and Beet pseudo‐yellows virus (BPYV) are whitefly‐transmitted criniviruses that cause foliar interveinal yellowing symptoms and result in high economic losses for cucurbit production. CYSDV and CCYV are transmitted by Bemisia tabaci, whereas BPYV is transmitted by Trialeurodes vaporariorum. During 2012–2017, an extensive survey was conducted to identify the viruses causing cucurbit yellows disease in Greece and Cyprus. The study sampled the main cucurbits and alternative hosts in these regions to determine crinivirus incidence, to identify the whitefly species present in the two countries and to characterize molecularly the virus populations. Results showed that CYSDV was the most widespread virus in Greece (49.9%), followed by CCYV (20.3%) and BPYV (18.4%). Bemisia tabaci and T. vaporariorum were identified in 54.5% and 45.6% of whitefly samples, respectively. In Cyprus, CYSDV was predominant (96.7%), followed by CCYV (19.2%), while no BPYV infection was detected. Approximately 15% of weed samples from 17 different species that belong to 12 botanical families were identified as hosts for one or more of these criniviruses. Finally, sequencing of the capsid protein gene of the crinivirus isolates revealed very low levels of genetic diversity, further supporting the genetic stability of crinivirus populations. The results of this long‐lasting epidemiological study in two countries of the eastern Mediterranean revealed substantial changes in the relative incidence and distribution of cucurbit‐infecting criniviruses and their whitefly vectors over the past 15 years, suggesting the need for adoption of novel management strategies.

The Economic Burden of Chronic Obstructive Pulmonary Disease in Greece.

Chronic obstructive pulmonary disease (COPD) is a leading cause of disability and death worldwide, imposing a substantial socioeconomic burden on societies and patients due to the long-term management required. To assess the economic burden of COPD in Greece and its potential determinants. A population-based, random-digit dialled, telephone nationwide survey was conducted to recruit patients with COPD in Greece (N = 351). A structured questionnaire was used to collect data. The total annual cost per patient from a societal perspective was calculated. The mean (95% CI) annual total cost per patient for the management of COPD from a societal perspective was €2150 (€1879-€2443). The total annual cost was mainly driven by the medication cost (36.1%), followed by the cost of hospitalizations (26.7%) and long-term oxygen therapy (13.8%). Multiple generalized linear model revealed that age, COPD Assessment Test (CAT) score and exacerbations were independently associated with the total annual cost. Investment in interventions aiming at delaying progression of disease, preventing acute exacerbations, and managing chronic symptoms are required to reduce the overall economic burden of COPD in Greece.

Membranoproliferative glomerulonephritis in a patient with chronic brucellosis.

Brucellosis is the most common zoonotic disease in Greece, with an endemic distribution and can affect any organ. Infiltration of the renal parenchyma causes acute and chronic interstitial nephritis with granulomas, whereas renal glomeruli are rarely affected. The disease has been sporadically reported, and it causes various histopathologic patterns. Herein, we describe the case of a 39-year-old stock breeder with a history of recurrent episodes of bacteremia caused by Brucella melitensis over a period of 3 years. Two months after the last episode of bacteremia, he presented with mild renal insufficiency, nephrotic range proteinuria, and microscopic hematuria. A renal biopsy revealed membranoproliferative glomerulonephritis with a pattern of focal-segmental nodular sclerosis and moderate tubulointerstitial fibrosis. The patient received antimicrobial and corticosteroid therapy with partial remission of the nephrotic syndrome.

The burden of disease in Greece, health loss, risk factors, and health financing, 2000–16: an analysis of the Global Burden of Disease Study 2016

SummaryBackgroundFollowing the economic crisis in Greece in 2010, the country's ongoing austerity measures include a substantial contraction of health-care expenditure, with reports of subsequent negative health consequences. A comprehensive evaluation of mortality and morbidity is required to understand the current challenges of public health in Greece.MethodsWe used the results of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 to describe the patterns of death and disability among those living in Greece from 2000 to 2010 (pre-austerity) and 2010 to 2016 (post-austerity), and compared trends in health outcomes and health expenditure to those in Cyprus and western Europe. We estimated all-cause mortality from vital registration data, and we calculated cause-specific deaths and years of life lost. Age-standardised mortality rates were compared using the annualised rate of change (ARC). Mortality risk factors were assessed using a comparative risk assessment framework for 84 risk factors and clusters to calculative summary exposure values and population attributable fraction statistics. We assessed the association between trends in total, government, out-of-pocket, and prepaid public health expenditure and all-cause mortality with a segmented correlation analysis.FindingsAll-age mortality in Greece increased from 944·5 (95% uncertainty interval [UI] 923·1–964·5) deaths per 100 000 in 2000 to 997·8 (975·4–1018) in 2010 and 1174·9 (1107·4–1243·2) in 2016, with a higher ARC after 2010 and the introduction of austerity (2·72% [1·65 to 3·74] for 2010–16) than before (0·55% [0·24 to 0·85] for 2000–10) or in western Europe during the same period (0·86% [0·54 to 1·17]). Age-standardised reduction in ARC approximately halved from 2000–10 (−1·61 [95% UI −1·91 to −1·30]) to 2010–16 (−0·87% [–2·03 to 0·20]), with post-2010 ARC similar to that in Cyprus (−0·86% [–1·4 to −0·36]) and lower than in western Europe (−1·14% [–1·48 to −0·81]). Mortality changes in Greece coincided with a rapid decrease in government health expenditure, but also with aggregate population ageing from 2010 to 2016 that was faster than observed in Cyprus. Causes of death that increased were largely those that are responsive to health care. Comparable temporal and age patterns were noted for non-fatal health outcomes, with a somewhat faster rise in years lived with disability since 2010 in Greece compared with Cyprus and western Europe. Risk factor exposures, especially high body-mass index, smoking, and alcohol use, explained much of the mortality increase in Greek adults aged 15–49 years, but only explained a minority of that in adults older than 70 years.InterpretationThe findings of increases in total deaths and accelerated population ageing call for specific focus from health policy makers to ensure the health-care system is equipped to meet the needs of the people in Greece.FundingBill & Melinda Gates Foundation.

Τreatment and prevention of canine heartworm disease (dirofilariosis): what is new?

Canine heartworm disease (dirofilariosis) is a frequent parasitic disease in Greece and other para-Mediterranean countries. Immediate adulticide therapy, followed by administration of microfilaricidals, has been the mainstay of heartworm treatment. However, a more recent approach has included the requirement to killing microfilariae and Wolbachia pipientis prior to adulticide treatment. Administration of prophylactic doses of milbemycin, moxidectin, ivermectin or selamectin for 2 to 3 months, as well as of doxycycline (10 mg kg-1 bw, per os, twice daily) for a month, seems to negate the ‘susceptibility gap’ and to decrease the possibility of pulmonary thromboembolism. Moreover, an alternative protocol of adulticide therapy (2.5 mg kg-1 bw of melarsomine, intramuscularly, followed by two further injections, 24-hours apart, a month later) is considered superior to the classical one, regardless of the clinical stage of the disease.Treatment of potential complications (right heart failure or vena cava syndrome) includes administration of heart failure medication and surgical removal of adult worms. Strict exercise restriction seems to play the most important role in reducing the possibility of pulmonary thromboembolism. Alternative protocol melarsomine administration, after treatment with macrocyclic lactones and doxycycline, increases the therapeutic effect and improves prognosis in earlier stages of the disease. Continuous (or at least during the warm period of the year) preventive administration of microfilaricidals coupled with annual serological testing of animals is important for effective disease control.

Adult congenital heart disease in Greece: Preliminary data from the CHALLENGE registry

BackgroundThe majority of patients with congenital heart disease (CHD), nowadays, survives into adulthood and is faced with long-term complications. We aimed to study the basic demographic and clinical characteristics of adult patients with congenital heart disease (ACHD) in Greece. MethodsA registry named CHALLENGE (Adult Congenital Heart Disease Registry. A registry from Hellenic Cardiology Society) was initiated in January 2012. Patients with structural CHD older than 16years old were enrolled by 16 specialized centers nationwide. ResultsOut of a population of 2115 patients with ACHD, who have been registered, (mean age 38years (SD 16), 52% women), 47% were classified as suffering from mild, 37% from moderate and 15% from severe ACHD. Atrial septal defect (ASD) was the most prevalent diagnosis (33%). The vast majority of ACHD patients (92%) was asymptomatic or mildly symptomatic (NYHA class I/II). The most symptomatic patients were suffering from an ASD, most often the elderly or those under targeted therapy for pulmonary arterial hypertension. Elderly patients (>60years old) accounted for 12% of the ACHD population. Half of patients had undergone at least one open-heart surgery, while 39% were under cardiac medications (15% under antiarrhythmic drugs, 16% under anticoagulants, 16% under medications for heart failure and 4% under targeted therapy for pulmonary arterial hypertension). ConclusionsACHD patients are an emerging patient population and national prospective registries such as CHALLENGE are of unique importance in order to identify the ongoing needs of these patients and match them with the appropriate resource allocation.

Α Cost of Illness Analysis of Hepatitis B Virus Infection in Greece

Background/Objective: Although often called a “silent disease”, HBV entails a significant disease and financial burden for the health system. An attempt to provide detailed estimates of the direct cost of this – rather neglected – disease in Greece comprised the objective of this study. Methods: The medical records of 254 patients diagnosed with HBV and monitored in the Hepatology Unit of the ‘Attikon’ university hospital provided the basis for the analysis. Detailed resource use data (physician visits, medications, labwork, and hospitalizations) were derived from the patients’ records for a retrospective 12month period, before their most recent visit to the clinic. Calculations followed a third-party payer perspective, according to official prices and tariffs, and are expressed in year 2015 Euros.

Novel NPC1 mutations with different segregation in two related Greek patients with Niemann-Pick type C disease: molecular study in the extended pedigree and clinical correlations

BackgroundNiemann-Pick type C disease (NPC) is an autosomal recessive, neurovisceral, lysosomal storage disorder with protean and progressive clinical manifestations, resulting from mutations in either of the two genes, NPC1 (~95% of families) and NPC2. Contrary to other populations, published evidence regarding NPC disease in Greece is sparse.MethodsThe study population consisted of two Greek NPC patients and their extended pedigree. Patients’ clinical, biochemical, molecular profiles and the possible correlations are presented. Genotyping was performed by direct sequencing. Mutations’ origin was investigated through selected exonic NPC1 polymorphisms encountered more frequently in a group of 37 Greek patients with clinical suspicion of NPC disease and in a group of 90 healthy Greek individuals, by the use of Haplore software.ResultsTwo novel NPC1 mutations, [IVS23 + 3insT (c.3591 + 3insT) and p. K1057R (c.3170A > C)] were identified and each mutation was associated with a specific haplotype. One of the patients was entered to early treatment with miglustat and has presented no overt neurological impairment after 11.5 years.ConclusionsThe splicing mutation IVS23 + 3insT was associated in homozygocity with a severe biochemical and clinical phenotype. A possible founder effect for this mutation was demonstrated in the Greek Island, as well as a different origin for each novel mutation. Longitudinal follow-up may contribute to clarify the possible effect of early miglustat therapy on the patient compound heterozygous for the two novel mutations.

The direct and indirect costs of managing chronic obstructive pulmonary disease in Greece.

ObjectiveCOPD is associated with significant economic burden. The objective of this study was to explore the direct and indirect costs associated with COPD and identify the key cost drivers of disease management in Greece.MethodsA Delphi panel of Greek pulmonologists was conducted, which aimed at eliciting local COPD treatment patterns and resource use. Resource use was translated into costs using official health insurance tariffs and Diagnosis-Related Groups (DRGs). In addition, absenteeism and caregiver’s costs were recorded in order to quantify indirect COPD costs.ResultsThe total costs of managing COPD per patient per year were estimated at €4,730, with direct (medical and nonmedical) and indirect costs accounting for 62.5% and 37.5%, respectively. COPD exacerbations were responsible for 32% of total costs (€1,512). Key exacerbation-related cost drivers were hospitalization (€830) and intensive care unit (ICU) admission costs (€454), jointly accounting for 85% of total exacerbation costs. Annual maintenance phase costs were estimated at €835, with pharmaceutical treatment accounting for 77% (€639.9). Patient time costs were estimated at €146 per year. The average number of sick days per year was estimated at 16.9, resulting in productivity losses of €968. Caregiver’s costs were estimated at €806 per year.ConclusionThe management of COPD in Greece is associated with intensive resource use and significant economic burden. Exacerbations and productivity losses are the key cost drivers. Cost containment policies should focus on prioritizing treatments that increase patient compliance as these can lead to reduction of exacerbations, longer maintenance phases, and thus lower costs.