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Systemic lupus erythematosus is a heterogeneous, multisystem autoimmune disease. These attributes cause lupus to be a challenging condition to adequately manage, which is further aggravated by the lack of treatment modalities. Belimumab is a full human monoclonal antibody, and its safety and efficacy in lupus management have been demonstrated in a number of randomized clinical trials. However, these gains come at a high cost in an era that is demarcated by soaring pharmaceutical expenditure. Therefore, the objective of this paper is to critically assess the economic evaluations of belimumab. A systematic review was performed for economic evaluations of belimumab and the retrieved studies were assessed with the quality of health economic studies questionnaire. A total of 3 studies and 5 abstracts were retrieved. Belimumab demonstrated a consistent favorable economic profile across Spain, Italy, Portugal, Greece, Hong Kong, Canada, and Greece. The sensitivity analyses revealed that the effectiveness of treatment and the discontinuation rate had the greatest effect on the outcome. Current data underscore a favorable cost-effectiveness ratio of belimumab in the treatment of systemic lupus erythematosus. Results are consistent across Spain, Italy, Portugal, Greece, Hong Kong, Canada, and Greece, countries for which an economic evaluation was available. Nevertheless, the low number of assessments, along with concerns regarding its long-term effectiveness, underpin areas that necessitate further research. [ABSTRACT FROM AUTHOR]

Cyprus entered a prolonged financial recession, which escalated to a bailout agreement with a team of international lenders. This rendered as prerequisites structural reforms aiming to enhance efficiency of the system. To report on the impact of the financial crisis and ensuing health sector reforms in Cyprus. A cross-sectional study with datasets from the 2010 and 2014 (11 088 individuals and 9983 individuals, respectively) Cyprus European Union Statistics on Income and Living Conditions. We analyzed data using a logistic regression model and also performed a documentary analysis. Compared to 2010, in 2014 the percentage of Cypriots who self-reported their health state as very good was stable (1.03; confidence interval [CI] 95%, 0.98-1.09]), whereas the percentage of Cypriots who self-reported their health state as bad demonstrated a statistically significant reduction (0.75 [CI 95% 0.66-0.85]). The cumulative financial affordability impact the said measures had on the patients was negative: a significant increase was reported for patients reporting unmet medical needs ("cost" and "long waiting lists") (1.22 [CI 95% 1.03-1.35]), whereas inconclusive findings were reported apropos dental health needs (0.96 [CI 95% 0.88-1.04]). We demonstrate that crisis and health reforms did not exert any negative effects on Cypriots' health; nevertheless, a significant increase of patients who face difficulties in financing their health needs was reported. The mental health sector was, in particular, affected by the crisis, and consequently, health agencies must closely monitor this topic along with the aforementioned affordability issues. [ABSTRACT FROM AUTHOR]

• With an increasing percentage of the population presenting with atrial fibrillation, a long-term anticoagulation treatment is needed in order to prevent the complications that stem out of this health condition. • We created an indirect treatment network utilising direct and indirect evidence, to compare the efficacy between the current benchmark, warfarin, and the new category, Xa inhibitors. • Evidence suggests that the new category can offer significant benefits to patients and satisfy a previously unmet clinical need. • We also noted differences among the new agents, both in safety and efficacy. The study sets out to compare the safety and efficacy of oral Non-vitamin K antagonists and warfarin in patients with atrial fibrillation. Patients with atrial fibrillation carry a higher than normal risk for stroke, thus making them dependent on long-term anticoagulation treatment. While warfarin is considered to be the gold standard, several of its attributes, hinder adherence of patients to the therapeutic regimen. A new therapeutic category, the oral Non-vitamin K antagonist oral anticoagulants, aims to provide better and safer care to patients presenting with atrial fibrillation. An indirect mixed treatment comparison using data from published randomised controlled trials. Looking at the primary efficacy endpoint of stroke or systematic embolism, apixaban, rivaroxaban and dabigatran, demonstrated significant superiority compared to warfarin, while a trend exists for edoxaban [OR: 0.84 (95% CI 0.74–1.02)]. At the primary safety endpoint of major bleeding, evidence suggest that apixaban and edoxaban are superior to warfarin. Warfarin proved to be safer regarding gastrointestinal bleeding, compared to rivaroxaban, dabigatran and edoxaban. At the secondary efficacy endpoints of hemorrhagic and intracranial stroke, all Non-vitamin K antagonists oral anticoagulants were related to reduced risk versus warfarin. The Non-vitamin K antagonist oral anticoagulants constitute a new and promising category in the field of atrial fibrillation, even in the context of uncertainty, which an indirect comparison yields. [ABSTRACT FROM AUTHOR]

This paper performs price comparisons of branded pharmaceutical products in markets of eleven European Union countries. We follow a Laspeyres index approach, using Cyprus as the base country and analyse prices in the private and public markets and also consider biotechnology products separately. We find that Germany, Denmark and Austria demonstrate the highest pharmaceutical prices in the EU, followed by Cyprus. When adjusting for per capita income, Cyprus demonstrates the highest prices. Given that there is no universal health insurance in Cyprus, and that the country recently faced a financial crisis, our findings underline possible affordability problems for patients. In order to remove barriers to access to medicines, pharmaceutical pricing regulation could be adjusted and price revisions should take place more frequently, and, most importantly, Cyprus must move in the direction of adopting universal health insurance. [ABSTRACT FROM AUTHOR]

Background: Soaring health expenditures worldwide call for potent cost-containment approaches. Global budgets have been used by several countries to harness their health expenditures by constraining the total payable amount to a predefined budget threshold. Objectives: Cyprus is vacillating on the use of a global budget for its National Health System; nevertheless, its attributes must be scrutinized to rule out potential adverse effects on quality of care and access of patients. The delegation of budget across providers is a context-sensitive process and as such it must be based on historical data and performance incentives as well. Conclusions: A global budget is not a panacea, and consequently the enhancement of health system’s performance, appropriateness assessment, and volume and capacity control measures are incumbent. A global budget demonstrates a higher complexity factor for pharmaceuticals, which mandates a thorough assessment of pharmaceuticals before their reimbursement and elaboration of measures to safeguard timely access to innovation. [ABSTRACT FROM AUTHOR]

Background: Laboratory test ordering is a significant part of the diagnosis definition and disease treatment monitoring process. Inappropriate laboratory test ordering wastes scarce resources, places unnecessary burden on the health care delivery system, and exposes patients to unnecessary discomfort. Inappropriate ordering is caused by many factors, such as lack of guidelines, defensive medicine, thoughtless ordering, and lack of awareness of costs incurred to the system.Objectives: The purpose of this study is to assess two successive measures, which were introduced in a Cyprus emergency department (ED) for the purpose of synergistically reducing inappropriate laboratory ordering: the introduction of a copayment fee to reduce nonemergent visits, and the development of a Web-based protocol defining the tests emergency physicians could order.Methods: An autoregressive integrated moving average model for interrupted time series analysis was constructed. Data include number and type of tests ordered, along with number of visits for a period of 4 years from an ED in Cyprus.Results: Copayment fee and introduction of a revised Web-based protocol for a test ordering form did not reduce the number of ordered tests in the ED unit. Copayment fee alone resulted in a statistically significant reduction in ED visits.Conclusions: The implementation of two consecutive measures resulted in an increase of ordered tests per patient. Laboratory ordering is a multidimensional process that is primarily supplier induced, therefore, all underlying possible causes must be scrutinized by health authorities. These include lack of guidelines, defensive medicine and thoughtless prescribing. To attain significant gains, an integrated approach must be implemented. [ABSTRACT FROM AUTHOR]

Tendering has proven its efficacy mainly in generic procurement, however due to several impediments, its penetration among European Countries is low and data regarding its long-term effect are scarce. Methods We assess the long-term effect of tendering on prices of branded products in Cyprus through the utilization of a repeated measures generalized linear model. We used products that were continuously included in Cyprus formulary for seven consecutive years. Results Tendering demonstrates a statistically significant reduction, superior to reduction reached with official external price referencing scheme, and it retains its long-term potency on price reduction. It is mediated by other variables such as interchangeability, in-patient status and indication of the product. Volume of sales is not related to the rate of reduction. Conclusions Tendering can be considered as a potent pricing and reimbursement method in the long-term. It is a context sensitive scheme, therefore it must be applied with regards to each country׳s operational health policy framework. [ABSTRACT FROM AUTHOR]

Background The increasing use of drug eluting stents in interventional cardiology calls for assessment of their efficacy and safety, both among drug-eluting and bare-metal stents, in the context of rational decision making. Methods We searched for papers that compared any of the sirolimus-eluting stent, paclitaxel-eluting stent, drug- eluting stent, biodegradable stent, everolimus-eluting stent, zotarolimus-resolute eluting stent, biolimus- eluting stent, bare-metal stent and zotarolimus-eluting stent. The search was contacted through Medline, the Cochrane database, Embase, TCTMD, ClinicalTrials.gov, Clinical Trial Results, CardioSource, abstracts and presentations from major cardiovascular meetings. We also searched for further articles cited by selected papers. Furthermore, important conferences and relevant proceedings and abstracts, such as the American Heart Association, American College of Cardiology, Transcatheter Cardiovascular Therapeutics, Society of Cardiovascular Angiography and Intervention, European Society of Cardiology, and Euro-PCR, were also searched. Inclusion criteria were: randomised controlled trials (RCTs), size of study (≥ 100 patients), duration more than 6 months and definition of reported endpoints (target vessel revascularization, thrombosis, myocardial infarction and cardiac death). Analysis of the data was performed for short-term (less than a year) and long-term outcomes (more than a year). A mixed treatment comparison approach was utilised for the data analysis. Conclusions Based on the rankings of each treatment, a distinct difference between the 2nd and 1st generation stents was identified. We can conclude that everolimus, zotarolimus-resolute and biolimus eluting stents carry the highest probabilities of being superior for all endpoints. [ABSTRACT FROM AUTHOR]

Background Tendering has been a promising approach for procuring pharmaceuticals. Significant price reductions have been well documented by several authors. To our knowledge, there are limited data detailing the impact of variables in the tendering process. Objectives In this article, our objective was to evaluate the impact of potentially exploratory variables, which included innovation status, total value and volume of sales of each product, health care setting administration (hospital/outpatient), patent status (branded/generic), tendering type, and wholesale price, on price reduction in the tendering process. Methods Financial data of public sector sales during 2011 were analyzed. On the basis of these data, we selected 178 medicines with corresponding sales of €49 million, out of a total market value of €104 million. Medicines were selected according to volume, value, and therapeutic value across all therapeutic areas. We performed a beta regression for the assessment of impact of variables and applied the same methodology to different subgroups. Conclusions The generic status of medicines is statistically significantly associated with a higher price reduction. Tendering type by alternative, high wholesale prices, and high volume are robust estimators for price reduction. Innovation status does not have any effect on price reduction. Outpatient medicines reach lower prices as compared with hospital medicines. A rather unexpected finding is the negative correlation of high sales value with price reduction. These findings will lead to better understanding of the tendering framework, enabling us to further evolve its operational capacity, aiming to generate more savings. Moreover, our study indicates areas in which a more optimized approach is needed. [ABSTRACT FROM AUTHOR]

Background The incidence of tuberculosis (TB) in Cyprus has doubled over the last decade and an urgent overhaul is needed to curb its spread. Objectives To analyze the incidence of TB on the basis of nationality, age, and sex and provide an insight on TB pattern in Cyprus. Methods We performed an odds ratio statistical analysis of the latest data and concluded that some nationalities are significantly associated with this increase. Results We identified that this can be partly attributed to a legislation gap, which provides that screening is mandatory only for third-country migrants, whereas there is no provision for high-risk European migrants. Conclusions On the basis of our findings, we suggest that health policies for TB in Cyprus be reformed and epidemiological findings be embedded in a revised integrated policy. This will make health policies more efficient and help contain scarce resources, both human and monetary. [ABSTRACT FROM AUTHOR]

Background Cyprus has been procuring medicines for the public sector through tendering and is one of a few EU member states with this policy both in outpatient and inpatient health sector. Objectives The aim of this paper is the assessment of financial benefit from tendering and evaluation of its operational framework. Data and methods We compare value (weighted price) reduction, from a public payer׳s perspective, by using tendering prices compared with official pharmacy procurement prices, for the same volume of products (strength and package). Moreover, we assess mean price reduction of official pharmacy procurement prices as an effect of tendering, for the same sample. We perform the same analysis for the total sample and for 3 overlapping subcategories: branded, generics and Top twenty products in value. Products were selected based on clinical importance, volume and value. Sample includes 176 products, corresponding to 49.3 million euro cost and relevant data were extracted from Public Pharmaceutical sales of 2011 and the official 2011 pricelist of Ministry of Health. Results 60.6% value reduction and 39.39% mean price reduction have been achieved with tendering system. Generics demonstrated the greatest reduction both in value (94.8%) and in mean price (62.97%). Branded products reached 33.4% value and 25.99% mean price reduction, while top twenty products achieved 29% value and 23% mean price reduction. Conclusion Tendering is emerging as a sustainable and potent solution to a fast expanding pharmaceutical sector and it is a context sensitive cost containment approach. It must be implemented within a transparent, strict and specific framework. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Health care decision making, assessment, and procurement of medicines is a complex, human resource–demanding, and time-consuming process. A thorough evaluation of all factors involved is necessary to optimize the process. The objective of this study was to describe and analyze the current stage of health technology assessment (HTA) in Cyprus. Methods: Literature research and private communication with all involved parties and competent authority. Moreover, data, decisions, and recommendations of the Drug’s Committee were used. Results: Cyprus is a latecomer in this field. HTA has entered a growing phase after the 2007 reform. It has not reached its full potential, and the current state is applicable only to the public sector, because of the nonexistence of a national health system. Therefore, this poses both a great challenge and a great barrier considering maximization of the value of money spent and health access equity. Conclusions: There is definitely enough space and clear necessity for further dissemination, and early successes indicate that steps should be taken toward the introduction of an HTA procedure that will cover both private and public sectors. The introduction of a national health system will further enhance the uptake of HTA, optimize the process, and use the common knowledge strategy for evidence-based decision making. [Copyright &y& Elsevier]