Chronic aortic aneurysms are permanent and localized dilations of the aorta that remain asymptomatic for long periods of time but continue to increase in diameter before they eventually rupture. Left untreated, the patients’ prognosis is dismal, since the internal bleeding of the rupture brings about sudden death. Although successful treatment cures the disease, the risky procedures can result in paraplegia from spinal cord ischaemia or even death, particularly for aneurysms extending from the thoracic to the abdominal aorta and thus involving many segmental arteries to the spinal cord, i.e. thoracoabdominal aortic aneurysms of Crawford type II. Although various strategies have achieved a remarkable decrease in the incidence of paraplegia, it is still no less than 10 to 20%. However, it has been found that the deliberate occlusion of the segmental arteries to the paraspinous collateral network finally supplying the spinal cord does not increase rates of permanent paraplegia. A therapeutic option, ‘minimally invasive segmental artery coil embolization’ has been devised which proceeds in a ‘staged’ way to occlude groups of arteries under highly controlled conditions after which time must be allowed for arteriogenesis to build a robust collateral blood supply. PAPA-ARTiS is a phase II trial to demonstrate that a staged treatment approach can reduce paraplegia and mortality dramatically. It can be expected to have both a dramatic impact on the individual patient's quality of life if saved from a wheelchair, and also upon financial systems through savings in; 1) lower costs in EU health care; 2) lower pay-outs in disability insurance (est. at 500k in Year 1), and; 3) loss of economic output from unemployment. Approx. 2500 patients a year in Europe undergo these high risk operations with a cumulative paraplegia rate of over 15%; therefore >100M per year in costs can be avoided and significantly more considering the expected elimination of type II endoleaks.

FRESHER brings together ten research groups, including leaders in the management of large European Foresight projects and highly experienced health policy modelers, in an interdisciplinary team engaged in FoResight and Modelling for European Health policy and Regulation. The overall project objective is the representation of alternative futures where the detection of emerging health scenarios will be used to test future policies to effectively tackle the burden of non communicable diseases (NCDs). The project will produce quantitative estimates of the future global burden of NCDs in the EU and its impact on health care expenditures and delivery, population well-being, health and socio-economic inequalities, and potential changes in these impacts according to alternative health and non-health policy options. The added value of FRESHER lies in the fact that these estimates: - will not only be based on extrapolation of past health trends but also on foresight techniques (mapping of risk factors, horizon scanning and identification of key drivers for change, scenarios building) giving credit to the interdependencies of structural long-term trends in demography, gender relations, technological, economic, environmental, and societal factors at 2050. - will be produced through the development of an empirically-based micro-simulation model (starting from the Chronic Disease Policy Model of OECD), allowing to quantify the current and future health and economic impacts of NCDs and testing “what if” policy options according to alternative foresight scenarios, as well as potential new policies and policy combinations. FRESHER heavily relies on an interactive process with key stakeholders, at all stages of the project, in elaborating the framework, and giving inputs for the qualitative foresight scenarios and the quantitative micro-simulation model, and in deriving recommendations for future policies affecting population health and well-being.