Quality of Life and Mental Health in Multiple Sclerorsis Patients in Bosnia and Herzegovina Measured by Generc and Disease-Specific Questionaire.

BACKGROUND: Multiple sclerosis (MS) as chronic neurodegenerative disease significantly impact patients' quality of life (QoL). QoL instruments can be generic (EQ-5D, SF-36) and disease-specific like MSQoL-54. Use of disease-specific instruments is preferred since it captures broader symptoms related to MS than generic instruments. Mental health is impacted by MS and different psychiatric conditions significantly impact QoL. We have conducted prospective non-interventional study among MS patients. Aim was to measure and compare MS patients QoL by generic and disease-specific instrument at baseline and after one year and to identify potential correlation between these two types of measurements and to assess mental health scores among MS patients in Bosnia and Herzegovina (B&H) and other countries. SUBJECTS AND METHODS: Study included 62 patients diagnosed with MS and treated at Neurology clinic in Sarajevo from April 2016 to May 2017. Study was approved by Ethical Committee. QoL has been measured by EQ-5D and MSQoL-54. Measurement has been performed at baseline and after 12 months. RESULTS: Average utility score measured by EQ-5D at the baseline and end of the study were 0.688 and 0.639 respectively with no significant difference (p=0.850). EQ-5D utility and MSQoL-54 score showed high correlation at baseline; rho=0.873 p=0.0001 for physical health and rho=0.711 p=0.0001 for mental health. At the end of the study no significant correlations have been found (p>0.05). High negative correlation found between EDSS and scores measured by EQ-5D and MSQoL-54; at baseline (rho=-0.744 p=0.0001) and at the end of the study (rho=-0.832 p=0.0001). Similar MS impact and loss of QoL found in B&H and other countries. CONCLUSIONS: Both instruments can be used in measuring QoL but disease-specific are preferred since they capture broader symptoms impacting MS patient QoL. Using QoL instruments could drive clinician decision and patient-centric care as well as reimbursement and policy decision by recording treatment outcomes.

HEALTH TECHNOLOGY ASSESSMENT IN CENTRAL-EASTERN AND SOUTH EUROPE COUNTRIES: BOSNIA AND HERZEGOVINA.

OBJECTIVES: The aim of this study was to describe the healthcare system and health financing in Bosnia and Herzegovina and recent trends in health technology assessment (HTA) placement in the system. METHODS: A short review of PubMed published literature has been conducted using key words related to reimbursement, HTA, and health policy. We also revised legislation in Bosnia and Herzegovina published in Official Gazettes related to healthcare financing and organization. RESULTS: A deecentralized system in Bosnia and Herzegovina led to high differences in health policy. HTA has been recognized in legislation in Bosnia and Herzegovina, but it still has not been introduced in practice in full capacity. A small number of publications are found in PubMed treating these issues, but generally the problem of introduction of HTA in Bosnia and Herzegovina is lack of experts, as well as the political environment and education in this field. CONCLUSIONS: HTA in the Federation of Bosnia and Herzegovina and the Republic of Srpska has a short history because of a huge political impact in the decision-making process, decentralized system, and multiple decision makers in these regions. Challenges remain in assessments, in development of more transparent approaches in different areas of the health system in these regions, and in consistent application of appropriate standards especially in education of professionals who will provide establishment of HTA in the health system of The Federation of Bosnia and Herzegovina and the Republic of Srpska.

Validation of the Disease-specific Questionnaire MSQoL-54 in Bosnia and Herzegovina Multiple Sclerosis Patients Sample.

INTRODUCTION: The purpose of this study was to validate Bosnian translation of disease specific quality of life measure MSQoL-54 which is widely used in practice. MATERIAL AND METHODS: Previously translated and culturally adopted MSQoL-54 questionnaire used in this study has been provided and licensed by Optum Inc. The questionnaire was validated in 62 MS patients seen at Neurology clinic at University Clinical Center Sarajevo, during April 2016 until May 2016. Internal reliabilities of Bosnian version MSQoL-54 were assessed for multiple item scales by using Cronbach's alpha coefficient. Clinical validity was assessed comparing means of the two summary MSQoL-54 scores by the EDSS score. Pearson's (r) correlation coefficient was used to investigate the relationship between the composite scores and the main clinical and demographic variables. RESULTS: Patients' participation was satisfactory and all scales fulfilled the usual psychometric standards. Highly significant inverse relationship was found between both composite scores and clinical characteristics of the disease and the EDSS. The lowest internal consistency reliability is found on social function scale (0.743), overall quality of life (0.782) and pain (0.833). The highest internal consistency reliability is found on role limitations due to physical problems (0.959), physical health (0.962) and role limitations due to emotional problems (0.966). The mean value of MSQoL-54 PHC (Physical Health Composite) and MHC (Mental Health Composite) were 49.82±18.90 (36.05-61.38) 51.84±22.22 (34.93-70.20) respectively. Our study has shown that the Bosnian version of MSQoL-54 is easy to administer and well accepted by patients and may be useful as clinical outcome measures in patients with MS.

Comparison of Psychotropic Drug Prescribing Quality between Zagreb, Croatia and Sarajevo, B&H.

BACKGROUND: The purpose of this paper was to compare outpatient consumption and quality of psychotropic drug prescribing between Croatia and Bosnia & Herzegovina 2006-2010. METHODS: Data on drug utilization from Zagreb Municipal Pharmacy and Sarajevo Public Pharmacy were used to calculate the number of defined daily doses (DDD) and DDD per 1000 inhabitants per day (DDD/TID) using the WHO Anatomical-Therapeutic-Chemical methodology. RESULTS: Total utilization of psychopharmaceuticals increased in both cities; however, it was higher in Zagreb than in Sarajevo throughout the study period. The utilization of psycholeptics increased in Zagreb by 2.4% (from 74.5 to 76.3 DDD/TID) and in Sarajevo by 3.8% (from 62.4 to 64.8 DDD/TID). The utilization of anxiolytics decreased in Zagreb by 2.1% and in Sarajevo by even 18.7%. The utilization of antidepressants increased in both cities with predominance of SSRI over TCA utilization, greater in Sarajevo (96.6%) than in Zagreb (10.2%). The anxiolytic/antidepressant ratio decreased by 11.1% in Zagreb (from 2.87 to 2.55) and by 58.7% in Sarajevo (from 5.66 to 2.34). Outpatient utilization of antipsychotics increased significantly in Sarajevo, predominated by typical ones, whereas in Zagreb the utilization of antipsychotics was stable, predominated by atypical ones. CONCLUSIONS: In Croatia and Bosnia & Herzegovina, there was an obvious tendency to follow western trends in drug prescribing, as demonstrated by the increased use of antidepressants and reduced use of anxiolytics. Despite some improvement observed in the prescribing quality, high use of antipsychotics with dominance of typical antipsychotics in Sarajevo points to the need of prescribing guidelines for antipsychotics.

The Moisturizing Efficacy of a Proprietary Dermo-Cosmetic Product( CLS02021) Versus Placebo in a 4-week Application Period.

Background: Studies suggest that applying probiotic skincare products may have beneficial effects on the skin due to bacteria competitiveness and specific metabolites produced by probiotics. The cream CLS02021 is a postbiotic blend of metabolites, including organic acids, enzymes, and peptides that are a result of the co-fermentation of three proprietary probiotic strains and is specific for its high concentration of the enzyme Sphingomyelinase which plays a significant role in cell signaling pathways and ceramide production. Objective: The aim of this study is to evaluate the cosmetic effects of probiotic-derived Ingredient CLS02021 and its safety in healthy volunteers. Methods: Fifty healthy volunteers between 18 and 69 years old were recruited to participate in this multicentric, randomized, intra-individual, double-blind group study. Following a face-split design, volunteers applied both face cream containing CLS02021 on one side of their face and a placebo cream on the other side of their face for a total duration of four weeks, two times a day. Evaluation of the cosmetic effects included instrument measurements of moisturizing, elasticity, wrinkle depth, sebum production, pore size, melanin production, sensitivity, and side effects. Results: A significant difference of CLS02021 over the placebo group was observed for moisture and elasticity increase (both p<0.001), pore size (p<0.01), and a wrinkle depth decrease (p<0.05). No significant differences were noted in sebum production, melanin level, skin cleanliness, and sensitivity between groups. Conclusion: CLS02021, as a probiotic-derived ingredient, showed strong beneficial effects on skin moisture and elasticity increase, wrinkle depth, and pore size reduction. Face cream containing CLS02021 is well tolerated and could be an organic choice for cosmetic hydrating and antiaging skincare treatment.

Costs of Diabetes Mellitus and Its Complications in Bosnia and Herzegovina.

Background: The economic burden induced by all types of Diabetes mellitus (DM) and their complications has reached 1.8% of gross domestic product (GDP) globally. The economic burden of diabetes mellitus in Bosnia & Herzegovina (B&H) is still unknown. Objective: To investigate the economic burden of diabetes in Bosnia and Herzegovina, including the costs of diagnosing and treating diabetes and its complications. Methods: The study was designed as a top-down cost of illness study, based on prevalence, analyzing both direct and indirect costs of DM and complications caused by DM. All types of DM were taken into account, and estimates were based on total B&H population. Costs of services per patient were calculated by multiplication of share of treated population, service utilization data and unit costs. Results: Annual economic burden associated with DM in B&H is around 189 million euro (739 euro per patient), which makes 1.11% of gross domestic product (GDP) of B&H in 2020 (16,993,101,523 euro, according to the World Bank data). The largest part of this burden was created by DM medication and costs of managing complications (heart failure and stable angina being major cost drivers among the complications), followed by laboratory tests and physician visits. Conclusion: Total costs of DM per patient in B&H are within the range of costs in other Central-Eastern European (CEE) countries, reflecting significant economic burden, but also determination of healthcare payers in B&H to provide optimal management of DM in congruence with contemporary clinical guidelines.

Historical Developments of Bosnia and Herzegovina Pharmaceutical Industry - the Past and the Future Perspectives of Domestic Manufacturing.

Background: History of pharmaceutical industry in Bosnia and Herzegovina (B&H) has its roots from 1951. Importance of domestic industry not just from economical aspect but also from public health perspective and as scientific base has not been evaluated previously. Objective: The aim of this article was to provide the review of the pharmaceutical industry developments in Bosnia and Herzegovina, its roots, current position and future perspectives.. Methods: Research of published scientific papers as well other documents and archives of pharmaceutical manufacturers has been conducted. We have also analysed market trends focusing on domestic producers. Results and Discussion: Over more than seventy years of B&H pharmaceutical industry has been developing. During Yugoslavia only two companies existed of which one, Bosnalijek is still present, while Sanofarm has been closed. After 1996, expansion of domestic manufacturers started and today six companies are present. They are mainly oriented to generic drugs production in different forms. Total market share of domestic producers in B&H is 20-25% which is relatively low comparing to other countries. Many of domestic manufacturers are exporting their products to some of the most demanding markets in Europe and Middle East. Conclusion: Long history of domestic drug manufacturers in B&H gives solid legacy for future developments. Importance of local producers has been confirmed during war in B&H and COVID-19 pandemic as a crisis situation, mainly from public health perspective and sustainable supply of essential medicines. Higher support by state and collaboration with academia in order to expand portfolio, especially in area of biologic medicines is required in future.

COVID-19 Impact on Access and Performing Dental Care in Bosnia and Herzegovina.

BACKGROUND: The world was struck with a pandemic accompanied by maybe one of the most popular words out there right now, which is COVID-19. It has affected every aspect of life imaginable, especially in the medical sector particularly in our case dental care. OBJECTIVE: This study goes on to analyse and assess the impact of COVID-19 on dental care in Bosnia and Herzegovina, varying from the staff, patients, supplies/equipment, and finances. METHODS: An online survey and over-the-phone surveys were conducted, bringing in raw information to help with this study. RESULTS: In total there were 10 different dental offices that information was obtained from. About 90% say that the pandemic has affected their patient flow, obviously due to some restrictions and regulations. And 60% say that the cost of PPE has increased since the pandemic started, while 40% said otherwise. Other data can be found in the rest of the study. CONCLUSION: Entering into the pandemic, dental practices quickly started to realize the seriousness of this situation, changing the way they do normal everyday work to accustom to this "new norm". During such a problem, both sides have to participate to act upon accordingly to bring health and safety for everyone.

Mobile Pharmacies Throughout History.

BACKGROUND: Mobile pharmacies are special organizational units or infrastructures that serve to supply medicines to remote communities or are stationed on ships or as such exist during war conflicts on the battlefields to provide first aid to the wounded and to provide the necessary medicines. The establishment of mobile pharmacies is regulated by the law of each state and only preparations approved by law can be found in it. There are also regulations for the good storage and warehousing of these drugs. OBJECTIVE: The aim of this article was to provide an overview of the available literature on the topic "Mobile pharmacies through history", which shows the development and progress in the structure and function of mobile pharmacies throughout history. METHODS: This is an descriptive study based on the searched available literature from the on-line databases regarding to present a historical overview of mobile pharmacies during the most significant war events in Europe and the USA. RESULTS AND DISCUSSION: Mobile pharmacies were first mentioned in Egypt and the Roman Empire, but it was not until 1500 that military and ship's doctors began using them, and wealthy nobles had their own boxes of medicines, which they carried on long voyages. Mobile pharmacies became more and more popular, so in the 18th century, practical manuals on the use of the contents of the box began to be published. The importance of a mobile pharmacy was shown in the wars, where people, before their appearance, died due to the impossibility of providing first aid on the battlefield. The advanced medicine and pharmacy that developed on land, greatly affected the health care at the sea. The constant incidence of infectious diseases, poverty and inadequate nutrition, insecurity of navigation and long voyages are the main reasons why sailors often fell ill and were exposed to injuries at work. A situation like that required that the problem of health protection on ships gets solved in accordance with the then principles of medicine and pharmacy. CONCLUSION: Authors demonstrated the importance of mobile pharmacies in treating and providing medical protection on boat trips. Regarding the ship's pharmacies, pharmacists have the role of supplying ships with medicines, conducting training for captains and ship staff, advising shipping companies and captains on equipping ship pharmacies and advising on the preparation of national regulations and national ship pharmacy supply policy.

Utilization and Perception of Information and Communication Technologies Among Pharmacists and Development of Pharmacy Informatics in Bosnia and Herzegovina.

BACKGROUND: Information and communication technologies (ICT) are widely used in a health care as a result of pharmaceutical informatics and technology developments. There is a huge potential for pharmaceutical practice of technologies utilization in a different practice settings especial community pharmacy and patient counseling. OBJECTIVE: To evaluate Bosnia and Herzegovina (BH) pharmacists` knowledge and attitudes towards informational and communication technologies and extend of its utilization. METHODS: Online survey conducted among pharmacists from different practice settings. RESULTS: Pharmacists in BH are familiar and well known regarding importance of informational technologies. 93% are using special pharmaceutical information systems, and majority use technologies and software for prescription processing (47%), calculations (24%) communication (22%) and 9% for Internet search. 90% of pharmacists have profiles on social media mainly Facebook, followed by Instagram and LinekdIn mainly used for networking and communication with peers but less with patients. They have positive attitude regarding potential benefits of using social media for communication with patients and treatment outcomes improvement. CONCLUSION: Pharmacists in Bosnia and Herzegovina have satisfactory level of information and communication technologies understanding and knowledge. It is of high importance that education of future pharmacist in this field is in line with nature of pharmaceutical informatics in light of its clinical application rather than technical so future pharmacists can contribute to improvements in social media medicines-related information, learn from consumers' online activities, and design new ways of delivering care to communities and individuals.

Physician Practice and Knowledge on Diabetes Management During Ramadan in Bosnia and Herzegovina.

INTRODUCTION: Ramadan is the holy month of Muslims including fasting sometimes more than 20 hours. Even diabetes patients can be exempted from fasting it has been shown that almost 80% of diabetes type 2 patients intend and do fasting. To avoid acute complications during fasting, different recommendations on diabetes management are available. Considering the fact that there are more than 226 thousand diabetics in Bosnia and Herzegovina, it is important to provide structured support and healthcare service to those who are practicing fast during Ramadan. AIM: To evaluate knowledge, practice and attitudes of physicians treating diabetes (diabetologists and endocrinologists) in Bosnia and Herzegovina regarding management of diabetes in fasting patients during Ramadan. METHODS: A 32 questions survey has been developed, validated and disseminated to the 27 specialists treating diabetes in Bosnia and Herzegovina through online form examining demographic characteristics, current practices and attitudes and knowledge on diabetes management during Ramadan. RESULTS: All surveyed physicians deal with patients who are fasting during Ramadan. The majority of surveyed physicians 23 (85,2%) proactively initiate a discussion about planned fasting. More than 63,0% are following their experience and only 18,5% ADA/EASD guidelines on diabetes management during Ramadan. There are no significant differences between gender of the physicians, place of work and specialization when it comes to specific knowledge related to treatment guidelines, but some differences are observed. CONCLUSION: Although overall physicians` knowledge of diabetes management during Ramadan is satisfying there is opportunity in additional specialized education and measures introduction into the practice in order to improve treatment outcomes and standards of care.

Diabetology Care During COVID-19 Lockdown in Bosnia and Herzegovina - Diabetologists and Patients Perspective.

INTRODUCTION: COVID-19 pandemic suddenly affected all countries and health care systems from different perspectives including severe disruption of chronic disease services including diabetes. Diabetes is a serious condition and highly present in Bosnia and Herzegovina population, so provision of diabetes care is a important part of good control. Countries had different responses to adopt diabetes care under new circumstances as well as Bosnia and Herzegovina. AIM: To investigate and evaluate the impact of the COVID-19 pandemic on the provision of diabetology care in Bosnia and Herzegovina from the perspective of patients and diabetologists. METHODS: Online survey for diabetologists and patient organizations have been developed with adopted question for different perspectives. The survey has been conducted online early September 2020. Collected data were analyzed in SPSS software for descriptive statistics. RESULTS: 25 diabetologists and 24 diabetes patient organizations responded. 72% of diabetologists believe that pandemic has partially altered work with patients and 56% believe that the organization of diabetes care has successfully responded to the new circumstances but 80% believe that the diabetes care system should change. 75% of patient organizations thought that the organization of diabetes care did not adequately respond and 87.5% believe system should change. CONCLUSION: No significant differences found between RS and FBiH when it comes to majority of questions. Both diabetologists and patients consider that system of diabetes care in Bosnia and Herzegovina should be improved in future. It has been also found that diabetologists in Bosnia and Herzegovina responded and adopted their practices similar to other countries.

The Role of Diet Therapy in the Treatment of Liver Disease.

INTRODUCTION: The liver is the largest gland in the human body, and serves to store nutrients and neutralize harmful compounds. The liver plays a very important role in a number of metabolic, both catabolic and anabolic processes, and is therefore called the "central laboratory" of the organism. If liver disease occurs, they can affect all its parts-liver cells, bile ducts, blood and lymph vessels. The liver is damaged by various toxins, drugs, infections, disturbances in the blood supply and other disorders. Diet therapy has been a part of the process in the treatment of liver disease for a while. The therapeutic principle is better known as the "liver diet". The liver diet not only means the replenishment of calories and nutrients, but it significantly affects the course of the disease. AIM: The aim of the research is to show that diet therapy plays an important role in the treatment of liver disease as a component for faster recovery of the liver and restoration of its normal function, as well as protecting the liver after overcoming the disease. RESULTS: Among the respondents, there were 39 men (64%) and 22 women (36%) who had liver disease as a chronic condition. Most respondents are between 51 and 65 years old (28 and 46%, respectively), while the least number of respondents are in the 20 to 30 age group. The largest number of respondents cited alcohol as the cause of the disease, 31 of them (50.8%), while the virus was the cause of the disease in 15 respondents (24.5%). Of the total sample, most respondents answered that they sometimes (45.9%) or often (47.5%) overeat. The results of the questionnaire showed that 85.2% of the respondents were smokers before the diagnosis of the disease. In most respondents, the food they ate before diagnosis was moderately fatty (52.5%). Using chi-square tests, it was found that there are statistically significant differences in the consumption of almost all foods before the diagnosis of the disease and after the obtained dietary recommendations (p<0.05). CONCLUSIONS: The aim of the research was confirmed that diet therapy plays an important role in the treatment of liver disease as a component for faster recovery of the liver and restoration of its normal function, and after overcoming the disease it still protects the liver. The main purpose of creating a diet therapy program and plan proved to be significant and necessary because more than half of the respondents rated our advice as excellent. As most causes of liver disease can be prevented, it is necessary to work on familiarizing the population with risk factors, promote a healthy lifestyle and proper nutrition, and identify at-risk patients who must enter the monitoring system for early detection of liver disease.

Disposal of Used Pens and Needles from Diabetes Patients Perspective.

INTRODUCTION: Diabetes as lifelong chronic disease requires pharmacological treatment using plastic pens and needles. Proper disposal of used pens and needles have impact not just on health but environment as well. In 2020 there will be 3.2 million pens used and disposed in Bosnia and Herzegovina resulting in over 600 tons of this waste. Worldwide problem is related to proper disposal of used insulin pens and sharps. AIM: To investigate and evaluate what are the attitudes, knowledge and practices on insulin pens and needles disposal among diabetes patients in Bosnia and Herzegovina. METHODS: The research was conducted in five cities in Bosnia and Herzegovina in period December 2019-January 2020 using questionnaire consisted of 28 questions distributed among patients with diabetes through their local patient associations. RESULTS: Total 250 diabetes patients participated. 40.4% inject medicines for 2 times per day and 37.6% for three and more times a day. Patients have not been instructed on proper disposal of used pens or needles in 67.6% and 66% respectively. The most appropriate place to dispose used pens is pharmacies and 90% of respondents would participate in program of collecting used pens if one exists. 75.6% of respondents consider improper disposal of pens and needles as healthcare problem, 18.8% see this as ecological problem and for 4% of them this is not a problem at all. CONCLUSION: Current practice of disposing used insulin pens and sharps is improper. Patients are aware of health and environmental risk. There is a huge opportunity for pharmacists and other healthcare provides to provide better information and counseling diabetes patients on this topic.

Use of Food Supplements in Diabetes Mellitus Treatment in Bosnia and Herzegovina from the Pharmacists Perspective.

INTRODUCTION: Food supplements utilization is showing increasing trend among healthy as well as chronic disease population. Diabetes as a pandemic disease is treated by different interventions and traditional pharmacological treatment, but also utilization of natural products and food supplements (FS) are becoming important. Role of the pharmacist in diabetes management includes different interventions like counseling and recommendation of FS. AIM: To explore current trends in dietary supplements utilization among diabetic patients from the pharmacists' perspective, pharmacists' attitudes and knowledge about this group of products and suggest future directions related to this issue. METHODS: We have analyzed pharmacists' perception of FS utilization for diabetes and its complication treatment by conducting online survey. The survey was developed by authors based on research aim and published literature. RESULTS: It has been found that 72% of patients with diabetes are purchasing different FS and that they are willing to pay between 5,0-15,0 EUR per visit for this products. Even in majority of cases pharmacists proactively advice patients about FS selection they identify need for specific education in this field in order to strengthen their competencies and competitiveness. Pharmacists also identified need for FS specially formulated and intended for blood glucose controls and most often diabetes complications and related conditions. CONCLUSION: This is the first study in this field conducted in Bosnia and Herzegovina suggesting further activities and research of this topic.

Pharmacists' Attitudes and Role in Diabetes Management in Bosnia and Herzegovina.

INTRODUCTION: Diabetes is the fastest growing chronic diseases worldwide and in Bosnia and Herzegovina. International standards for diabetes care have recognized the crucial role of pharmacists in diabetes management. Community pharmacists can provide services beyond medication dispensing inducing patient identification, assessment, education, referral, monitoring and behavioral counseling. Pharmacists' attitudes toward diabetes are generally positive but do not correlate with the degree of their involvement in diabetes management and frequency of providing diabetes-related services varied throughout countries. AIM: To measure pharmacists' attitude toward diabetes management and to identify pharmacy services that are currently provided to patients with diabetes. MATERIAL AND METHODS: We have conducted a descriptive, cross-sectional survey-based study among pharmacists from Bosnia and Herzegovina attending on of the conferences in May 2018. Majority of pharmacist attending such conferences are from community pharmacies across the whole country considering surveyed sample was representative. The questionnaire contained 3 different sections: a) participants' demographics, b) measured participants' attitude toward diabetes using the DAS-3 to measure participants' degree of agreement to 33 diabetes-related statements, on a 5-point Likert type scale and c) a list of possible diabetes patient support activities that could be delivered by pharmacists based on authors experience and available literature. RESULTS: The majority of respondents (86,5%) were female and 53,8% work in private owned pharmacies. Interest in diabetes was indicated by 94,2% while 59,6% completed special diabetes continuing education in the past. All the respondents expressed positive attitudes in all DAS-3 with no significant difference between overall DAS-3 and subscale values. Provided services differ but mainly drug oriented and partially include comorbidity counseling. CONCLUSION: Pharmacists had positive attitudes toward diabetes but they provided limited diabetes-related services to patients. Additional special education is needed.

Pharmacoeconomic Analysis of Antiepileptic Reimbursement for Neuropathic Pain in Bosnia and Herzegovina - Budget Impact Analysis of Pregabalin.

INTRODUCTION: Neuropathic pain resulting from injury to the nervous system. Up to 7% to 8% of the European population is affected. A number of different treatments for neuropathic pain have been studied including antiepileptic. Pregabalin and gabapentin are often considered first-line treatments. Pregabalin provides equivalent efficacy to gabapentin, showing greater potency at much lower doses and is considered as cost-effective intervention. In Federation of Bosnia and Herzegovina (FB&H), gabapentin is fully reimbursed, while pregabalin is enlisted on list B with copayment. AIM: To develop simple budget impact (BI) model and assess BI of introducing pregabalin into full reimbursement in FB&H. MATERIAL AND METHODS: Budget impact model was developed using Microsoft Excel 2010. Local epidemiology data and data on drug consumption from government reports in 2016 were used. Two scenarios with three-year time horizon have been developed: 1) without and 2) with pregabalin reimbursed at the same level as gabapentin. Two developed scenarios have been compared from health insurance fund (HIF) perspective. RESULTS: In scenario 1 consider both drugs fully reimbursement and without patient switch among alternatives the total cost would be increased for 780,025 KM; 852,027 KM and 943,830 KM over a 3-year period. In scenario 2 considering both drugs fully reimbursed but with patient switch topregabalin total annual cost would be increased for 732,241 KM; 742,395 KM and 751,761 KM. Comparing scenario 1 and 2 it is found that scenario 2 is more favorable from HIF perspective. CONCLUSION: Implementation of pharmacoeconomic principles in reimbursement decisions in Bosnia and Herzegovina would improve access to medicines and contribute rationale resource consumption.

How Cost-of-Illness (COI) Study Provides Direct and Indirect Costs of Multiple Sclerosis (MS) in Bosnia and Herzegovina ?

BACKGROUND: This cost-of-illness (COI) study provides deep insight in direct and indirect costs of multiple sclerosis (MS) in Bosnia and Herzegovina (BH). AIM: Objective of this study was to analyze the costs and quality of life (QoL) of patients with MS in BH. PATIENTS AND METHODS: We applied the same methodology already used in study conducted across nine European countries. Sixty-two patients participated with EDSS score not higher than 6.5. Costs are collected using a questionnaire quality of life was measured by EQ-5D and MSQOL-54 questionnaires. RESULTS: Mean age of respondents was 39.8 The mean utility measured by EQ-5D-3L was 0.68 at the beginning and 0.63 at the end of the study. QoL measured by MSQoL-54 showed improvement at the end of the trial. Costs are presented from the societal and payer perspective. Cost of MS in Bosnia and Herzegovina annually amount 124.8 million BAM. Cost driver where indirect and DMDs costs, with significant differences among subgroups. CONCLUSIONS: This study provides an in-depth analysis of MS costs in BH providing data for health policies development and information for future cost-effectiveness evaluations of new therapeutic options as well as for comparison of MS costs with other countries.

Rare Diseases and Orphan Drugs Accessibility in Bosnia and Herzegovina.

INTRODUCTION: Rare diseases are becoming more and more important since awareness is increasing. There are a lot of initiatives to ensure access to orphan drugs intended to treat these diseases but due to high price patients have low access and policy makers and payers are struggling with costs and assuring patient access rights to the available medication. AIM: Objective of this study is to assess current situation regarding rare diseases in Bosnia and Herzegovina (BiH) and availability of orphan drugs. Four domains are examined: legislation and policy, diagnostics and research, patient organizations and reimbursement and availability of medicines for rare diseases. RESULTS: There are official programs and legislation ground for rare diseases in both entities of BiH: Republic of Srpska (RS) and Federation of BiH (FBiH). Diagnostic and genetic counseling are available but only for few rare diseases. Patient organizations are formed and active but still without engagement in some of international organizations. There are no special reimbursement criteria for orphan medicines. Number of reimbursed medicines is significantly lower than those on ORPHANET list, 67 and 26 in RS and FBiH respectively. Huge difference in number of reimbursed medicines within the country entities may be consequence of counting method. CONCLUSION: Even thou rare diseases in BiH are recognized in countries official programs and documents, with patients having their organizations, much more have to be done in availability of medicines and diagnostics in the rare disease field. Insufficient funds are huge obstacle toward this goal. New methods of medicine evaluation are need and recommended in order of better availability.

An Instrument for Rating Quality of Life Related to Sore Throat in Patients Suffering from Acute Pharyngitis or Tonsillitis.

INTRODUCTION: Quality of life in patients with acute pharyngitis or tonsillitis is significantly lower than in healthy persons, and it should be taken into account when efficacy of new therapeutic options is investigated. OBJECTIVE: The aim of this study was to develop and validate a reliable instrument that can measure quality of life in adult outpatients with sore throat caused by acute pharyngitis or acute tonsillitis. METHOD: The study was of a cross-sectional type, and assessed reliability and validity of newly developed questionnaire for measurement of quality of life in adult outpatients with sore throat (STQoL) caused by acute pharyngitis or acute tonsillitis. It was conducted on a sample of 282 patients, with mean age 39.0 ± 14.8 years, male/female ratio 104/178 (36.9%/63.1%). RESULTS: Final version of the STQoL scale with 21 items showed excellent reliability, with Cronbach's alpha 0.949. It was temporally stable, and both divergent and convergent validity tests had good results. Factorial analysis revealed three domains, Social/psychic aspects, Physical aspects and Environmental aspects of sore throat related quality of life. CONCLUSIONS: The STQoL scale is reliable and valid specific instrument for measuring sore throat related quality of life, which is an important treatment outcome in patients with acute pharyngitis or tonsillitis.