Cost-effectiveness of ambroxol in the treatment of Gaucher disease type 2.

Objective: Our aim was to compare the costs and efficacy of ambroxol in combination with imiglucerase with the costs and efficacy of imiglucerase only in the treatment of Gaucher disease type 2 (GD2) in the socio-economic settings of the Republic of Serbia, an upper-middle-income European economy. Methods: The perspective of the Serbian Republic Health Insurance Fund was chosen for this study, and the time horizon was 6 years. The main outcomes of the study were quality-adjusted life years gained with ambroxol + imiglucerase and comparator, and direct costs of treatment. The study was conducted through the generation and simulation of the Markov chain model. The model results were obtained after Monte Carlo microsimulation of a sample with 1,000 virtual patients. Results: Treatment with ambroxol in combination with imiglucerase was cost-effective when compared with imiglucerase only and was associated with positive values of net monetary benefit regardless of the onset of the disease. Such beneficial result for ambroxol and imiglucerase combination is primarily driven by the low cost of ambroxol and its considerable clinical effectiveness in slowing the progression of neural complications of GD2. Conclusion: If ambroxol and imiglucerase are used in combination for the treatment of GD2, it is more cost-effective than using imiglucerase alone.

The Influence of Treatment Modalities on the Quality of Life of Psoriasis Patients.

Background: We aimed to identify the quality of life (QoL) of patients with psoriasis, to determine the possible differences depending on the therapeutic modalities (biologic, conventional treatment and phototherapy), and to examine other variables that could affect the success of the treatment. Methods: This research was a non-experimental, quantitative, observational study that included 183 psoriasis patients. The study was conducted from November 2021 to December 2022 at the University Clinical Center Kragujevac, Serbia. The following instruments were used: Dermatology Life Quality Index (DLQI), Psoriasis Area and Severity Index (PASI), as well as a general questionnaire that contained a set of questions which referred to sociodemographic data. Results: There was a statistically significant difference in the average values of the DLQI score concerning the application of different therapeutic modalities (P<0.001). Biologic treatment was the modality with the lowest impairments in the QoL domain (average value of DLQI score 10.6±7.3), followed by patients on conventional treatment (average value of DLQI score 12.9±7.9), and the highest levels of impaired QoL were in patients who received phototherapy (average value of the DLQI score 13.7±9.3). Conclusion: Patients on biological therapy at all four time points individually (baseline, 4, 12 and 16 weeks) had the lowest average values of the DLQI score, i.e. the best QoL compared to subjects who received other therapy.

Mentalizing, Resilience, and Mental Health Status among Healthcare Workers during the COVID-19 Pandemic: A Cross-Sectional Study.

The COVID-19 pandemic has caused unprecedented stress on healthcare professionals worldwide. Since resilience and mentalizing capacity play very important preventive roles when it comes to mental health, the main goal of this study was to determine whether the capacity for mentalizing and resilience could explain the levels of depression, anxiety, and stress among healthcare workers during the COVID-19 pandemic. The study was conducted in Serbia on a sample of 406 healthcare workers (141 doctors and 265 nurses) aged 19 to 65 (M = 40.11, SD = 9.41). The participants' mental health status was evaluated using the Depression, Anxiety, and Stress Scale-DASS-42. The Reflective Functioning Questionnaire was used to evaluate the capacity for mentalizing. Resilience was assessed using the Brief Resilience Scale. The results of the correlation analysis showed that there were negative correlations between resilience and all three dimensions of mental health status: depression, anxiety, and stress. Hypermentalizing was negatively correlated with depression, anxiety, and stress, while hypomentalizing was positively correlated. Hierarchical linear regression analysis showed that both resilience and hypermentalizing were significant negative predictors of depression, anxiety, and stress, and that hypomentalizing was a significant positive predictor of depression, anxiety, and stress. Furthermore, socioeconomic status was a significant negative predictor of depression, anxiety, and stress. Marital status, number of children, and work environment were not statistically significant predictors of any of the three dimensions of mental health status among the healthcare workers in this study. There is an urgent need to establish and implement strategies to foster resilience and enhance the capacity for mentalizing among healthcare workers in order to minimize the devastating effects of the COVID-19 pandemic on mental health.

Economic analysis of cerliponase alfa for treatment of late-infantile neuronal ceroid lipofuscinosis type 2 (CLN2).

BACKGROUND: Cerliponase alfa is an orphan drug approved for the treatment of late-infantile neuronal ceroid lipofuscinosis type 2 (CLN2). AIM: Our goal was to assess the cost-effectiveness of cerliponase alfa in patients with CLN2 in the socioeconomic context of the Republic of Serbia in contrast to symptomatic therapy. METHOD: For this study, a forty-year horizon and the perspective of the Serbian Republic Health Insurance Fund were used. Quality-adjusted life years gained with cerliponase alfa and comparator, as well as direct treatment costs, were the study's key outcomes. The creation and simulation of a discrete-event simulation model served as the basis for the investigation. Monte Carlo microsimulation was performed on a sample of 1000 virtual patients. RESULTS: When compared to symptomatic therapy, cerliponase alfa treatment was not cost-effective and was linked to negative net monetary benefit regardless of when the illness signs started. CONCLUSION: Cerliponase alfa is not more economical than symptomatic therapy for the treatment of CLN2 when using typical pharmacoeconomic analysis. Cerliponase alfa has been shown to be effective but more has to be done to make it accessible to all CLN2 patients.

Relationship between mentalizing and teacher burnout: A cross sectional study.

BACKGROUND: Teaching is considered a high-risk profession due to the high impact of occupational risk factors which can endanger educators' mental health and lead to burnout syndrome. This study aimed to examine whether the capacity for mentalizing in teachers explains the degree of their burnout syndrome. The expectation was that a low capacity for mentalizing increases the degree of burnout. METHODS: A cross-sectional study was conducted on a sample of 823 teachers. The Maslach Burnout Inventory-Educators Survey was used to examine the burnout syndrome. The capacity for mentalizing was examined using hypomentalizing and hypermentalizing scales from the Reflective Functioning Questionnaire. RESULTS: The expectation that a low capacity for mentalizing increases teachers' burnout confirms the finding that hypomentalizing is a positive predictor of their emotional exhaustion as a dimension of burnout (ß = 0.09; p < 0.01). Unexpectedly, hypomentalizing proved to be a positive predictor of personal accomplishment (ß = 0.09; p < 0.05), which indicates that with a lower capacity for mentalizing, teachers experience greater personal accomplishment. Also, hypermantalizing was a negative predictor of emotional exhaustion (ß = -0.17; p < 0.01) and depersonalization (ß = -0.31; p < 0.01), and a positive predictor of personal accomplishment (ß = 0.30; p < 0.01). The findings showed that with higher socioeconomic status, with marriage and having children, the burnout of teachers is lower, as expected. CONCLUSIONS: Capacity for mentalizing and burnout syndrome in teachers are interrelated phenomena. With a good capacity for mentalizing, emotional exhaustion and burnout in teachers are reduced. Knowledge and skills that enable a good capacity for mentalizing should be included in educational and teacher training programs.

Cost-effectiveness of miglustat versus symptomatic therapy of Niemann-Pick disease type C.

BACKGROUND: Niemann-Pick disease type C (NP-C) is a progressive neurodegenerative disorder with early infantile (< 2 years), late infantile (2-6 years), juvenile (7-15 years) and adolescent (> 15 years) onset. The mainstay of therapy for NP-C patients with neurological symptoms is miglustat, a drug that may modify the course of the disease. AIM: Our aim was to evaluate the cost-effectiveness of miglustat in comparison to symptomatic therapy in patients with NP-C in the socio-economic settings of the Republic of Serbia, an upper-middle-income European economy. METHOD: The perspective of the Serbian Republic Health Insurance Fund was chosen for this study, and the time horizon was eighty years. The main outcomes of the study were quality-adjusted life years gained with miglustat and comparator, and direct costs of treatment. The study was conducted through the generation and simulation of the Discrete-Event Simulation model. The model results were obtained after Monte Carlo microsimulation of a sample with 1000 virtual patients. RESULTS: Treatment with miglustat was not cost-effective when compared with symptomatic therapy and was associated with negative values of net monetary benefit regardless of the onset of neurological manifestations (- 110,447,627.00 ± 701,614.00 RSD, - 343,871,695.00 ± 2,577,441.00 RSD, - 1,397,908,502.00 ± 23,084,235.00 RSD and - 2,953,680,879.00 ± 33,297,412.00 RSD) for early infantile, late infantile, juvenile and adolescent cohorts, respectively). CONCLUSION: When traditional pharmacoeconomic evaluation is employed, miglustat is not a cost-effective option in comparison to symptomatic therapy for the treatment of NP-C. However, given the proven efficacy of miglustat, there is a need to find ways to make this drug available to all patients with NP-C.

Resilience, Mentalizing and Burnout Syndrome among Healthcare Workers during the COVID-19 Pandemic in Serbia.

The aim of this study was to examine whether the capacity for mentalizing and resilience among healthcare workers (HCWs) explains the degree of burnout syndrome during the COVID-19 pandemic in Serbia. The research was conducted on a sample of 406 healthcare workers (141 doctors and 265 nurses), aged 19 to 65 years (M = 40.11, SD = 9.41)­203 worked on the COVID-19 frontline, and 203 in regular clinical conditions. The Maslach Burnout Inventory was used to measure the burnout syndrome. Capacity for mentalizing was examined using the Reflective Functioning Questionnaire. The Brief Resilience Scale was used to measure resilience. The results indicated that there were negative correlations between resilience and the dimensions of burnout­emotional exhaustion (r = −0.38; p < 0.01) and depersonalization (r = −0.11; p < 0.05), and a positive correlation between resilience and personal accomplishment (r = 0.27; p < 0.01), as was expected. The analyses of hierarchical linear regression showed that hypomentalizing was a significant positive predictor of emotional exhaustion (ß = 0.12; p < 005) and depersonalization (ß = 0.15; p < 0.05), resilience was a significant negative predictor of emotional exhaustion (ß = −0.28, p < 0.01) and positive predictor of personal accomplishment (ß = 0.20; p < 0.01), and that the degree of explained variance of burnout dimensions was higher when resilience and hypomentalizing were included in regression models, in addition to sociodemographic variables. The findings suggest that being a woman and working on the COVID-19 frontline implies a higher burnout, while the level of burnout decreases with better socioeconomic status and more children. Resilience, capacity for mentalizing, and burnout syndrome among HCWs are interrelated phenomena, which have important professional implications.