The value of innovation in decision-making in health care in Central Eastern Europe - The Sixth International Conference, 2 June 2017, Belgrade, Serbia.

The Pharmacoeconomics Section of the Pharmaceutical Association of Serbia organised a one day international conference on the value of innovation in decision-making in health care in Central and Eastern Europe. The focus of the conference was on reimbursement decisions for medicines using health technology assessment and the use of managed entry agreements (MEAs). The objectives of this conference were firstly to discuss the challenges and opportunities with the use of MEAs in Central and Eastern European countries; secondly the role of patient registries especially with outcome based schemes, and finally new approaches to improve accessibility to new medicines including better managing their entry.

[Assessment of diabetes mellitus type 2 treatment costs in the Republic of Serbia].

BACKGROUND/AIM: High morbidity and mortality rates, chronic course of disease and numerous clinical complications, make diabetes mellitus (DM) type 2 bear significant financial burden for healthcare system of Serbia. The aim of this study was to compare true disease-related expenses measured in the random sample of patients originating from the Central Serbia in 2007 and national estimate of total expenses based on available evidence on antidiabetic drugs and insulins acquisition costs in the same fiscal year. METHODS: The study design was prevalence-based, bottom-up cost of illness analysis. It was implemented on a randomized sample of 99 adults with confirmed diagnosis of DM type 2. During 2007 all direct (drug acquisition, medical services, medical devices usage) and indirect costs associated with their primary disease (premature death, impaired working ability, early retirement, absentism), were taken into account. Other approach was to calculate average national rate of antidiabetic drugs and insulin utilization and sales at the domestic market during the mentioned period of time. Taking into consideration available estimate from the Institute of Public Health of Serbia of 475,000 people with this disease at the national level, we were able to compare these data. Assuming that our sample was enough representative and that the structure of costs was approximately similar at the local and national level, we were able to calculate an estimate of total cost of the disease. All costs were expressed in Serbian official currency, dinar (CSD). RESULTS: Values of costs measured per patient in our sample in a given year were for drug acquisition 20,352.45 CSD, medical services 24,338.26 CSD, medical devices 3174.46 CSD and loss of productivity and absentism 5547.78 CSD. There were 2 cases of early retirement due to the disease and no cases of dialysis treatment or premature death. A total number of sickness absence days of employed patients, was 1025 and a total number of hospital treatment days was 360. A total amount of all costs was 53,412.96 CSD per patient per year. According to the National Medicines and Medical Devices Agency an overall value of oral antidiabetic drug sales for 2007 per patient was 1835.32 CSD and for insulins and analogs 2948.18 CSD. CONCLUSION: Comparing true size of national financial burden of DM type 2 with experiences of other authors, we can see that it is comparable with European OECD average. But, if the structure of expenses is taken into account, Serbia is more similar tothose countries reported in the Third World economies. Ourlocal findings on a sample of diabetic population show that real patient expenses were even 2.28 times higher than those estimated at the national level.

Effect of sodium bicarbonate in rats acutely poisoned with dichlorvos.

The development of effective antidotes against organophosphates such as dichlorvos has been a persistent challenge over the past decades. Therapy of organophosphate poisoning is based on the administration of atropine and oxime as standard antidotes. The present study was undertaken to evaluate the ability of sodium bicarbonate to improve protective effects of standard antidotes in rats poisoned with dichlorvos. The aim of this experiment was to establish the correlation between protective effects and biochemical parameters relevant for acid-base status. In order to examine the protective effect of both standard antidotes and their combinations, groups of experimental animals were poisoned subcutaneously with increasing doses of dichlorvos. Immediately thereafter, rats were treated with atropine 10 mg/kg intramuscularly, oximes 10 mg/kg intramuscularly and sodium bicarbonate 3 mmol/kg intraperitoneally. These antidotes were administered either as single doses or in combinations. In the biochemical part of the experiments, rats were poisoned with dichlorvos 1.3 LD(50) (10.64 mg/kg) subcutaneously and immediately thereafter treated with atropine 10 mg/kg intramuscularly, oximes (trimedoxime or obidoxime) 10 mg/kg intramuscularly and sodium bicarbonate 3 mmol/kg intraperitoneally either as single doses or in combinations. Parameters relevant for acid-base status were measured 10 minutes after the administration of antidotes. The results of our study indicate that addition of sodium bicarbonate to standard antidotes significantly improves protective effects of atropine, obidoxime and trimedoxime. Correlation between protection and biochemical outcome is clearly evident when sodium bicarbonate is being added to atropine.