Trends in the cost and utilization of psychotropic medicines for major psychiatric disorders in Bulgaria from 2013 to 2017

Background and objectives: Major psychiatric disorders require prolonged use of psychotropic medications and pose a significant economic burden. The purpose of the study is to examine the trend in outpatient utilization and public expenditures for reimbursed psychotropic medicines for major psychiatric disorders in Bulgaria from 2013 to 2017.MethodsData on the cost and utilization of reimbursed psychotropic medications for schizophrenia and affective disorders are collected retrospectively from the National Health Insurance Fund (NHIF) for the period 2013–2017. The diagnostic groups included in the analysis are based on ICD codes from F20.0 to F33.4. Psychotropic drugs are systematized according to ATC code and INN. Reimbursed pharmacotherapy costs are analyzed per year and diagnosis. Drug utilization is calculated for each year in defined daily doses per 1000 inhabitants per day (DDD/1000inh/day).ResultsThe number of patients decreased from 62 500 to 54 000, or from 834 per 1 00 000 in 2013 to 733 per 1 00 000 in 2017, or with a 3.5% decrease per year. The highest number (28,674 in 2013; 26,235 in 2017) and with the highest relative share (46%–49%) were patients with paranoid schizophrenia. The reimbursed pharmacotherapy cost showed a decreasing tendency from 35 to 31 million BGN in 2013 and 2017, respectively. In total 31 INN of medicines for psychotic disorders therapy were reimbursed. The utilization of all ATC groups is decreasing from 28.04 to 17.38 DDD/1000inh/day.ConclusionsThe number of reimbursed patients with major psychiatric disorders, as well as the cost of pharmacotherapy and utilization of psychotropic medicines decreased in the period 2013–2017. (AU)

Important problems in the diagnosis and treatment of primary sclerosing cholangitis (based on the Russian consensus on diagnosis and treatment autoimmune hepatitis. Moscow, 2018).

The article is published based on the results of the Russian Consensus on the diagnosis and treatment of primary sclerosing cholangitis (PSC), discussed at the 44th annual Scientific Session of the CNIIG "Personalized Medicine in the Era of Standards" (March 1, 2018). The aim of the review is to highlight the current issues of classification of diagnosis and treatment of patients with PSC, which causes the greatest interest of specialists. The urgency of the problem is determined by the multivariate nature of the clinical manifestations, by often asymptomatic flow, severe prognosis, complexity of diagnosis and insufficient study of PSC, the natural course of which in some cases can be considered as a function with many variables in terms of the nature and speed of progression with numerous possible clinical outcomes. In addition to progression to portal hypertension, cirrhosis and its complications, PSC can be accompanied by clinical manifestations of obstructive jaundice, bacterial cholangitis, cholangiocarcinoma and colorectal cancer. Magnetic resonance cholangiography is the main method of radial diagnostics of PSC, which allows to obtain an image of bile ducts in an un-invasive way. The use of liver biopsy is best justified when there is a suspicion of small-diameter PSC, autoimmune cross-syndrome PSC-AIG, IgG4-sclerosing cholangitis. Currently, a drug registered to treat primary sclerosing cholangitis which can significantly change the course and prognosis of the disease does not exist. There is no unified view on the effectiveness and usefulness of ursodeoxycholic acid and its dosage in PSC. Early diagnosis and determination of the phenotype of PSC is of clinical importance. It allows to determine the tactics of treatment, detection and prevention of complications.

Alterations in the parameters of classic, global, and innovative assays of hemostasis caused by sample transportation via pneumatic tube system.

BACKGROUND: Pneumatic tube system (PTS) is an integral part of large medical facilities providing rapid interconnection between units within the hospital and often used to transport blood samples. The aim of our study was to compare a wide variety of hemostasis assays to identify assays sensitive to this transport method and diagnostic relevance of the alterations. METHODS: Routine coagulation and platelet tests (APTT, PT, TT, fibrinogen, light transmission aggregometry (LTA) with ADP, collagen, ristomycin and epinephrine), whole blood flow cytometry platelet function test (levels of CD42b, CD61, CD62P, PAC1, annexin V binding and mepacrine release) and global coagulation tests (thromboelastography (TEG), thrombin generation (TGT), thrombodynamics (TD), thrombodynamics-4D (TD-4D)) were determined in PTS- and manually transported samples of 10 healthy volunteers. RESULTS: There were no significant differences between the values of APTT, PT, TT or fibrinogen between the samples transported by PTS or manually. The results for LTA demonstrated increase in the collagen-induced aggregation (84 ±â€¯7% versus 73 ±â€¯5%), while the response to epinephrine was decreased (58 ±â€¯20% versus 72 ±â€¯7.4%). Flow cytometry-based platelet function test showed a pre-activation of platelets by PTS-transportation while all integral assays of coagulation tested in the present study (TEG, TGT, TD, TD-4D) demonstrated a hypercoagulation shift. CONCLUSIONS: Transportation by PTS caused significant shifts in parameters of functional and integral assays that exceeded parameter variation values and sometimes even were comparable to normal ranges. The results obtained in this study indicate that using of PTS for such assays may cause sufficient alterations of results and can lead to patient's mistreatment.

Important problems in the diagnosis and treatment of autoimmune hepatitis (based on the Russian consensus 2017).

The analysis of publications devoted to the Russian Consensus on the Diagnostic and Treatment of Autoimmune Hepatitis (AIH), which was considered at the 43rd annual Scientific Session of the CNIIG From Traditions to Innovation (March 4, 2017) is carried out. The presence of clear algorithms and recommendations for the diagnosis and treatment of AIH significantly help the doctor in real clinical practice, but do not exclude a personified approach to the patient.