Dragana Lakic - Academia.edu (original) (raw)

Papers by Dragana Lakic

Value in Health

chart review study of patients aged 1-12 years with a primary varicella diagnosis between 2011 an... more chart review study of patients aged 1-12 years with a primary varicella diagnosis between 2011 and 2015. Healthcare resource utilization (HCRU) associated with varicella, unit costs, and work loss were used to estimate direct and indirect costs. All costs are presented in 2015 Polish Zloty (PLN) / Euros (€). Results: 150 children with varicella were included (75 outpatients, 75 inpatients), with a mean age of 3.9 (SD: 2.6) and 4.2 (SD: 2.3) years, respectively. One or more complications were experienced by 14.7% of outpatients and 82.7% of inpatients, the most common being skin and soft tissue infections, dehydration, pneumonia, and cerebellitis. HCRU estimates included use of over-the-counter (OTC) medications (80.0% outpatients, 81.3% inpatients), prescription medications (80.0% outpatients, 93.3% inpatients), tests/procedures (0.0% outpatients, 69.3% inpatients), and consultation with allied health professionals (0.0% outpatients, 24.0% inpatients). The average duration of hospital stay was 4.7 (95% CI: 4.1 , 5.3) days for inpatients. The total combined direct and indirect cost per varicella case was 5013.3 PLN / € 1,198.1, for inpatients and 1027.2 PLN/ € 245.5, for outpatients. The overall annual cost of varicella in Poland for children aged 1-15 years in 2015 was estimated at 177,655,759.6 PLN,/€ 42,458,716.0. ConClusions: Varicella is associated with substantial clinical burden in Poland, resulting in the utilization of a significant amount of healthcare resources.

Arhiv za farmaciju, 2016

Utvrđeno je da sprovođenje menadžmenta terapije varfarinom od strane farmaceuta značajno unapređu... more Utvrđeno je da sprovođenje menadžmenta terapije varfarinom od strane farmaceuta značajno unapređuje kontrolu antikoagulacije i smanjuje broj slučajeva krvarenja, a time i pridružene troškove lečenja. Cilj ovog rada je farmakoekonomska evaluacija pružanja farmaceutske zdravstvene zaštite (FZZ) pacijentima na varfarinu u odnosu na standardnu zdravstvenu zaštitu (SZZ), iz perspektive Republičkog fonda za zdravstveno osiguranje (RFZO). Sprovedena je analiza isplativosti primenom drveta odlučivanja, za period od 10 dana. U modelu su kombinovani podaci za posmatrane ishode iz odgovarajućih studija, dok su direktni medicinski troškovi preuzeti iz važećih cenovnika zdravstvenih usluga, kao i Liste lekova RFZO. Dodatno je sprovedena analiza uticaja na budžet, radi projektovanja potencijalnih ušteda u slučaju implementacije ove farmaceutske usluge. FZZ je troškovno isplativija strategija, obzirom na veću efektivnost (+0,154), a manji trošak (-374,51 RSD) u odnosu na SZZ. Negativna vrednost inkrementalnog odnosa troškova i efektivnosti za FZZ dodatno potvrđuje njenu isplativost, kao dominantne strategije. Analiza osetljivosti je potvrdila robusnost modela, dok su analizom uticaja na budžet projektovane značajne uštede, od 50.863.313 RSD za petogodišnji period 2016.-2020. Pružanje FZZ pacijentima na antikoagulantnoj terapiji varfarinom predstavlja troškovnoisplativiju strategiju u odnosu na SZZ u Republici Srbiji, zbog čega je poželjno da se implementira u nacionalni zdravstveni sistem u budućnosti.

Biochemia Medica, 2015

Acute kidney injury (AKI) is significant problem in children with congenital heart disease (CHD) ... more Acute kidney injury (AKI) is significant problem in children with congenital heart disease (CHD) who undergo cardiac surgery. The economic impact of a biomarker-based diagnostic strategy for AKI in pediatric populations undergoing CHD surgery is unknown. The aim of this study was to perform the cost effectiveness analysis of using serum cystatin C (sCysC), urine neutrophil gelatinase-associated lipocalin (uNGAL) and urine liver fatty acid-binding protein (uL-FABP) for the diagnosis of AKI in children after cardiac surgery compared with current diagnostic method (monitoring of serum creatinine (sCr) level). We developed a decision analytical model to estimate incremental cost-effectiveness of different biomarker-based diagnostic strategies compared to current diagnostic strategy. The Markov model was created to compare the lifetime cost associated with using of sCysC, uNGAL, uL-FABP with monitoring of sCr level for the diagnosis of AKI. The utility measurement included in the analysis was quality-adjusted life years (QALY). The results of the analysis are presented as the incremental cost-effectiveness ratio (ICER). Analysed biomarker-based diagnostic strategies for AKI were cost-effective compared to current diagnostic method. However, uNGAL and sCys C strategies yielded higher costs and lower effectiveness compared to uL-FABP strategy. uL-FABP added 1.43 QALY compared to current diagnostic method at an additional cost of 8521.87perpatient.Therefore,ICERforuL−FABPcomparedtosCrwas8521.87 per patient. Therefore, ICER for uL-FABP compared to sCr was 8521.87perpatient.Therefore,ICERforuL−FABPcomparedtosCrwas5959.35/QALY. Our results suggest that the use of uL-FABP would represent cost effective strategy for early diagnosis of AKI in children after cardiac surgery.

Acta chirurgica iugoslavica, 2013

Srpski arhiv za celokupno lekarstvo, 2014

Views on the conduct of labor have changed over time, and a significant difference exists in rela... more Views on the conduct of labor have changed over time, and a significant difference exists in relation to obstetric centers. To assess cost, clinical outcomes and cost-effectiveness of different types of labor in singleton pregnancies. A decision model was used to compare vaginal labor, induced labor and planned cesarean section. All data were taken from the Book of Labor from the University Hospital for Gynecology and Obstetrics "Narodni Front", Belgrade, Serbia for labors conducted during one month period in 2011. Successful delivery (i.e. labor that began up to 42 gestation weeks, without maternal mortality and the newborn Apgar scores greater than or equal to seven in the fifth minute of life) was considered as the outcome of the cost effectiveness-analysis. To test the robustness of this definition probabilistic sensitivity analysis was performed. From a total of 667 births, vaginal labor was conducted in 98 cases, induced vaginal in 442, while planned cesarean section was performed 127 times. Emergency cesarean section as a complication was much higher in the vaginal labor cohort compared to the induced vaginal cohort (OR=17.374; 95% CI: 8.522 to 35.418; p<0.001). The least costly type of labor was induced vaginal labor: average cost 461 euro, with an effectiveness of 98.17%. Both, vaginal and planned cesarean labor were dominated by the induced labor. The results were robust. Elective induction of labor was associated with the lowest cost compared to other types of labor, with favorable maternal and neonatal outcomes.

Biochemia Medica, 2013

We examined the cost-eff ectiveness of the three diff erent D-dimer measurements in the screening... more We examined the cost-eff ectiveness of the three diff erent D-dimer measurements in the screening of DVT in models with and without calculation of pre-test probability (PTP) score. Moreover, we calculated the minimal cost in DVT detection. Material and methods: In the group of 192 patients with clinically suspected acute DVT, we examined the three diff erent D-dimer measurements (Innovance D-dimer, Hemosil D-dimer HS and Vidas D-dimer Exclusion II) in combination with and without PTP assessment. Results: The diagnostic alternative employing Vidas D-dimer Exclusion II assay without and with PTP calculation gave lower incremental cost-eff ectiveness ratio (ICER) than the alternative employing Hemosil D-dimer HS assay (0.187 Euros vs. 0.998 Euros per one additional DVT positive patient selected for CUS in model without PTP assessment and 0.450 vs. 0.753 Euros per one DVT positive patient selected for CUS in model with PTP assessment). According to sensitivity analysis, the Hemosil D-dimer HS assay was the most cost eff ective alternative when one patient was admitted to the vascular ambulance per day. Vidas D-dimer Exclusion II assay was the most cost eff ective alternative when more than one patient were admitted to the vascular ambulance per day. Cost minimisation analysis indicated that selection of patients according to PTP score followed by D-dimer analysis decreases the cost of DVT diagnosis. Conclusions: ICER analysis enables laboratories to choose optimal laboratory tests according to number of patients admitted to laboratory. Results support the feasibility of using PTP scoring and D-dimer measurement before CUS examination in DVT screening.

Value in Health, 2010

Objectives: Coronary artery disease (CAD), as the leading cause of death, poses a huge economic b... more Objectives: Coronary artery disease (CAD), as the leading cause of death, poses a huge economic burden on health-care systems. We used a multimarker approach to explore discriminative abilities of several lipid, inflammatory, and oxidative stress/antioxidative defense markers as CAD predictors. We assessed their cost-effectiveness compared with the Framingham risk score (FRS). Methods: Using a decision model, we evaluated the costs, accuracy, and cost-effectiveness of each model. The FRS was used as the baseline model. Other models were formed with the consecutive addition of selected markers: apolipoprotein A-I (apoA-I), apolipoprotein B (apoB), apolipoprotein (a) [apo(a)] isoform, lipoprotein (a), high-sensitivity C-reactive protein, malondialdehyde, superoxide dismutase (SOD), sulfhydryl, and superoxide anion (O2 -). A best-case model was formed from a combination of diagnostic markers to yield the best patient stratification algorithm. All models were assessed by their predictive probabilities using receiver operating characteristic curves. To accomplish our goals, we recruited 188 CAD patients (verified by coronary angiography) and 197 asymptomatic CAD-free subjects for comparison. The analysis was performed from a third-party payer perspective. Results: Only two strategies had outstanding discriminative abilities: the best-case model (FRS, SOD, and O2 -) and FRS plus SOD with area under the curve (AUC) values of 0.924 and 0.906, respectively. The costeffectiveness ratio varied between €593 per AUC for the baseline model to €2425 per AUC for FRS plus apo(a) isoform. Strategies involving oxidative stress/antioxidative defense markers were more cost-effective than strategies involving lipid or inflammatory markers. All results were robust. Conclusion: Our results support the feasibility of a multimarker approach for CAD screening. The introduction of oxidative stress/antioxidative defense markers in the clinical laboratory would be convenient and cost-effective.

Vojnosanitetski Pregled, 2014

Background/Aim. Cardiovascular disease imposes a burden to society in terms of mortality, morbidi... more Background/Aim. Cardiovascular disease imposes a burden to society in terms of mortality, morbidity and economic losses. The aim of this study was to estimate the economic burden of cardiovascular disease in Serbia in 2009 from the perspective of the society. Methods. For the purpose of the study cardiovascular disease was defined by the International Classification of Diseases, 10th revision, as the following diagnosis: hypertension, coronary heart disease, cardiomyopathy, heart failure and cerebrovascular disease. The prevalence, top-down method was used to quantify the annual cardiovascular costs. Productivity losses were estimated using the human capital approach and the friction cost method. A discount rate of 5% was used to convert all future lifetime earnings into the present value. Results. The total direct costs of cardiovascular disease in 2009 were € 400 million. The results showed that more than half a million working days were lost due to incapacity resulting from cardiovascular diseases, yielding the € 113.9 millon. The majority of total costs (€ 514.3 million) were for: medication (29.94%), hospital days (28.97%) and hospital inpatient care -surgical and diagnostic interventions (17.84%). The results were robust to a change in 20% of volume or the unit price of all direct and indirect cost and to discount rate 2% and 10%. Conclusions. The total cardiovascular disease costs in 2009 represented approximately 1.8% of the Serbian gross domestic product. The results of the study would be valuable to health policy makers to bridge the gap between invested resources and needs, in order to improve cardiovascular disease outcomes.

Pharmacy Practice (Internet), 2009

To compare the prescribing practice and pharmacotherapy outpatient cost of hypertension and its c... more To compare the prescribing practice and pharmacotherapy outpatient cost of hypertension and its common complications between two neighboring countries, Bulgaria and Serbia. The study questions focus on consistency of the prescribing practice with the treatment guidelines; comparability of the treatment patterns among both countries, and burden of hypertension cost to the population and third party payer in the countries under consideration. Retrospective study, one year time horizon is for outpatient therapy. Patients with arterial hypertension in Bulgaria are most often on monotherapy (61% vs 6% in Serbia), as well as those with complications (66% vs 0% Serbia). In both countries the first choice of therapy are the ACE inhibitors (37.01% in Serbia and 41% in Bulgaria) and then follows the calcium antagonists, beta-blockers, and diuretics. The weighed monthly cost of hypertension and complicated hypertension is almost doubled in Serbia (12.56 vs 8.23 EUR for hypertension, and 13.39 vs 8.23 EUR) and prevailing part is reimbursed (88% vs 44% in Bulgaria). Our study confirms that hypertension and its complications therapy consumes a huge amount of financial resources. In both countries under consideration the therapy is corresponding with the European treatment guidelines. The international cost comparisons are possible but they depend on many external factors as the regulatory measures, prescribing habits and reimbursement policy and should be analysed within this framework.

Value in Health, 2012

dex scores have been slightly increased from 0.94 to 0.96 during 2007-2010. Male adults had highe... more dex scores have been slightly increased from 0.94 to 0.96 during 2007-2010. Male adults had higher EQ-5D index scores than female (0.96 vs. 0.92). Elderly (ageՆ60) had significantly lower EQ-5D index scores (score ranges: 0.02 to 0.11) than young adult (ageϭ19-29) after adjusting for other variables. EQ-5D index scores were significantly reduced by stroke (reduced by -0.10), arthritis (reduced by -0.05), cardiovascular disease (reduced by -0.04), and diabetes (reduced by -0.02). CONCLUSIONS: QOL in South Korean adults was significantly reduced by chronic diseases and age. Despite national efforts to detect and treat chronic diseases at early stage of disease, significant reduction in QOL due to chronic diseases still exist. It is emphasized the need for implementation of effective public health programs for decreased prevalence of chronic diseases.

Value in Health, 2013

OBJECTIVES: Rotavirus (RV) is the most frequent cause of severe gastroenteritis frequently requir... more OBJECTIVES: Rotavirus (RV) is the most frequent cause of severe gastroenteritis frequently requiring hospitalization. RV is responsible for > 1/2 of all hospital stays for acute gastroenteritis. The objective was to estimate the burden of community acquired rotavirus gastro-enteritis requiring hospitalization (CRVGE) in children ≤ 5 years old in Czech Republic (CR) and Slovakia (SK). METHODS: Multi-center, retrospective patient chart review was conducted in both pediatric and infection disease settings in CR (n= 109) and SK (n= 115). Resource use analysis including length of hospital stay and tests performed were evaluated. Patients requiring rehydration, complications and comorbidities were considered. Direct cost from payer's perspective were retrieved from official DRG lists (CR) and fixed hospitalization cost rates per case (SK). Micro-costing was done in parallel based on the resource use data. RESULTS: Mean length of hospital stay in CR and SK was 3.9 (SD 1.9) and 4.1 days (SD 1.7) respectively. Prevalent diagnostic tests used were latex agglutination 44.0% (CR) and immunochromatography 92% (SK). Rehydration was required in 84.4% (CR) and 97% (SK) of cases. Comorbidities were reported in 24.8% (CR) and 27% (SK); complications in 10.1% (CR) and 7.8% (SK). The national list-based reimbursement per hospitalized CRVGE is € 370-645 (CR) and € 561 (SK). The calculated average total costs, including treatment prior to, and after admission, were € 462 (CR) and € 583 (SK). The major cost item was the hospital stay with € 391 (CR) and € 540 (SK). Costs for tests and drugs during hospitalization were € 30 (CR) and € 25 (SK). The costs of pre and post-hospitalization care were € 20 (CR) and € 13 (SK). CONCLUSIONS: Although the length of hospitalization in both countries is similar costs seem to be substantially lower in CR, possibly as a result of recently launched DRG system. Common complications and comorbidities account for 30% of average hospital costs.

Biotechnology & Biotechnological Equipment, 2013

Biotechnology & Biotechnological Equipment, 2012

To date there is no Markov model to evaluate the cost-effectiveness of antihypertensive pharmacot... more To date there is no Markov model to evaluate the cost-effectiveness of antihypertensive pharmacotherapies at national level in developing countries. The aim of our study was to evaluate different antihypertensives and determine their cost-effectiveness as monotherapy treatment in primary care in Serbia.

Biotechnology & Biotechnological Equipment, 2012

Value in Health

chart review study of patients aged 1-12 years with a primary varicella diagnosis between 2011 an... more chart review study of patients aged 1-12 years with a primary varicella diagnosis between 2011 and 2015. Healthcare resource utilization (HCRU) associated with varicella, unit costs, and work loss were used to estimate direct and indirect costs. All costs are presented in 2015 Polish Zloty (PLN) / Euros (€). Results: 150 children with varicella were included (75 outpatients, 75 inpatients), with a mean age of 3.9 (SD: 2.6) and 4.2 (SD: 2.3) years, respectively. One or more complications were experienced by 14.7% of outpatients and 82.7% of inpatients, the most common being skin and soft tissue infections, dehydration, pneumonia, and cerebellitis. HCRU estimates included use of over-the-counter (OTC) medications (80.0% outpatients, 81.3% inpatients), prescription medications (80.0% outpatients, 93.3% inpatients), tests/procedures (0.0% outpatients, 69.3% inpatients), and consultation with allied health professionals (0.0% outpatients, 24.0% inpatients). The average duration of hospital stay was 4.7 (95% CI: 4.1 , 5.3) days for inpatients. The total combined direct and indirect cost per varicella case was 5013.3 PLN / € 1,198.1, for inpatients and 1027.2 PLN/ € 245.5, for outpatients. The overall annual cost of varicella in Poland for children aged 1-15 years in 2015 was estimated at 177,655,759.6 PLN,/€ 42,458,716.0. ConClusions: Varicella is associated with substantial clinical burden in Poland, resulting in the utilization of a significant amount of healthcare resources.

Arhiv za farmaciju, 2016

Utvrđeno je da sprovođenje menadžmenta terapije varfarinom od strane farmaceuta značajno unapređu... more Utvrđeno je da sprovođenje menadžmenta terapije varfarinom od strane farmaceuta značajno unapređuje kontrolu antikoagulacije i smanjuje broj slučajeva krvarenja, a time i pridružene troškove lečenja. Cilj ovog rada je farmakoekonomska evaluacija pružanja farmaceutske zdravstvene zaštite (FZZ) pacijentima na varfarinu u odnosu na standardnu zdravstvenu zaštitu (SZZ), iz perspektive Republičkog fonda za zdravstveno osiguranje (RFZO). Sprovedena je analiza isplativosti primenom drveta odlučivanja, za period od 10 dana. U modelu su kombinovani podaci za posmatrane ishode iz odgovarajućih studija, dok su direktni medicinski troškovi preuzeti iz važećih cenovnika zdravstvenih usluga, kao i Liste lekova RFZO. Dodatno je sprovedena analiza uticaja na budžet, radi projektovanja potencijalnih ušteda u slučaju implementacije ove farmaceutske usluge. FZZ je troškovno isplativija strategija, obzirom na veću efektivnost (+0,154), a manji trošak (-374,51 RSD) u odnosu na SZZ. Negativna vrednost inkrementalnog odnosa troškova i efektivnosti za FZZ dodatno potvrđuje njenu isplativost, kao dominantne strategije. Analiza osetljivosti je potvrdila robusnost modela, dok su analizom uticaja na budžet projektovane značajne uštede, od 50.863.313 RSD za petogodišnji period 2016.-2020. Pružanje FZZ pacijentima na antikoagulantnoj terapiji varfarinom predstavlja troškovnoisplativiju strategiju u odnosu na SZZ u Republici Srbiji, zbog čega je poželjno da se implementira u nacionalni zdravstveni sistem u budućnosti.

Biochemia Medica, 2015

Acute kidney injury (AKI) is significant problem in children with congenital heart disease (CHD) ... more Acute kidney injury (AKI) is significant problem in children with congenital heart disease (CHD) who undergo cardiac surgery. The economic impact of a biomarker-based diagnostic strategy for AKI in pediatric populations undergoing CHD surgery is unknown. The aim of this study was to perform the cost effectiveness analysis of using serum cystatin C (sCysC), urine neutrophil gelatinase-associated lipocalin (uNGAL) and urine liver fatty acid-binding protein (uL-FABP) for the diagnosis of AKI in children after cardiac surgery compared with current diagnostic method (monitoring of serum creatinine (sCr) level). We developed a decision analytical model to estimate incremental cost-effectiveness of different biomarker-based diagnostic strategies compared to current diagnostic strategy. The Markov model was created to compare the lifetime cost associated with using of sCysC, uNGAL, uL-FABP with monitoring of sCr level for the diagnosis of AKI. The utility measurement included in the analysis was quality-adjusted life years (QALY). The results of the analysis are presented as the incremental cost-effectiveness ratio (ICER). Analysed biomarker-based diagnostic strategies for AKI were cost-effective compared to current diagnostic method. However, uNGAL and sCys C strategies yielded higher costs and lower effectiveness compared to uL-FABP strategy. uL-FABP added 1.43 QALY compared to current diagnostic method at an additional cost of 8521.87perpatient.Therefore,ICERforuL−FABPcomparedtosCrwas8521.87 per patient. Therefore, ICER for uL-FABP compared to sCr was 8521.87perpatient.Therefore,ICERforuL−FABPcomparedtosCrwas5959.35/QALY. Our results suggest that the use of uL-FABP would represent cost effective strategy for early diagnosis of AKI in children after cardiac surgery.

Acta chirurgica iugoslavica, 2013

Srpski arhiv za celokupno lekarstvo, 2014

Views on the conduct of labor have changed over time, and a significant difference exists in rela... more Views on the conduct of labor have changed over time, and a significant difference exists in relation to obstetric centers. To assess cost, clinical outcomes and cost-effectiveness of different types of labor in singleton pregnancies. A decision model was used to compare vaginal labor, induced labor and planned cesarean section. All data were taken from the Book of Labor from the University Hospital for Gynecology and Obstetrics "Narodni Front", Belgrade, Serbia for labors conducted during one month period in 2011. Successful delivery (i.e. labor that began up to 42 gestation weeks, without maternal mortality and the newborn Apgar scores greater than or equal to seven in the fifth minute of life) was considered as the outcome of the cost effectiveness-analysis. To test the robustness of this definition probabilistic sensitivity analysis was performed. From a total of 667 births, vaginal labor was conducted in 98 cases, induced vaginal in 442, while planned cesarean section was performed 127 times. Emergency cesarean section as a complication was much higher in the vaginal labor cohort compared to the induced vaginal cohort (OR=17.374; 95% CI: 8.522 to 35.418; p<0.001). The least costly type of labor was induced vaginal labor: average cost 461 euro, with an effectiveness of 98.17%. Both, vaginal and planned cesarean labor were dominated by the induced labor. The results were robust. Elective induction of labor was associated with the lowest cost compared to other types of labor, with favorable maternal and neonatal outcomes.

Biochemia Medica, 2013

We examined the cost-eff ectiveness of the three diff erent D-dimer measurements in the screening... more We examined the cost-eff ectiveness of the three diff erent D-dimer measurements in the screening of DVT in models with and without calculation of pre-test probability (PTP) score. Moreover, we calculated the minimal cost in DVT detection. Material and methods: In the group of 192 patients with clinically suspected acute DVT, we examined the three diff erent D-dimer measurements (Innovance D-dimer, Hemosil D-dimer HS and Vidas D-dimer Exclusion II) in combination with and without PTP assessment. Results: The diagnostic alternative employing Vidas D-dimer Exclusion II assay without and with PTP calculation gave lower incremental cost-eff ectiveness ratio (ICER) than the alternative employing Hemosil D-dimer HS assay (0.187 Euros vs. 0.998 Euros per one additional DVT positive patient selected for CUS in model without PTP assessment and 0.450 vs. 0.753 Euros per one DVT positive patient selected for CUS in model with PTP assessment). According to sensitivity analysis, the Hemosil D-dimer HS assay was the most cost eff ective alternative when one patient was admitted to the vascular ambulance per day. Vidas D-dimer Exclusion II assay was the most cost eff ective alternative when more than one patient were admitted to the vascular ambulance per day. Cost minimisation analysis indicated that selection of patients according to PTP score followed by D-dimer analysis decreases the cost of DVT diagnosis. Conclusions: ICER analysis enables laboratories to choose optimal laboratory tests according to number of patients admitted to laboratory. Results support the feasibility of using PTP scoring and D-dimer measurement before CUS examination in DVT screening.

Value in Health, 2010

Objectives: Coronary artery disease (CAD), as the leading cause of death, poses a huge economic b... more Objectives: Coronary artery disease (CAD), as the leading cause of death, poses a huge economic burden on health-care systems. We used a multimarker approach to explore discriminative abilities of several lipid, inflammatory, and oxidative stress/antioxidative defense markers as CAD predictors. We assessed their cost-effectiveness compared with the Framingham risk score (FRS). Methods: Using a decision model, we evaluated the costs, accuracy, and cost-effectiveness of each model. The FRS was used as the baseline model. Other models were formed with the consecutive addition of selected markers: apolipoprotein A-I (apoA-I), apolipoprotein B (apoB), apolipoprotein (a) [apo(a)] isoform, lipoprotein (a), high-sensitivity C-reactive protein, malondialdehyde, superoxide dismutase (SOD), sulfhydryl, and superoxide anion (O2 -). A best-case model was formed from a combination of diagnostic markers to yield the best patient stratification algorithm. All models were assessed by their predictive probabilities using receiver operating characteristic curves. To accomplish our goals, we recruited 188 CAD patients (verified by coronary angiography) and 197 asymptomatic CAD-free subjects for comparison. The analysis was performed from a third-party payer perspective. Results: Only two strategies had outstanding discriminative abilities: the best-case model (FRS, SOD, and O2 -) and FRS plus SOD with area under the curve (AUC) values of 0.924 and 0.906, respectively. The costeffectiveness ratio varied between €593 per AUC for the baseline model to €2425 per AUC for FRS plus apo(a) isoform. Strategies involving oxidative stress/antioxidative defense markers were more cost-effective than strategies involving lipid or inflammatory markers. All results were robust. Conclusion: Our results support the feasibility of a multimarker approach for CAD screening. The introduction of oxidative stress/antioxidative defense markers in the clinical laboratory would be convenient and cost-effective.

Vojnosanitetski Pregled, 2014

Background/Aim. Cardiovascular disease imposes a burden to society in terms of mortality, morbidi... more Background/Aim. Cardiovascular disease imposes a burden to society in terms of mortality, morbidity and economic losses. The aim of this study was to estimate the economic burden of cardiovascular disease in Serbia in 2009 from the perspective of the society. Methods. For the purpose of the study cardiovascular disease was defined by the International Classification of Diseases, 10th revision, as the following diagnosis: hypertension, coronary heart disease, cardiomyopathy, heart failure and cerebrovascular disease. The prevalence, top-down method was used to quantify the annual cardiovascular costs. Productivity losses were estimated using the human capital approach and the friction cost method. A discount rate of 5% was used to convert all future lifetime earnings into the present value. Results. The total direct costs of cardiovascular disease in 2009 were € 400 million. The results showed that more than half a million working days were lost due to incapacity resulting from cardiovascular diseases, yielding the € 113.9 millon. The majority of total costs (€ 514.3 million) were for: medication (29.94%), hospital days (28.97%) and hospital inpatient care -surgical and diagnostic interventions (17.84%). The results were robust to a change in 20% of volume or the unit price of all direct and indirect cost and to discount rate 2% and 10%. Conclusions. The total cardiovascular disease costs in 2009 represented approximately 1.8% of the Serbian gross domestic product. The results of the study would be valuable to health policy makers to bridge the gap between invested resources and needs, in order to improve cardiovascular disease outcomes.

Pharmacy Practice (Internet), 2009

To compare the prescribing practice and pharmacotherapy outpatient cost of hypertension and its c... more To compare the prescribing practice and pharmacotherapy outpatient cost of hypertension and its common complications between two neighboring countries, Bulgaria and Serbia. The study questions focus on consistency of the prescribing practice with the treatment guidelines; comparability of the treatment patterns among both countries, and burden of hypertension cost to the population and third party payer in the countries under consideration. Retrospective study, one year time horizon is for outpatient therapy. Patients with arterial hypertension in Bulgaria are most often on monotherapy (61% vs 6% in Serbia), as well as those with complications (66% vs 0% Serbia). In both countries the first choice of therapy are the ACE inhibitors (37.01% in Serbia and 41% in Bulgaria) and then follows the calcium antagonists, beta-blockers, and diuretics. The weighed monthly cost of hypertension and complicated hypertension is almost doubled in Serbia (12.56 vs 8.23 EUR for hypertension, and 13.39 vs 8.23 EUR) and prevailing part is reimbursed (88% vs 44% in Bulgaria). Our study confirms that hypertension and its complications therapy consumes a huge amount of financial resources. In both countries under consideration the therapy is corresponding with the European treatment guidelines. The international cost comparisons are possible but they depend on many external factors as the regulatory measures, prescribing habits and reimbursement policy and should be analysed within this framework.

Value in Health, 2012

dex scores have been slightly increased from 0.94 to 0.96 during 2007-2010. Male adults had highe... more dex scores have been slightly increased from 0.94 to 0.96 during 2007-2010. Male adults had higher EQ-5D index scores than female (0.96 vs. 0.92). Elderly (ageՆ60) had significantly lower EQ-5D index scores (score ranges: 0.02 to 0.11) than young adult (ageϭ19-29) after adjusting for other variables. EQ-5D index scores were significantly reduced by stroke (reduced by -0.10), arthritis (reduced by -0.05), cardiovascular disease (reduced by -0.04), and diabetes (reduced by -0.02). CONCLUSIONS: QOL in South Korean adults was significantly reduced by chronic diseases and age. Despite national efforts to detect and treat chronic diseases at early stage of disease, significant reduction in QOL due to chronic diseases still exist. It is emphasized the need for implementation of effective public health programs for decreased prevalence of chronic diseases.

Value in Health, 2013

OBJECTIVES: Rotavirus (RV) is the most frequent cause of severe gastroenteritis frequently requir... more OBJECTIVES: Rotavirus (RV) is the most frequent cause of severe gastroenteritis frequently requiring hospitalization. RV is responsible for > 1/2 of all hospital stays for acute gastroenteritis. The objective was to estimate the burden of community acquired rotavirus gastro-enteritis requiring hospitalization (CRVGE) in children ≤ 5 years old in Czech Republic (CR) and Slovakia (SK). METHODS: Multi-center, retrospective patient chart review was conducted in both pediatric and infection disease settings in CR (n= 109) and SK (n= 115). Resource use analysis including length of hospital stay and tests performed were evaluated. Patients requiring rehydration, complications and comorbidities were considered. Direct cost from payer's perspective were retrieved from official DRG lists (CR) and fixed hospitalization cost rates per case (SK). Micro-costing was done in parallel based on the resource use data. RESULTS: Mean length of hospital stay in CR and SK was 3.9 (SD 1.9) and 4.1 days (SD 1.7) respectively. Prevalent diagnostic tests used were latex agglutination 44.0% (CR) and immunochromatography 92% (SK). Rehydration was required in 84.4% (CR) and 97% (SK) of cases. Comorbidities were reported in 24.8% (CR) and 27% (SK); complications in 10.1% (CR) and 7.8% (SK). The national list-based reimbursement per hospitalized CRVGE is € 370-645 (CR) and € 561 (SK). The calculated average total costs, including treatment prior to, and after admission, were € 462 (CR) and € 583 (SK). The major cost item was the hospital stay with € 391 (CR) and € 540 (SK). Costs for tests and drugs during hospitalization were € 30 (CR) and € 25 (SK). The costs of pre and post-hospitalization care were € 20 (CR) and € 13 (SK). CONCLUSIONS: Although the length of hospitalization in both countries is similar costs seem to be substantially lower in CR, possibly as a result of recently launched DRG system. Common complications and comorbidities account for 30% of average hospital costs.

Biotechnology & Biotechnological Equipment, 2013

Biotechnology & Biotechnological Equipment, 2012

To date there is no Markov model to evaluate the cost-effectiveness of antihypertensive pharmacot... more To date there is no Markov model to evaluate the cost-effectiveness of antihypertensive pharmacotherapies at national level in developing countries. The aim of our study was to evaluate different antihypertensives and determine their cost-effectiveness as monotherapy treatment in primary care in Serbia.

Biotechnology & Biotechnological Equipment, 2012