Epidemiology and comprehensive economic impact of atrial fibrillation and associated stroke in Slovakia.

BACKGROUND: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. It is also a major risk factor for ischemic stroke. The main objective of our study was to identify direct and indirect costs of AF and AF-related stroke in Slovakia. METHODS: We conducted a retrospective population-based study of AF and stroke related costs both from the third-party healthcare payers and societal perspective. The prevalence and incidence of AF and stroke were determined from central government run healthcare database. Further we estimated both indirect and direct costs of AF and stroke. All costs and healthcare resources were assessed from 2015 through 2019 and were expressed in the respective year. RESULTS: Over the 5-year study period, the prevalence of AF increased by 26% to a total of 149,198 AF cases in 2019, with an estimated total annual economic burden of €66,242,359. Direct medical costs accounted for 94% of the total cost of AF. The total cost of treating patients with stroke in 2019 was estimated at €89,505,669. As a result, the medical costs of stroke that develops as a complication of AF have been estimated to be €25,734,080 in 2019. CONCLUSIONS: Our study shows a substantial economic burden of AF and AF-related stroke in Slovakia. In view of the above, both screening for asymptomatic AF in high-risk populations and effective early management of AF with a focused on thromboprophylaxis rhythm control should be implemented.

Economic burden of multiple sclerosis in Slovakia - from 2015 to 2020.

BACKGROUND: Multiple sclerosis (MS) is a chronic, inflammatory disease of the central nervous system, commonly diagnosed during young adulthood. The proportion of direct and indirect costs of MS vary across settings. The International Multiple Sclerosis Study, involving 1152 patients with MS from 19 countries, reported the average annual costs per patient to be €41,212, with direct medical costs of €21,093, direct non-medical costs of €2110, and €16,318 marked as indirect costs. However, there are no precise data on the economic burden of MS in Slovakia. Therefore, the main objective of this study is to assess the economic impact of MS in Slovakia by identifying and measuring the direct medical costs and indirect costs of this disease. METHODS: We conducted a retrospective prevalence-based cost-of-illness analysis for MS in Slovakia sourced from the third-party payer and societal perspective. Patient co-payments and out-of-pocket expenses were not included in our study. We analysed all available costs and healthcare resources utilised in a 6-years period, from 2015 to 2020. For each year, all costs (in euro) were specified as total and the average annual cost per patient. RESULTS: The estimated total economic burden of MS in Slovakia in 2020 was €57,347,523, with direct medical costs estimated to be €53,348,337 and indirect costs standing at €3,999,186. The total annual cost per patient in 2020 was €6682. Over the 6 years, the total diagnostic and treatment cost of patients with MS was estimated to be €283,974,236. With an average year-by-year increase of 5%, the total direct costs of MS had significantly grown during the examined 6 years. The total cost due to the MS-associated loss of productivity in these 6 years was €16,633,798. The average year-by-year increase of indirect costs of MS was 20%. CONCLUSIONS: Our study revealed the substantial health and economic burden of MS, with the average annual cost per patient to be approximately €6,682 in 2020. We provide the first extensive assessment of the burden of MS on Slovakian patients, the healthcare system, and society. It indicates the need for a detailed analysis of the employment of patients with MS to assess disability and work performance and the development of allied health policies.

Cost-effectiveness of colorectal cancer screening in Slovakia.

BACKGROUND: Colorectal cancer (CRC) is an ideal disease for screening due to known and detectable precursor lesions and slow progression from benign adenoma to invasive cancer. The introduction of organized population-based screening programs reduces the burden of colorectal cancer and increases the quality of the screening process with a more favorable harm to benefit ratio compared to opportunistic screening. METHODS: The study used the microsimulation screening analysis-colon simulation model for the estimation of the effect of various factors on cancer incidence and mortality. The model simulated the Slovakian population from 2018 to 2050. Study includes the analysis of two screening strategies the fecal immunochemical test (FIT) every 2 years and annual FIT. Cost-effectiveness parameters were evaluated comparing each simulated screening scenario with no screening. RESULTS: Compared to no screening, the biennial FIT would detect 29 600 CRC cases and annual FIT 37 800 CRC cases. Mortality due to CRC showed benefits for both strategies with 17,38% reduction in biennial FIT and 24,67% reduction in annual FIT approach. Both screening programs were more costly as well as more effective compared to no screening. The ICER for biennial FIT strategy was 1776 EUR per 1 QALY and for the annual FIT 3991 EUR per 1 QALY. CONCLUSIONS: In summary, this is the first cost-effectiveness analysis focusing on multiple national CRC screening strategies in Slovakia. Both strategies demonstrated cost-effectiveness compared to no screening. However, for optimal population-based programmatic screening strategy, the policymakers should also consider human resources availability, acceptability of screening test among the population or additional resources including the screening funding.

Economic aspects of multiple myeloma: real costs associated with disease in the Slovak Republic.

Health care costs are continuously increasing. Multiple myeloma represents approximately 1% of all malignancies and the 5-year prevalence is 230,000 patients on average. In addition, there is an annual incidence of 3.8/100,000 in Slovakia. In total economic burden assessment, it is important to focus not only on direct but also on indirect costs, including the lost productivity due to premature death. Based on the data and information obtained from the key stakeholders the Ministry of Health, the Ministry of Labor, the Social Insurance Agency, and NCZI, we provided the assessment of direct and indirect costs. The total cost of the disease for the model patient represents €409,071 from the diagnosis of MM to death. The major cost burden is associated with the treatment, €155,645 followed by the costs of productivity loss due to premature death, €127,611. Cost-of-illness studies provide an important view on the total burden of the disease in specific areas and are necessary for an adequate decision-making process from the regulatory and reimbursement perspective.

Anaphylaxis in Public Health.

The increasing number of patients with anaphylactic reactions is a modern challenge for healthcare professionals in clinical practice and public health professionals. It remains difficult to determine the prevalence or incidence of anaphylaxis in the population due to the long absence of a consensus definition, the fact that analyses are performed on various population groups and the use of different data collection methodologies. In the United States, anaphylaxis mortality ranges from 0.63 to 0.76 cases per million inhabitants, with 58% of these deaths due to drug anaphylaxis. The risk factors for anaphylaxis are ramipril and metoprolol use, which is common in patients with cardiovascular disease. Also, a higher level of gliadin following excess gluten intake is associated with a higher incidence of anaphylaxis. Drugs, food and insect stings have long been known as anaphylaxis inductors. In diagnosis, determination of serum tryptase concentration is used. In patients with normal tryptase concentration, it is appropriate to screen other inflammatory mediators. The authors of this article present new findings on anaphylaxis in the literature and recommended practices of professional societies in the context of public health.

Analysis of body segments and postural state in school children.

OBJECTIVE: Aim of our study was to identify the number of existing posture disorders in children in primary schools and to identify the most prevalent position of body segments that cause postural disorders. METHODS: The occurrence of postural disorders was analysed in the school year 2016/2017. The sample consisted of 311 pupils age 6-8 from the 16 districts of the Slovak republic. We used Klein, Thomas and Mayer method to evaluate the posture. Flat feet were evaluated according to Napoleon Wolanski scale. The results were verified by using a base rate quantity test. We determined the level of statistical significance at p = 0.05. RESULTS: We observed statistically significant postural disorders in children. Poor posture occurs in more than 50% of the population under the study. The most critical body segments which were subjected to pathology were shoulder blades and shoulders. Pathology in these segments exceeds 80%. Flat feet occurrence was in 65% children. Adverse results were also seen in pathologic position of: pelvis anteversion (46 %), head protruding (42%) and spinal curvature deformities in the sagittal plane (30%). In the frontal plane deformities of spinae reached 13%. CONCLUSION: Health status of the children's locomotor system, especially postural system is poor. High prevalence of postural disorders in children requires preventive programs such as introducing corrective exercises into physical education and engaging children in sports. Knowledge of the most frequent body segments defects in children can be helpful for professionals in creating adequate corrective programs for children.

Slovak and Czech OECD Data under the Magnifying Glass: Cardiovascular Pharmaceutical Consumption by Defined Daily Dose.

OBJECTIVE: The aim of this study is to point out certain discrepancies and inaccuracies in reporting data concerning the consumption of cardiovascular pharmaceuticals (Anatomical Therapeutic Chemical code C, cardiovascular system) - measured in defined daily doses (DDDs) per 1,000 inhabitants per day - as reported by the Slovak Republic and the Czech Republic for the year 2014. This data also appears in the online database of the Organization for Economic Co-operation and Development (OECD) Health Statistics. METHODS: First, we take the Czech wholesalers' data by DDD as reported to the OECD, and we compare this Czech data with the Slovak data. We calculate the Slovak data by the method traditionally used in the Slovak Republic (SDS - standard dose of substance). However, the data we use for the Slovak Republic is that reported by health insurance companies and hospital pharmacies, while the official data reported to the OECD is based on wholesalers' reports. Secondly, we recalculate medicine consumption for both countries using DDD. RESULTS: A comparison based on the first methodological approach shows the Slovak Republic having a higher consumption of cardiovascular medicines than the Czech Republic. A second comparison, using the same measurement tool (DDD) for both countries, shows cardiovascular medicine consumption to be actually lower in the Slovak Republic as compared to the Czech Republic. CONCLUSION: Our results indicate that, when actual DDDs for both countries are used, cardiovascular pharmaceutical consumption in the Slovak Republic is shown to be lower than in the Czech Republic.

Etiology, Risk Factors and Outcome of 1003 Cases of Infective Endocarditis from a 33-year National Survey in the Slovak Republic: An increasing proportion of elderly patients.

BACKGROUND: Infective endocarditis (IE) is still a significant cause of mortality in European hospitals, despite of the fact, that large nationwide studies were performed in last twenty years and pathogens are well known. The aim of the study was to assess risk factors, mortality, etiology and proportion of elderly patients within a longitudinal nation wide survey of infectious endocarditis in Slovakia. PATIENTS AND METHODS: Etiology, risk factors and outcome of 1003 cases of infective endocarditis (IE) in Slovakia over the last 33 years have been assessed. RESULTS: The majority of IE were caused by Staphylococci (28.3%), 15.6% were due to Viridans streptococci, 10% due to Enterococci, 8.2% by gram-negative bacteria, Acinetobacter baumannii and Pseudomonas aeruginosa, 3.7% by other organisms and 31.0% of all cases were culture negative. The following risk factors were recorded: age > 65 (36.8%), rheumatic fever (15.3%), dental surgery (8.7%), previous non-cardiological surgery (8.2 %), neoplasia (8.1%), diabetes (7.8%), any endoscopy (8.5%) and dialysis (4.6%). All patients were treated with antimicrobials, 507 (51%) also with surgery. Survival rate at day 60 after diagnosis was 88.1% (n=883). Only age >65 (34.3% vs. 49.5%, p=0.045) and persistent bacteremia (with three or more positive blood cultures 15.7% vs. 34.5%, p=0,001) were significantly associated with higher attributable mortality. Concerning risk factors, etiology and therapeutic strategies, rheumatic fever and neoplasia showed decrease in tendency. Dental surgery and tonsillitis were less frequent as well (26.7% vs. 2%, p<0,001 and 16% vs. 1%, p<0.001). There was a significant shift in etiology after 1997: culture-negative endocarditis was surprisingly more frequently observed in the 2007-2017 period than before and represented 10.7% of all cases in 1984-1990 in comparison to 25.1-25.6% in 2007-2010 and 2011-2017. Staphylococci decreased from 48% to 29.6% (2007-2017), but are still major pathogens. Persistent bacteremia (3 or more positive blood cultures 5.3% vs. 24.7%, p<0,001) was less commonly observed within the 1st period (1984-1990) in comparison to 2007-2010. More patients in the 1st period (1984-1990) had embolization complications of IE than in the fifth and sixth period (2007-2017) (76 vs. 16.3% p<0.001). CNS embolization decreased from 14% to less than 5% (p<0.003). Attributable mortality was lower too (26.7% vs. 9.5%, p<0.001) because of increased proportion of cardiac surgery in the treatment of IE in 2007-2017 in comparison to 1984-1990. CONCLUSIONS: Study has showed significant shifts in etiology, risk factors and complications over the observed time periods in Slovakia.

EDTORIAL_.

Why did we prepare this supplement and why it is about interdisciplinary public health issues? It is rather difficult question, but with a simple answer. Neurology field, neuroendocrinology field and many other areas of medicine are actually very important partners for public health professionals. Public health promotes and protects the health of people and the communities where they live, learn, work and play. While doctors treat people who are sick, those of us working in public health try to prevent people from getting sick or injured in the first place.

Review of Utilization of Cardiovascular Medicines by Daily Defined Dose in the Czech Republic and Slovak Republic.

To the Editor, Drug utilization is an important field of drug policy and an integral part of public health internationally. This area of research attracts increasing interest but the pioneering work was done 50 years ago when the first drug consumption report from six European countries for the period of 1966-1967 showed great differences in drug utilization between population groups (WHO, 1968). These results gave important stimulus for creation of Anatomical Therapeutic Chemical (ATC) classification and technical unit of measurement called the Defined Daily Dose (DDD) which is specified as "the assumed average maintenance dose per day for a drug used for its main indication in adults" that dealt with the objections against traditional units of measurement in drug utilization studies (WHO, 2016). The ATC/DDD methodology has in the meantime proved its suitability in drug utilization monitoring and research. As mentioned previously, consumption of pharmaceuticals is often used as a basis for comparison between countries. Based on our professional expertise, we decided to analyze the consumption of cardiovascular medicines by DDD in the Czech Republic and Slovak Republic within all ATC groups reported to OECD (OECD, 2016a). According to OECD indicator results, the Slovak Republic showed in 2014 a higher pharmaceutical consumption by DDD in ATC group C (cardiovascular system) compared to the Czech Republic (OECD, 2016a).

Decision and cost analysis of empirical antibiotic therapy of acute sinusitis in the era of increasing antimicrobial resistance: do we have an additional tool for antibiotic policy decisions?

OBJECTIVE: No previous analyses have attempted to determine optimal therapy for upper respiratory tract infections on the basis of cost-minimization models and the prevalence of antimicrobial resistance among respiratory pathogens in Slovakia. This investigation compares macrolides and cephalosporines for empirical therapy and look at this new tool from the aspect of potential antibiotic policy decision-making process. METHODS: We employed a decision tree model to determine the threshold level of macrolides and cephalosporines resistance among community respiratory pathogens that would make cephalosporines or macrolides cost-minimising. To obtain information on clinical outcomes and cost of URTIs, a systematic review of the literature was performed. The cost-minimization model of upper respiratory tract infections (URTIs) treatment was derived from the review of literature and published models. RESULTS: We found that the mean cost of empirical treatment with macrolides for an URTIs was €93.27 when the percentage of resistant Streptococcus pneumoniae in the community was 0%; at 5%, the mean cost was €96.45; at 10%, €99.63; at 20%, €105.99, and at 30%, €112.36. Our model demonstrated that when the percentage of macrolide resistant Streptococcus pneumoniae exceeds 13.8%, use of empirical cephalosporines rather than macrolides minimizes the treatment cost of URTIs. CONCLUSIONS: Empirical macrolide therapy is less expensive than cephalosporines therapy for URTIs unless macrolide resistance exceeds 13.8% in the community. Results have important antibiotic policy implications, since presented model can be use as an additional decision-making tool for new guidelines and reimbursement processes by local authorities in the era of continual increase in antibiotic resistance.

Rare Disease Terminology and Definitions-A Systematic Global Review: Report of the ISPOR Rare Disease Special Interest Group.

BACKGROUND: At present, there is no universal definition of rare disease. OBJECTIVE: To provide an overview of rare disease definitions currently used globally. METHODS: We systematically searched for definitions related to rare disease from organizations in 32 international jurisdictions. Descriptive statistics of definitions were generated and prevalence thresholds were calculated. RESULTS: We identified 296 definitions from 1109 organizations. The terms "rare disease(s)" and "orphan drug(s)" were used most frequently (38% and 27% of the definitions, respectively). Qualitative descriptors such as "life-threatening" were used infrequently. A prevalence threshold was specified in at least one definition in 88% of the jurisdictions. The average prevalence threshold across organizations within individual jurisdictions ranged from 5 to 76 cases/100,000 people. Most jurisdictions (66%) had an average prevalence threshold between 40 and 50 cases/100,000 people, with a global average of 40 cases/100,000 people. Prevalence thresholds used by different organizations within individual jurisdictions varied substantially. Across jurisdictions, umbrella patient organizations had the highest (most liberal) average prevalence threshold (47 cases/100,000 people), whereas private payers had the lowest threshold (18 cases/100,000 people). CONCLUSIONS: Despite variation in the terminology and prevalence thresholds used to define rare diseases among different jurisdictions and organizations, the terms "rare disease" and "orphan drug" are used most widely and the average prevalence threshold is between 40 and 50 cases/100,000 people. These findings highlight the existing diversity among definitions of rare diseases, but suggest that any attempts to harmonize rare disease definitions should focus on standardizing objective criteria such as prevalence thresholds and avoid qualitative descriptors.

Social marketing as a tool to improve behavioral health services for underserved populations in transition countries.

Human development efforts continue to change the world and improve quality of life for humans. Without the struggle and drive to contemplate new ideas to improve society, the global community would be in a constant state of oppression. Although cultures and norms change as international boundaries are crossed, the universal goal is to improve standards of living to include behavioral health services for underserved populations. In recent times, pioneers and community groups have used social marketing as an instrument to change public perceptions and behaviors within societies. These efforts have transformed nations in the acceptance and understanding of community health and rehabilitation, education, service, and human rights. This article examines the justification for utilization of the concepts and tools of social marketing to bring about proactive behavior modification among segments of underserved populations. A section of this article provides an overview of the basics of social marketing for the benefit of makers of health policy in transition countries. Finally, the case of 2 underserved population segments in the Republic of Slovakia, a new member of the European Union (former socialist block member), is examined for possible implementation.