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Obesity is a chronic, complex, relapsing disease impacting healthcare systems and the economy worldwide. We aim to analyze the utilization trends of antiobesity drugs, and their reimbursement status on drug lists of health insurance funds (HIF) in selected European countries. The DDD/1000 inhabitants/day methodology is used for utilization trend analysis, where data from official national utilization reports were used. For the reimbursement status analysis of 5 antiobesity drugs (orlistat, semaglutide, liraglutide, naltrexone/bupropion, setmelanotide), the websites of national health insurance funds (HIF) of 22 European countries were screened. Trend analysis revealed fluctuation for almost all antiobesity drugs (the highest decrease seen for orlistat in Serbia, and the highest increase for liraglutide in Croatia). Novel antiobesity drugs show an increasing utilization trend in almost all the countries. In two out of three European countries, 437 antiobesity drugs are not covered by the HIF. Slovenia and Denmark reimburse most of the antiobesity drugs. The Netherlands is the only country where the cost of setmelanotide is paid by the HIF. Our results emphasize the importance of prioritizing the introduction and implementation of new strategies and reimbursement scheme models in global and national antiobesity policies.

Economic evaluation in health (also known as pharmacoeconomic in case of medicines) identifies, measures, and values costs and outcomes of alternative healthcare technologies, and can be performed alongside controlled clinical trials, but analytical modelling is usually used. Decision trees and Markov models are the two most common approaches used in economic evaluation. The biggest advantages of a decision tree are clarity, simplicity, and straightforwardness. On the other hand, the main advantage of the Markov model is its ability to incorporate complex events into the simulation, which is practically impossible to do with a decision tree. Reimbursement policy in Serbia mandatorily incorporates economic evaluations to promote availability and accessibility of the prescription medicines. To show current pharmacoeconomic value of a medicine, budget impact analysis and the cost-effectiveness analysis should be included. The latter should be conducted using appropriate modelling techniques. However, since no official methodological guidelines about the modelling and economic analysis exist, the submissions by marketing authorization holders vary greatly. The future of pharmacoeconomic modelling depends on the research area of interest, with new frameworks and approaches being developed.

It has been determined that Pharmacist-Managed Anticoagulation Service (PMAS) for patients on warfarin improves anticoagulation control and decreases the rate of bleeding, thus reducing the overall health care costs. This study aims to compare the cost-effectiveness of providing pharmaceutical care (PC) and usual medical care (UMC) to patients on warfarin, from the perspective of the National Health Insurance Fund (NHIF) in Serbia. The cost-effectiveness analysis was conducted, with a time horizon of 10 days. Decision tree modeling combined data on efficacy from eligible studies, while the costs were taken from NHIF Drug and Service fee lists. Additionally, the budget impact analysis was performed, aiming to project annual savings by implementing PMAS as a part of anticoagulation clinics. PC has been perceived to be cost-effective strategy, since it enables a higher probability of well controlled INR value (additional effectiveness 0,154), along with lower costs (-374,51 RSD), compared to UMC. Negative incremental cost-effectiveness ratio additionally demonstrated cost-effectiveness of PC, as dominant strategy. Sensitivity analysis confirmed the model robustness, and budget impact analysis has also demonstrated significant annual savings, in the total amount of 50.863.313 RSD for a five year period 2016-2020. Providing PC to patients on warfarin represents a more cost-efficient strategy than UMS, in addition to better safety profile, which is why it should be implemented in the national health care system in the future.

Urinary tract infections are inflammations processes on lower or upper parts of urinary tract. Therapy of urinary tract infections differs for complicated and non-complicated infections and site of infection. The aim of this paper is pharmacoeconomic analysis of different strategies in management of urinary tract infections from the perspective of Republic Fond for Health Insurance. The decision tree was constructed to evaluate costs and effectiveness of different strategies used for treatment of non-pregnant, adult women. As a positive outcome of the treatment number of cases where simptoms disapered is used. The results implied that the least costly strategy available is empiric treatment. More expensive but with greater outcomes was the strategy involving laboratory test together with empiric treatment. Although the empiric treatment proved to be cost-effective and in accordance with current recommendations and guidelines for therapy, recognition of the impact of this strategy upon antibiotic resistance may lead to conclusion that the dipstick strategy is superior strategy.

Empirical application of antifungal drugs in the treatment of invasive fungal infections (IFI) in febrile neutropenia represent significant cost, but it is essential in patients with leukemia and after hematopoietic stem cell transplantation. Numerous clinical studies have shown little difference in the efficacy of amphotericin B and caspofungin in IFI empirical therapy, but it does not reflect their cost-effectiveness. The aim of this study was to compare the costeffectiveness of caspofungin and amphotericin B lipid complex (ABLC) in the empirical antifungal therapy in patients with febrile neutropenia using model-decision tree, from the perspective of the National Health Insurance Fund (NHIF). We used the cost-effectiveness analysis, for a period of 14 days of therapy. In model we combined data on efficacy from randomized clinical trials, while the costs were taken from the Drug list or service fee NHIF. The total cost per additional cured fungal infection with caspofungin was 639,750.06 RSD, while with ABLC was 2,153,403.61 RSD. In the sensitivity analysis, using different weights of patients (50kg or 70kg) and different doses of ABLC, caspofungin was again most cost-effective strategy for empirical antifungal therapy. Caspofungin, in addition to a better safety profile, is more cost-efficient than ABLC. This fact should be kept in mind when choosing a therapy for the treatment of IFI in patients with febrile neutropenia.