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Stress is one of the most significant factors that can influence the academic performance of students. To explore the causes of stress in students, the crosssectional online survey was conducted during semester (in 2019 year) and during examination period (in 2020 year) period at the University of Belgrade - Faculty of Pharmacy. The main results indicated that female gender was the most significant predictor of stress during the examimation period, and the most frequent stress sources were limited time to prepare exams and/or colloquia. The role of family, friends, and boyfriend/girlfriend showed to be of great importance in stress reduction during the semester and especially during the examimation period. The most frequent manifestations of stress were feeling nervous, tired and worried. For stress reduction students usually listened to music and talked with friends. Therefore, student’s obligations and their overall living conditions should be observed comprehensively. These results may indicate further actions to decrease stress levels in students, and need for academic environment that may help students to achieve the best academic performance.

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., Ekonomske evaluacije u zdravstvu (ili farmakoekonomija u slučaju lekova) identifikuju, vrednuju i mere troškove i ishode alternativnih zdravstvenih tehnologija, i mogu se sprovoditi paralelno sa kliničkim studijama, ali se češće primenjuje modelovanje. Drvo odlučivanja i Markovljev model su dva najčešće korišćena modela u ekonomskim evaluacijama. Najveća prednost primene drveta odlučivanja je njegova jednostavnost, jasnoća i direktnost. Sa druge strane, najveća prednost Markovljevog modela je sposobnost da uključi kompleksne događaje u simulaciju, što je praktično nemoguće sa drvetom odlučivanja. Ekonomske evaluacije su obavezan zahtev u nekoliko procesa u cilju povećanja dostupnosti lekova u Srbiji. Kako bi se pokazala sadašnja farmakoekonomska prednost leka neophodno je sprovesti analizu uticaja na budžet i analizu troškovne isplativosti. Drugu analizu je neophodno sprovesti primenom odgovarajuće tehnike modelovanja. Međutim, kako ne postoje zvanične smernice o modelovanju i ekonomskim evaluacija, dokumentacija podneta od strane nosioca dozvole pokazuje značajno variranje. Budućnost modelovanja u farmakoekonomiji zavisi od istraživačkog interesa, pri čemu se razvijaju novi okviri i pristupi.

This study aims to evaluate clinical characteristics, quality of life and control of treatment and therapy satisfaction of patients with asthma in Bulgaria. A pilot study of Bulgarian patients with asthma selected by allergologists was performed. The predefined inclusion criteria were asthma diagnosis with at least 6 months of living with asthma and use of asthma medication. Patient characteristics, treatment, quality-of-life, control of asthma and therapy satisfaction were systematically assessed. A retrospective observational study was conducted among asthma patients in Sofia in 2019. A strict definition of asthma-based solely on physicians’ diagnosis was used. Allergologists from two national reference hospitals for asthma therapy selected asthma patients. Every third patient with asthma that visited the office within 5 months period, and that agreed to participate was selected for the study. Quality-of-life of patients was measured using the EQ5D Assessment Test, control of asthma was assessed using ATCQ and ATC tests. A total of 71 asthma patients were enrolled. Approximately 43.6% were male, 16.9% were smokers, occupational risk factors were low (4.22%), 25% had moderate and 38% had severe asthma. The mean scores of asthma control treatment were 16.92 ± 5.68. The group has relatively high percentages of severe asthma patients. The asthma was not well controlled. National asthma strategies should focus on prevention and early detection of the disease.

Uvod: Zdravstvene navike predstavljaju način života, obično se uspostavljaju tokom rane mladosti i mogu se menjati tokom života. Na zdravstvene navike utiču zdravstveno stanje, stavovi pojedinca i zdravstveno ponašanje. Promenom rizičnog ponašanja kroz primarnu prevenciju može se smanjiti rizik od nastanka mnogih bolesti i prerane smrti u kasnijem periodu.Zdravi stilovi života obuhvataju dobro izbalansiranu i zdravu ishranu, svakodnevno vežbanje, odgovarajuću dužinu i kvalitet sna, pravilno upravljanje stresom, odsustvo upotrebe duvanskih proizvoda, alkoholnih pića i pića koja sadrže kofein. Nacionalni program prevencije, lečenja i kontrole kardiovaskularnih bolesti u Republici Srbiji do 2020. godine kao jednu od mera prevencije hipertenzije naveo je pored promena stilova života i ponašanja, bolju informisanost, edukaciju i podizanje nivoa svesti o povećanom riziku za razvoj hipertenzije, što je moguće postići istraživanjima ponašanja u vezi sa zdravstvenim navikama.Neophodno je posvetiti posebnu pažnju promociji zdravlja među populacijom studenata, jer dokazi ukazuju da su ponašanja i životni stilovi mladih problematični, a period studiranja kritičan za zdravstveni život mladih, jer se mnogi studenti suočavaju sa brojnim izazovima, naročito vezanim za promene u društvenoj i životnoj sredini. Prevalenca arterijske hipertenzije u populaciji odraslih u Republici Srbiji iznosi 33,2%, a poznato je da se arterijska hipertenzija može javiti i kod mladih osoba. Faktori rizika koji dovode do nastanka arterijske hipertenzije mogu biti ireverzibilni faktori rizika, kao što su: telesna građa, pol, uzrast, pozitivna porodična anamneza, genetska predispozicija. Potencijalno reverzibilni faktori rizika su gojaznost, upotreba duvanskih proizvoda, konzumacija alkohola, prekomeran unos soli, neadekvatne nutritivne navike, nedovoljna fizička aktivnost, materijalni status, nizak nivo informisanosti i obrazovanja.Ciljevi istraživanja su bili da se :(i) Ispita prevalenca određenih zdrav, Introduction: Health habits are a way of life. They are usually established during early youth and can change throughout life. Health habits are influenced by health condition, health behavior and attitudes of an individual. By changing risky behavior through primary prevention, numerous diseases and premature death occurrence can be reduced in the later period.A healthy lifestyle includes a well-balanced and healthy diet, daily exercise, adequate length and quality of sleep, proper stress management, and not consuming tobacco, alcohol and caffeinated beverages. The National Programme for Prevention, Treatment and Control of Cardiovascular Diseases in the Republic of Serbia until 2020, as one of the measures for the prevention of hypertension, stated, in addition to changes in lifestyle and behavior, better information, education and raising awareness of the increased risk of hypertension, which could be achieved by behavioral research related to health habits.It is necessary to pay special attention to the promotion of health among student population, because the evidence indicates that their behavior and youth lifestyles are problematic, while the period of studying is critical for youngsters’ health because many students face numerous challenges especially those related to social and environmental changes. The prevalence of arterial hypertension in the adult population in the Republic of Serbia is 33.2%, and it is known that arterial hypertension can also occur in young people. The risk factors leading to arterial hypertension can be irreversible, such as body structure, gender, age, positive family anamnesis and genetic predisposition. Potentially reversible risk factors are obesity, tobacco use, alcohol consumption, excessive salt intake, inadequate nutritional habits, insufficient physical activity, material status, low level of information and education.Aim: The objectives of the research were:(i) To examine the prevalence of certain health habits in the stud

Uvod: Zdravstvene navike predstavljaju način života, obično se uspostavljaju tokom rane mladosti i mogu se menjati tokom života. Na zdravstvene navike utiču zdravstveno stanje, stavovi pojedinca i zdravstveno ponašanje. Promenom rizičnog ponašanja kroz primarnu prevenciju može se smanjiti rizik od nastanka mnogih bolesti i prerane smrti u kasnijem periodu. Zdravi stilovi života obuhvataju dobro izbalansiranu i zdravu ishranu, svakodnevno vežbanje, odgovarajuću dužinu i kvalitet sna, pravilno upravljanje stresom, odsustvo upotrebe duvanskih proizvoda, alkoholnih pića i pića koja sadrže kofein. Nacionalni program prevencije, lečenja i kontrole kardiovaskularnih bolesti u Republici Srbiji do 2020. godine kao jednu od mera prevencije hipertenzije naveo je pored promena stilova života i ponašanja, bolju informisanost, edukaciju i podizanje nivoa svesti o povećanom riziku za razvoj hipertenzije, što je moguće postići istraživanjima ponašanja u vezi sa zdravstvenim navikama. Neophodno je posvetiti posebnu pažnju promociji zdravlja među populacijom studenata, jer dokazi ukazuju da su ponašanja i životni stilovi mladih problematični, a period studiranja kritičan za zdravstveni život mladih, jer se mnogi studenti suočavaju sa brojnim izazovima, naročito vezanim za promene u društvenoj i životnoj sredini. Prevalenca arterijske hipertenzije u populaciji odraslih u Republici Srbiji iznosi 33,2%, a poznato je da se arterijska hipertenzija može javiti i kod mladih osoba. Faktori rizika koji dovode do nastanka arterijske hipertenzije mogu biti ireverzibilni faktori rizika, kao što su: telesna građa, pol, uzrast, pozitivna porodična anamneza, genetska predispozicija. Potencijalno reverzibilni faktori rizika su gojaznost, upotreba duvanskih proizvoda, konzumacija alkohola, prekomeran unos soli, neadekvatne nutritivne navike, nedovoljna fizička aktivnost, materijalni status, nizak nivo informisanosti i obrazovanja. Ciljevi istraživanja su bili da se : (i) Ispita prevalenca određenih z, Introduction: Health habits are a way of life. They are usually established during early youth and can change throughout life. Health habits are influenced by health condition, health behavior and attitudes of an individual. By changing risky behavior through primary prevention, numerous diseases and premature death occurrence can be reduced in the later period. A healthy lifestyle includes a well-balanced and healthy diet, daily exercise, adequate length and quality of sleep, proper stress management, and not consuming tobacco, alcohol and caffeinated beverages. The National Programme for Prevention, Treatment and Control of Cardiovascular Diseases in the Republic of Serbia until 2020, as one of the measures for the prevention of hypertension, stated, in addition to changes in lifestyle and behavior, better information, education and raising awareness of the increased risk of hypertension, which could be achieved by behavioral research related to health habits. It is necessary to pay special attention to the promotion of health among student population, because the evidence indicates that their behavior and youth lifestyles are problematic, while the period of studying is critical for youngsters’ health because many students face numerous challenges especially those related to social and environmental changes. The prevalence of arterial hypertension in the adult population in the Republic of Serbia is 33.2%, and it is known that arterial hypertension can also occur in young people. The risk factors leading to arterial hypertension can be irreversible, such as body structure, gender, age, positive family anamnesis and genetic predisposition. Potentially reversible risk factors are obesity, tobacco use, alcohol consumption, excessive salt intake, inadequate nutritional habits, insufficient physical activity, material status, low level of information and education. Aim: The objectives of the research were: (i) To examine the prevalence of certain health habits in the

Venous thromboembolism, including pulmonary embolism and deep vein thrombosis, is a signifi cant factor in morbidity and mortality of patients. New oral anticoagulants, such as apixaban, dabigatran, and rivaroxaban, have recently demonstrated their safety and efficacy in patients undergoing major orthopaedic surgery. Selection of the appropriate drug should be adjusted according to patient needs. Major bleeding is rare with new oral anticoagulants and is comparable with the bleeding rate associated with low-molecular-weight heparins. Clinical data indicate that therapy with apixaban and rivaroxaban was more effective compared to enoxaparin, while dabigatran has a similar efficacy to enoxaparin. Cost-effectiveness studies of new oral anticoagulants showed that these medicines offer higher efficacy with acceptable costs for the healthcare system, even saving costs in certain cases. Clinical practice in Serbia reflects considerably more frequent use of traditional anticoagulant medication therapy compared to new oral anticoagulants., Venska tromboembolija, koja uključuje plućnu emboliju i duboku vensku trombozu, predstavlja značajan faktor morbiditeta i mortaliteta pacijenata. Novi oralni antikoagulansi, poput apiksabana, dabigatrana i rivaroksabana, su nedavno pokazali svoju bezbednost i efikasnost kod pacijenata koji se podvrgavaju velikim ortopedskim intervencijama. Izbor odgovarajućeg leka treba prilagoditi individualnim potrebama pacijenta. Velika krvarenja su relativno retka u toku primene novih oralnih antikoagulanasa i uporedivi su sa stopom krvarenja prilikom primene nisko-molekularnih heparina. Klinički podaci ukazuju da je terapija apiksabanom i rivarokabanom efikasnija u odnosu na enoksaparin, dok dabigatran ima slične efekte kao enoksaparin. Troškovna isplativost novih oralnih antikoagulanasa potvrđuje veću efikasnost sa prihvatljivim troškovima za zdravstveni sistem, u nekim slučajevima čak i sa uštedama.

Aim To determine the general population willingness to pay for cognitive pharmacist service in community pharmacy, describe the behavior of participants regarding health care issues, and evaluate correlation between participants' sociodemographic characteristics or attitudes and their willingness to pay. Methods A questionnaire-based survey was conducted among general population visiting community pharmacies. The participants were asked about receiving cognitive pharmacist services to identify and resolve potential medication therapy problems after the initiation of a new medicine to optimize health outcomes of the patients. A univariate and multivariate analysis were used to analyze associations between different variables and willingness to pay for pharmacy service. Results Of 444 respondents, 167 (38%) reported that they were willing to pay for a medication management service provided in the community pharmacy. Univariate analysis showed significant association between the willingness to pay for pharmacist-provided service and respondents' socio-demographic factors, health-related characteristics, and behavior, dilemmas, or need for certain pharmacist-provided service. The logistic regression model was statistically significant (chi(2) = 4.599, P lt 0.001). Conclusions The respondents expressed their willingness to pay for cognitive pharmacist services, which has not been fully recognized within the health care system. In future, pharmacists should focus on practical implementation of the service and models of funding

Healthcare professionals should serve as promoters of ra-tional antibiotic use in attempt to decrease antibiotics misuse within the process of self-medication. Current pilot study was undertaken with the aim to identify potential predictors of self-medication with antibiotics (SMA) and to describe SMA practice among nursing students in Serbia. Data have been collected dur-ing the period March-May, 2016 in Medical school of bachelor degree, in Belgrade. Self-reported questionnaire served as a data source. Descriptive statistic was used to analyse study sample characteristics. Chi-square test was used to test differences be-tween groups. Study sample have included 138 participants. Al-most half of them, 43.8%, practice SMA. Life style (smoking, al-cohol consumption, sleeping habits and physical activity) and so-cio-demographic characteristics (excepted school grade) were not shown as SMA determinants. Time & money savings were stated as the most frequent reason for SMA, while common cold, sore throat and cough were the most common conditions cured through SMA. Pharmacists’ recommendations and previous pos-itive experience were specified as the most important in the pro-cess of antibiotics selection, indicated by 50.0% and 37.5% par-ticipants, respectively. Amoxicillin was the most frequently used antibiotic in SMA, used by 50% of participants who practice SMA. High proportion of SMA and observed practice among nursing students in Serbia call for efforts with regards to relevant educa-tion about rational antibiotic use, actual clinical guidelines and potential consequences of misuse., Zdravstveni stručnjaci bi trebalo da služe kao pokretači ra-cionalne upotrebe antibiotika u pokušaju da se smanji zloupo-treba antibiotika kroz proces samomedikacije. Pilot studija je sprovedena sa ciljem da se utvrde potencijalni prediktori samomedikacije antibioticima (SMA) i da se opiše praksa SMA među studentima sestrinstva u Srbiji. Podaci su sakupljeni tokom perioda Mart-Maj 2016, u Višoj školi strukovnih studija u Be-ogradu, Srbija. Za sakupljanje podataka korišćen je upitnih za samo-popunjavanje. U analizi karakteristika ispitivanog uzorka korišćena je deskriptivna statistika. Hi-kvadrat test je korišćen za ispitivanje razlike između grupa. Ukupan broj učesnika u studiji bio je 138. Gotovo polovina, 43,8% je koristila SMA. Životni stil (pušenje, konzumiranje alkohola, navike u pogledu sna, fizička aktivnost) i socio-demografske karakteristike (izuzev godine studija) nisu pokazane kao SMA. Uštede u vremenu i novcu su navedene kao najčešći razlog za SMA, dok su prehlada, upala grla i kašalj najčešće indikacije tretirane kroz SMA. Preporuke farmaceuta i prethodno pozitivno iskustvo su navedeni kao najznačajniji faktori u odabiru antibiotika, što je tvrdilo 50,0% i 37,5% učesnika, redom. Amoksicilin je bio najčešće korišćen an-tibiotik koji je koristilo 50% učesnika kroz SMA. Visok procenat SMA i uočena praksa među studentima sestrinstva u Srbiji ukazuje na potrebe za relevantnom edukacijom u vezi sa racion-alnom upotrebom antibiotika, aktuelnim preporukama u klin-ičkim vodičima i potencijalnim posledicama nepoštovanja datih preporuka.

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., Infekcije urinarnog trakta zahvataju donje i gornje delove urinarnog trakta. Terapija infekcija se razlikuje u zavisnosti da li su u pitanju komplikovane ili nekomplikovane infekcije kao i od mesta infekcije. Cilj ovog rada je farmakoekonomska analiza isplativosti primene različitih strategija u lečenju infekcija urinarnog trakta iz perspektive Republičkog fonda za zdravstveno osiguranje. Zarad procene troškova i efikasnosti primene različitih strategija u lečenju infekcija urinarnog trakta u odraslih žena koje nisu trudne konstruisano je drvo odlučivanja. Kao ishod lečenja posmatran je broj slučajeva u kojima je došlo do prestanka simptoma. Rezultati istraživanja su pokazali da je najisplativija strategija empirijska primena antibiotika. Nešto skuplja i efikasnija strategija je primena laboratorijskih testova uz empirijsku primenu antibiotika. Iako je empirijska primena antibiotika troškovno isplativa i u skladu sa važećim preporukama i protokolima lečenja infekcije urinarnog trakta, ukoliko se razmotri i antibiotska rezistencija kao rastući zdravstveni problem, strategija primene dipstik testa može biti superiorna.

Objectives: The aim of the study was to compare the access of patients with rare diseases (RDs) to biotechnological drugs in several Central and Eastern European countries (CEECs). We focused on the legislative pricing and reimbursement requirements, availability of biotechnological orphan medicinal products (BOMPs) for RDs, and reimbursement expenditures. Methods: A questionnaire-based survey was conducted among experts from 10 CEECs: Bulgaria, Croatia, Estonia, Greece, Hungary, Poland, Romania, Slovakia, Serbia, and Macedonia. The legal requirements for reimbursement and pricing of BOMPs were collected. All BOMPs and medicines without prior orphan designations were extracted from the European list of orphan medicinal products, 2017. The reimbursement status of these medicinal products in 2017 in the public coverage of the included CEECs as well as the share of their costs in relation to the total public pharmaceutical spending for the period from 2014 to 2016 were defined. Results: Our survey revealed that some differences in the legal requirements for pricing and reimbursement of BOMPs amongst the countries included in the study. All European Union countries have developed and implemented pharmacoeconomic guidelines with or without some specific reimbursement requirements for orphan medicinal products. Cost-effectiveness analysis, cost-utility analysis, Markov models, meta-analysis, and discount levels of costs and results were required only in Bulgaria, Poland and Hungary. The number of reimbursed BOMPs and biotechnological medicinal products for RDs without prior orphan designation was the highest in Hungary (17 and 40, respectively). Patient-based reimbursement schemes were available only in Hungary for 11 out of 17 BOMPs. Poland and Greece have the highest pharmaceutical expenditure of reimbursed BOMPs with are similar to 214 million and 180 million EUR, respectively in the observed period from 2014 to 2016. High proportion of the pharmaceutical expenditure o

Introduction Views on the conduct of labor have changed over time, and a significant difference exists in relation to obstetric centers. Objective To assess cost, clinical outcomes and cost-effectiveness of different types of labor in singleton pregnancies. Methods 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. Results 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 lt 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. Conclusion Elective induction of labor was associated with the lowest cost compared to other types of labor, with favorable maternal and neonatal outcomes., Uvod Način porođaja se tokom godina menjao, a značajna razlika postoji u pogledu kliničkog centra u kojem se porođaj obavlja. Cilj rada Cilj rada je bio da se procene troškovi, klinički ishodi i troškovna isplativost različitih vrsta porođaja kod jednoplodnih trudnoća. Metode rada Za potrebe rada konstruisano je 'drvo' odlučivanja, radi poređenja spontanog vaginalnog, indukovanog vaginalnog porođaja i planiranog carskog reza. Iz knjige porođaja GAK 'Narodni front' uzeti su podaci o svim porođajima obavljenim u jednomesečnom periodu 2011. godine. Kao ishod analize troškovne isplativosti posmatran je uspešan porođaj, definisan kao porođaj koji je počeo do navršene 42. nedelje gestacije, bez smrtnost majke i sa Apgar skorom novorođenčeta većim ili jednakim 7 u petom minutu po rođenju. Primenom probabilističke analize osetljivosti ispitana je pouzdanost rezultata. Rezultati Od ukupno 667 porođaja, vaginalni porođaj je urađen u 98 slučajeva, indukovani u 442 slučaja, a planirani carski rez 127 puta. Hitni carski rez, kao komplikacija, bio je znatno češći kod žena sa spontanim vaginalnim porođajem nego kod žena koje su porođene primenom indukcije (OR=17,374; 95%CI: 8,522-35,418; p lt 0,001). Indukovani vaginalni porođaj je imao najmanje troškove (461 evro), s efektivnošću od 98,17%. Spontani vaginalni i planirani carski rez su bile skuplje strategije s manjom efektivnošću (dominirane strategije). Rezultati su bili pouzdani. Zaključak Elektivan indukovani porođaj je imao najniže troškove u odnosu na druge vrste porođaja, sa željenim ishodima po majku i dete.

Introduction. Respiratory infections are the most common infections in children. The aims of the study were to analyze the use of antibiotics for respiratory infections in the period 2008 - 2010 in children's population in region of Niš and to estimate the rational use of antibiotics in relation to the recommendations of the National Guidelines for physicians in primary care. Material and methods. Data source was a Pharmacy Niš database. Antibiotics prescriptions were selected for the following diagnoses: H65-H75 (acute otitis media, mastoiditis), J01 (acute sinusitis), J02-J03 (tonsillopharyngitis), J12-J18 (community acquired pneumonia), J20 (acute bronchitis), J32 (chronic sinusitis), J42 (chronic bronchitis). Antibiotic consumption was expressed in defined daily dose/1000 inhabitants/day. Results. The most widely prescribed antibiotic for the treatment of upper respiratory tract infections in children during the three years was amoxicillin (34.63; 32.50 and 31.00 defined daily dose/1000 inhabitants/day in 2008, 2009 and 2010, respectively). In the treatment of infections of the middle ear and mastoid, the combination of amoxicillin and clavulanic acid, was the most prescribed antibiotics (60% of total consumption of antibiotics for this indication). Azithromycin was the most widely prescribed antibiotic for the treatment of lower respiratory tract infections in children during the observed period (6.92; 8.20 and 7.18 defined daily dose/1000 inhabitans/day in 2008, 2009 and 2010, respectively). Conclusion. Recommendations of national guidelines are not complied with the treatment of upper and lower respiratory infections in the children population in region of Niš. This could be a sign of potentially irrational use of antibiotics that need to be further examined. Education of physicians can influence irrational use of antibiotics., Uvod. Infekcije respiratornog sistema predstavljaju najčešće infekcije kod dece. Ciljevi ovog rada jesu analiza potrošnje antibiotika u lečenju infekcija gornjih i donjih respiratornih puteva kod dece u Nišavskom okrugu i procena racionalnosti upotrebe antibiotika u odnosu na preporuke Nacionalnog vodiča za lekare u primarnoj zdravstvenoj zaštiti. Materijal i metode. Kao izvor podataka korišćena je baza podataka Apoteke Niš za period 2008-2010. godine. Selektovani su svi izdati recepti antibiotika propisani deci starosti 0-19 godina za terapiju infekcija respiratornog trakta uključujući infekcije srednjeg uva ((H65-H75 (akutni otitis media i mastoiditis), J01 (akutni sinuzitis), J02-J03 (tonzilofaringitis), J32 (hronični sinuzitis) (J12-J18 (blaga do umerena pneumonija izazvana vanbolničkim uzročnikom), J20 (akutni bronhitis), J42 (hronični bronhitis)). Potrošnja je izražena u definitivnoj dnevnoj dozi/1 000 stanovnika/dan. Rezultati. Najpropisivaniji antibiotik za terapiju infekcija gornjeg respiratornog trakta kod dece u posmatranom periodu bio je amoksicilin (34,63; 32,5 i 31 definitivnoj dnevnoj dozi/1 000 stanovnika/ dan tokom 2008, 2009. i 2010. godine). Za terapiju infekcije srednjeg uva i mastoidnog nastavka najčešće je korišćena kombinacija amoksicilina i klavulanske kiseline (60% ukupne potrošnje svih antibiotika za ovu indikaciju). Azitromicin je bio najpropisivaniji antibiotik za terapiju infekcija donjeg respiratornog trakta kod dece tokom posmatranog perioda (6,92; 8,2 i 7,18 definitivnoj dnevnoj dozi/1 000 stanovnika/dan tokom 2008, 2009. i 2010. godine). Zaključak. Preporuke nacionalnih vodiča nisu poštovane ni u slučaju terapije gornjih ni donjih respiratornih infekcija kod dece u Nišavskom regionu. To može biti znak potencijalno neracionalne upotrebe antibiotika koju je potrebno dodatno istražiti. Dodatna edukacija lekara mogla bi uticati na smanjivanje neracionalne upotrebe antibiotika.

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 million. 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., Uvod/Cilj. Kardiovaskularne bolesti predstavljaju teret za društvo u smislu mortaliteta, morbiditeta i ekonomskih gubitaka. Cilj ove studije bio je procena ekonomskog značaja kardiovaskularnih bolesti u Srbiji u 2009. godini iz perspektive društva. Metode. Za potrebe istraživanja, kardiovaskularne bolesti su definisane pomoću Međunarodne klasifikacije bolesti, 10. revizija, kao sledeće dijagnoze: hipertenzija, koronarne bolesti, kardiomiopatija, srčana insuficijencija i cerebrovaskularne bolesti. Korišćen je top-down metod, baziran na prevalenciji, kako bi se kvantifikovali godišnji kardiovaskularni troškovi. Troškovi smanjene produktivnosti su procenjeni korišćenjem dva pristupa: pristup ljudskom kapitalu (human capital approach) i metod frikcionih troškova (friction cost method). Za obračunavanje troškova u sadašnju vrednost korišćena je diskontna stopa od 5%. Rezultati. Ukupni direktni troškovi kardiovaskularnih bolesti u 2009. godini iznosili su 400 miliona evra. Rezultati pokazuju da je više od pola miliona radnih dana izgubljeno zbog nesposobnosti usled kardiovaskularnih bolesti, dajući ukupno 113,9 miliona evra indirektne troškove. Većina ukupnih troškova (514,3 miliona evra) bili su za: lekove (29,94%), hospitalizaciju (28,97%) i bolničko lečenje - hirurške intervencije i dijagnostiku (17,84%). Rezultati su bili robusni na promene od 20% u volumenu ili ceni pojedinih kategorija troškova, kao i na primenjenu diskontnu stopu od 2% i od 10%. Zaključak. Ukupni troškovi kardiovaskularnih bolesti u 2009. godini su predstavljali oko 1,8% bruto domaćeg proizvoda. Rezultati studije su značajni za kreiranje zdravstvene politike i premošćavanja jaza između uloženih sredstava i potreba, a u cilju poboljšanja ishoda kardiovaskularnih bolesti.

Aim To analyze the pharmacy network (structure and resources) in Bulgaria, Croatia, Serbia, and Slovenia and its relation to public expenditures for medicines. Methods We performed a cross-sectional study using the officially published data for the period 2003-2008 in four selected countries. Data sources were relevant national institutions. Results In 2008, Serbia had 27.5, Bulgaria 66.8, Croatia 59.5, and Slovenia 71.2 pharmacists per 100000 inhabitants. There was a significant difference in the number of pharmacists per 100000 inhabitants between all countries except between Bulgaria and Slovenia. The number of inhabitants per one pharmacy was significantly different between all observed countries. The expenditures for medicines per capita in 2008 were between (sic)30.34 in Bulgaria to (sic)137.03 in Slovenia, with a significant difference between all countries except between Bulgaria and Serbia. The number of pharmacists per 100000 inhabitants and expenditures for medicines per capita were positively correlated in all observed countries, except in Bulgaria. Conclusion There were significant difference in the structure and availability of the pharmacy service in all selected countries. Expenditures for medicines were positively correlated with the number of pharmacists in all countries, except in Bulgaria. Our findings could be valuable to national regulatory bodies for the creation of national drug policies.

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 mono therapy treatment in primary care in Serbia. We developed a Markov model to estimate quality-adjusted life years (QALY), lifetime costs and incremental cost-effectiveness of different antihypertensive medicines used in the clinical practice in Serbia (diuretic, beta blocker Ca channel blocker and ACE inhibitors) to strategy "no intervention". Cohort of 55-year-old patients with hypertension (systolic and diastolic blood pressure >= 140 and 90 mmHg), without cardiovascular complications was run through the model. Acute myocardial infarction, angina pectoris, heart failure, stroke, and total mortality were observed as outcomes. The time horizon was over a lifetime, and the perspective was that of a third-party payer Annual discount rate of 5% was applied to all future costs and effects. The results showed small differences in QALY in strategies ACE inhibitor, beta blockers, and diuretic. The incremental cost-effectiveness ratio (ICER) for diuretic, compared to no intervention, was (sic)74.27/QALY. The ICER for beta blocker compared to diuretic was (sic)75.58/QALY. ACE inhibitor was extended dominated by diuretic and beta blocker, while Ca channel blocker had higher costs and less effectiveness compared to all previous strategies. The results of the probabilistic sensitivity analysis showed that application of antihypertensive therapy is cost-effective even at small values of willingness to pay. It could be concluded that for individuals aged 55 the diuretics are the most cost-effective strategy to start monotherapy of hypertension.

Discounting adjusts future costs and benefits in terms of their present value. The purpose of this study was to present the effect of discounting on Markov model prepared for the evaluation of the different antihypertensive treatments in Serbia. The Markov model consisting of eight states with the cycle length of six months was constructed. Comparator strategies were diuretic, beta blocker; calcium channel blocker and ACE inhibitors. All therapeutic strategies were compared with strategy no intervention". Complications of hypertension (acute myocardial infraction, angina pectoris or stroke alone or in combinations) and total mortality were observed as outcomes. Time horizon of the study was lifetime of the patient or 100 years old, due to assumption that 99% of the cohort would die at that age. Analyses were performed from the third-party payer perspective. Annual discount rate of 5% was applied at all future costs and effects. Undiscounted results showed that patients who started treatment with a beta blocker had the highest life expectancy (49.00 QALY) and being the most cost-effective strategy (ICER = (sic)46.63/QALY compared to no intervention). In the case of discounting the highest gain in the QALY had patients who were on beta blocker, 23.7 QALY. After the discounting cost-effective strategies were ACE inhibitor (ICER = (sic)253.08/QALY compared to no intervention) and diuretic (ICER = (sic)262.54/QALY compared to no intervention). The results of the study showed that the discounting could change the choice of cost-effective therapeutic strategy Biotechnol. & Biotechnol. Eq. 2011, 25(3), 2555-2558