In recent years, many countries have struggled with the fact that expenditures on health care are growing much faster than the overall level of wealth. Research objectives: 1) to conduct a meta-analysis of heparins by the means of their efficacy, safety parameters and treatment outcomes; 2) to conduct pharmacoepidemiological assessment of long-term heparins utilization in Lithuania; 3) to develop a pharmacoeconomic cost-minimization model for low-molecular-weight heparins based on reference pricing methodology; 4) to investigate heparins prescribing trends and to evaluate heparins prescription adherence to international clinical guidelines at a secondary level clinical hospital. Meta-analysis results showed that low-molecular-weight heparins could be considered interchangeable due to similar therapeutic profiles in some indications. In Lithuania consumption of heparins and corresponding costs were constantly increasing during the period of investigation; therefore it would be relevant to implement modern pharmacoeconomic methodologies to regulate costs. Cost-minimization model suggested that expenditures on this group of medicines could be decreased by nearly 70 percent. Analysis of pharmacoepidemiological study data confirmed that heparins prescription practices at the clinical hospital were insufficiently regulated. In addition this study conducted at the clinical hospital revealed non-compliance of heparins safety monitoring practices with clinical guidelines. / Pastaraisiais metais daugelyje šalių sveikatos priežiūros išlaidos augo daug greičiau nei bendras gerovės lygis, todėl yra nuolat diskutuojama, kaip šį išlaidų augimą reikėtų kontroliuoti. Darbo uždaviniai: 1) atlikti heparinų preparatų meta-analizę, palyginant jų efektyvumo ir saugumo parametrus bei gydymo baigtis; 2) atlikti heparinų preparatų ilgalaikio suvartojimo Lietuvoje farmakoepidemiologinį tyrimą; 3) suformuluoti farmakoekonominį kaštų mažinimo sprendimų modelį mažos molekulinės masės heparinų preparatų grupei, remiantis referentinės kainos metodika; 4) ištirti heparinų preparatų skyrimo tendencijas antrinio lygio klinikinėje ligoninėje ir palyginti heparinų preparatų skyrimo atitikimą tarptautinėms gairėms. Meta-analizės rezultatai parodė, jog mažos molekulinės masės heparinai gali būti tarpusavyje pa¬keičiami dėl analogiškų terapinių savybių tam tikrose indikacijose. Heparinų preparatų suvartojimas ir atitinkamos išlaidos tiriamuoju laikotarpiu Lietuvoje nuolat didėjo, todėl būtų aktualu taikyti šiuolaikines farmakoekonomines išlaidų reguliavimo metodikas. Pritaikius kaštų mažinimo modelį heparinų preparatų grupei, būtų galima sumažinti išlaidas šios grupės preparatams beveik 70 procentų. Farmakoepidemiologinio tyrimo rezultatai atskleidė, jog heparinų preparatų skyrimo praktika klinikinėje ligoninėje buvo nepakankamai reglamentuota. Taip pat heparinų preparatų saugumo parametrų stebėjimo praktika ligoninėje neatitiko tarptautinių rekomendacijų.

This diploma work is focused on using economic analysis methods to compare cost-effectivness of an innovative technology for treating aortic stenosis that is transcatheter implantation of an artificial valve CoreValve by Medtronic with traditional treatments. During the analyses we utilized only publicly available data which are often too general while more specific data might not be available because they do not exist or are not publicly available. This work sets up a theoretical foundation for the analyses, performs the analyse sof the product, PEST analyses and cost analyses. Since pacient's willigness to pay index (WTP) in the Czech republic has not yet been measured for this treatment, it is not posible to confirm the cost-effectivness of CoreValve, even though it has been confirmed in several countries based on the literature search related to this topic.

6 1. ABSTRACT Background: This study is primarily aimed at describing migraine illnesses, the existing patient care algorithm with this diagnosis and to estimate the direct costs of treatment of migraine from the point of view of the health care system in the Czech Republic. In the theoretical part, the basic concepts and procedures of health economics and the health technologies assessment are examined, especially the cost-of-illness of the analysis that is conducted in the practical part, namely just on the illness of migraine. Methods: The cost of drugs used to treat migraine is determined using FNHK (Fakultni nemocnice Hradec Kralove) prescription data. Further, using the data on health care (both ambulatory and inpatient care), these services are being appraised and this way the cost of treatment of a patient with the disease estimated from the point of view of the health system in the Czech Republic. Results: The average annual cost of treatment of one patient with episodic migraine was assessed at CZK 1,182 for outpatient care, CZK 786 for hospitalization and CZK 2,707 for medication. For chronic migraines, the average cost is higher and estimated at CZK 3,321 for outpatient care, CZK 2,745 for hospitalization and CZK 7,415 for medication. Conclusions: The total direct annual cost of the patient was...

Applying pharmacoeconomic methods were compared two selected treatments of depressive disorder. Markov model was created to evaluate cost-effectiveness of the two strategies. Knowledge from the clinical practice and the clinical research findings of the author are linked with pharmacoeconomic techniques into a multidisciplinary complex. The proposed sequential therapy uses a prediction of antidepressant response by utilizing of recent quantitative electroencephalography methods. Sequential therapy is more cost-effective compared with the conventional therapeutic strategy according to clinical guidelines. The results and limitations of the study are discussed at the conclusion from clinical and economic perspective.

Objective: To evaluate the utilization and cost of drugs for the treatment of asthma and COPD in Lithuania in 2006-2009. Methodology: The data on the sales of drugs for asthma and COPD for the year 2006-2009 was obtained from SoftDent, JSC, database. The utilization of the R03 group (drugs for obstructive airway diseases) of the Anatomical Therapeutic Chemical (ATC) classification was analysed. The utilization was expressed as DDD/1000 inhabitants per day. The pharmacoeconomical analysis was performed implementing cost-minimisation and reference pricing methodologies. Results: The total use of drugs for asthma and COPD increased from 23,70 DDD/1000 inhabitants/day in 2006 to 28,67 DDD/1000 inhabitants/day in 2009. The most significant increase is found in the use of inhaled corticosteroid/long-acting β2-agonist combinations. The costs for drugs for the treatment of asthma and COPD increased from 59,71 million Litas in 2006 to 80,12 million Litas in 2008 and decreased to 79,25 million Litas in 2009. The use of drugs of the ATC group R03 is about 2 times higher in Norway, Denmark and Finland and about 1,6 times lower in Estonia. The pharmacoeconomical analysis shows marked savings if the lowest of the second lowest prices of one DDD were implemented as the reference price. The most considerable saving is found to be for inhaled corticosteroid/long-acting β2-agonist combinations – using the lowest basic price of one DDD as the reference price, total 18,04 million Litas would... [to full text] / Tikslas: Įvertinti vaistų, vartojamų astmai ir lėtinei obstrukcinei plaučių ligai (LOPL) gydyti suvartojimą ir išlaidas Lietuvoje 2006-2009 metais. Metodika: Duomenys apie vaistų, vartojamų astmai ir LOPL gydyti pardavimus 2006-2009 metais gauti iš UAB SoftDent duomenų bazės. Analizuojami vaistai yra klasifikuojami R03 grupėje (vaistai obstrukcinėms plaučių ligoms) pagal Anatominę Terapinę Cheminę (ATC) klasifikaciją. Vaistų suvartojimas išreikštas DDD skaičiumi, tenkančiu tūkstančiui gyventojų per vieną dieną. Farmakoekonominė analizė atlikta taikant kaštų mažinimo ir referentinės kainos metodus. Rezultatai: Bendras vaistų astmai ir LOPL gydyti suvartojimas Lietuvoje išaugo nuo 23,70 DDD/1000 gyventojų per dieną 2006 metais iki 28,67 DDD/1000 gyventojų per dieną 2009 metais. Didžiausias suvartojimo augimas nustatytas inhaliuojamų gliukokortikosteroidų/ilgo veikimo β2-agonistų kombinuotų preparatų grupėje. Išlaidos vaistų, vartojamų astmai ir LOPL gydyti augo nuo 59,71 mln. Litų 2006 metais iki 80,12 mln. Litų 2008 metais ir 2009 metais sumažėjo iki 79,25 mln. Litų. Vaistų, klasifikuojamų R03 grupėje pagal ATC klasifikaciją, suvartojimas Lietuvoje yra apie 2 kartus mažesnis nei Norvegijoje, Danijoje ir Suomijoje ir apie 1,6 karto didesnis nei Estijoje. Farmakoekonominė analizė pateikia ženklius galimo taupymo pavyzdžius, jei mažiausia ar antra mažiausia vieno DDD kaina būtų taikoma kaip referentinė kaina. Reikšmingiausi farmakoekonominės analizės rezultatai nustatyti... [toliau žr. visą tekstą]

The cancer treatment is, thanks to new technologies, very expensive, nowadays. According to demographic data and analysis the Czech population is aging, and it is highly probable that these costs will rise even more. Therefore it is necessary to look through pharmacoeconomic analyzes to find optimal solutions of treatment. The goal of this thesis is to clarify the concept of pharmacoeconomics, cancer and breast cancer. Through the use of demographic data the aim is to assess the status of cancer patients in the future, determine the amount of expenditures for the treatment of breast cancer I have used a model patient, suffering this disease, determine the amount and cost of the conventional and biological method of treatment.

INFECTIOUS COMPLICATIONS IN CHRONIC RENAL FAILURE Infections represent a serious problem in chronic kidney disease (cohort and they are) associated with signifficant morbidity and mortality. The thesis originated in the nephrology division of the Department of Internal Medicine I., Charles University Teaching Hospital and Medical Faculty in Pilsen, an institution with a long standing research activity in the field. In the theoretical part of this work, a general summary of infectious complications in chronic kidney disease population is presented. The other part of this work presents results of our research dealing with pharmacoeconomical aspects of cytomegalovirus infection and finally our results in the field of influenza vaccination. The Aim of the first presented work was to evaluate the cost impact of four different strategies for prevention of cytomegalovirus infection after renal transplantation. We provide post hoc analysis of 2 randomized studies performed in our department and calculating direct CMV-related expenses using valacyclovir prophylaxis, ganciclovir prophylaxis, preemptive vlaganciclovir treatment and deferred therapy. To simulate ihe impact of varying prices of prharmacotherapy or diagnostic procedures, a sensitivity analysis was performed. With respect to our results, valacyclovir...

In my thesis, in the theoretical part I deal with atrial fibrillation. I also deal with management of atrial fibrillation treatment. In the paper I explain the basic principles of pharmaco-economic evaluation in the Czech Republic, on the basis of which laws these pharmacological interventions are evaluated and who are in the Czech Republic. In the work I present cost breakdown and what are the most commonly used pharmaco-economic analyzes. In the practical part I will apply the theoretical knowledge. I have developed cost utility analysis based on available clinical evidence - randomized clinical trials ARISTOTLE (Granger, 2011), RE-LY (Connolly, 2009), ROCKET AF (Patel, 2011). I made an indirect comparison of the total benefits of NOACs. In the baseline scenario, I have calculated QALY to evaluate the benefits of effectiveness, safety and reduction of mortality. I have also dealt with a bleeding-related scenario. The ICER's greatest contribution to the public healthcare system has shown the active substance apixaban in both scenarios. I added the results and confirmed the clinical results of a recent, robust, retrospective study by Mayo Clinic (Yao, 2016).

INFECTIOUS COMPLICATIONS IN CHRONIC RENAL FAILURE Infections represent a serious problem in chronic kidney disease (cohort and they are) associated with signifficant morbidity and mortality. The thesis originated in the nephrology division of the Department of Internal Medicine I., Charles University Teaching Hospital and Medical Faculty in Pilsen, an institution with a long standing research activity in the field. In the theoretical part of this work, a general summary of infectious complications in chronic kidney disease population is presented. The other part of this work presents results of our research dealing with pharmacoeconomical aspects of cytomegalovirus infection and finally our results in the field of influenza vaccination. The Aim of the first presented work was to evaluate the cost impact of four different strategies for prevention of cytomegalovirus infection after renal transplantation. We provide post hoc analysis of 2 randomized studies performed in our department and calculating direct CMV-related expenses using valacyclovir prophylaxis, ganciclovir prophylaxis, preemptive vlaganciclovir treatment and deferred therapy. To simulate ihe impact of varying prices of prharmacotherapy or diagnostic procedures, a sensitivity analysis was performed. With respect to our results, valacyclovir...