Publications by authors named "Mihajlo B Jakovljevic"

18 Publications

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Dynamics of Health Care Financing and Spending in Serbia in the XXI Century.

Front Public Health 2019 13;7:381. Epub 2019 Dec 13.

Department of Public Health and Healthcare, First Moscow State Medical University (Sechenov University), Moscow, Russia.

Serbia is an upper-middle income Eastern European economy. It has inherited system of health provision and financing, which is a mixture of Soviet Semashko and German Bismarck models. So far, literature evidence on long-term trends in health spending remains scarce on this region. Observational descriptive approach was utilized relying on nationwide aggregate data reported by the Republic Health Insurance Fund (RHIF) and the Government of Serbia to the WHO office. Consecutively, the WHO Global Health Expenditure Database was used. Long-term trends were extrapolated on existing data and underlying differences were analyzed and explained. The insight was provided across two distinctively different periods within 2000-2016. The first period lasted from 2000 till 2008 (the beginning of global recession triggered by Lehman Brothers' bankruptcy). This was a period of strong upward growth in ability to invest in health care. Spending grew significantly in terms of GDP share, national and per capita reported expenditures. During the second period (2009-2016), after the beginning of worldwide economic crisis, Serbia was affected in a way that its health expenditure growth in PPP terms slowed down effectively fluctuating around plateau values from 2014 to 2016. Serbia health spending showed promising signs of steady growth in its ability to invest in health care. Consolidation marked most of the past decade with certain growth rates in recent years (2017-2019), which were not captured in these official records. The future national strategy should be devised to take into account accelerated population aging as major driver of health spending.
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http://dx.doi.org/10.3389/fpubh.2019.00381DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6927281PMC
December 2019

Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-Years for 29 Cancer Groups, 1990 to 2016: A Systematic Analysis for the Global Burden of Disease Study.

Authors:
Christina Fitzmaurice Tomi F Akinyemiju Faris Hasan Al Lami Tahiya Alam Reza Alizadeh-Navaei Christine Allen Ubai Alsharif Nelson Alvis-Guzman Erfan Amini Benjamin O Anderson Olatunde Aremu Al Artaman Solomon Weldegebreal Asgedom Reza Assadi Tesfay Mehari Atey Leticia Avila-Burgos Ashish Awasthi Huda Omer Ba Saleem Aleksandra Barac James R Bennett Isabela M Bensenor Nickhill Bhakta Hermann Brenner Lucero Cahuana-Hurtado Carlos A Castañeda-Orjuela Ferrán Catalá-López Jee-Young Jasmine Choi Devasahayam Jesudas Christopher Sheng-Chia Chung Maria Paula Curado Lalit Dandona Rakhi Dandona José das Neves Subhojit Dey Samath D Dharmaratne David Teye Doku Tim R Driscoll Manisha Dubey Hedyeh Ebrahimi Dumessa Edessa Ziad El-Khatib Aman Yesuf Endries Florian Fischer Lisa M Force Kyle J Foreman Solomon Weldemariam Gebrehiwot Sameer Vali Gopalani Giuseppe Grosso Rahul Gupta Bishal Gyawali Randah Ribhi Hamadeh Samer Hamidi James Harvey Hamid Yimam Hassen Roderick J Hay Simon I Hay Behzad Heibati Molla Kahssay Hiluf Nobuyuki Horita H Dean Hosgood Olayinka S Ilesanmi Kaire Innos Farhad Islami Mihajlo B Jakovljevic Sarah Charlotte Johnson Jost B Jonas Amir Kasaeian Tesfaye Dessale Kassa Yousef Saleh Khader Ejaz Ahmad Khan Gulfaraz Khan Young-Ho Khang Mohammad Hossein Khosravi Jagdish Khubchandani Jacek A Kopec G Anil Kumar Michael Kutz Deepesh Pravinkumar Lad Alessandra Lafranconi Qing Lan Yirga Legesse James Leigh Shai Linn Raimundas Lunevicius Azeem Majeed Reza Malekzadeh Deborah Carvalho Malta Lorenzo G Mantovani Brian J McMahon Toni Meier Yohannes Adama Melaku Mulugeta Melku Peter Memiah Walter Mendoza Tuomo J Meretoja Haftay Berhane Mezgebe Ted R Miller Shafiu Mohammed Ali H Mokdad Mahmood Moosazadeh Paula Moraga Seyyed Meysam Mousavi Vinay Nangia Cuong Tat Nguyen Vuong Minh Nong Felix Akpojene Ogbo Andrew Toyin Olagunju Mahesh Pa Eun-Kee Park Tejas Patel David M Pereira Farhad Pishgar Maarten J Postma Farshad Pourmalek Mostafa Qorbani Anwar Rafay Salman Rawaf David Laith Rawaf Gholamreza Roshandel Saeid Safiri Hamideh Salimzadeh Juan Ramon Sanabria Milena M Santric Milicevic Benn Sartorius Maheswar Satpathy Sadaf G Sepanlou Katya Anne Shackelford Masood Ali Shaikh Mahdi Sharif-Alhoseini Jun She Min-Jeong Shin Ivy Shiue Mark G Shrime Abiy Hiruye Sinke Mekonnen Sisay Amber Sligar Muawiyyah Babale Sufiyan Bryan L Sykes Rafael Tabarés-Seisdedos Gizachew Assefa Tessema Roman Topor-Madry Tung Thanh Tran Bach Xuan Tran Kingsley Nnanna Ukwaja Vasiliy Victorovich Vlassov Stein Emil Vollset Elisabete Weiderpass Hywel C Williams Nigus Bililign Yimer Naohiro Yonemoto Mustafa Z Younis Christopher J L Murray Mohsen Naghavi

JAMA Oncol 2018 11;4(11):1553-1568

Institute for Health Metrics and Evaluation, University of Washington, Seattle.

Importance: The increasing burden due to cancer and other noncommunicable diseases poses a threat to human development, which has resulted in global political commitments reflected in the Sustainable Development Goals as well as the World Health Organization (WHO) Global Action Plan on Non-Communicable Diseases. To determine if these commitments have resulted in improved cancer control, quantitative assessments of the cancer burden are required.

Objective: To assess the burden for 29 cancer groups over time to provide a framework for policy discussion, resource allocation, and research focus.

Evidence Review: Cancer incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs) were evaluated for 195 countries and territories by age and sex using the Global Burden of Disease study estimation methods. Levels and trends were analyzed over time, as well as by the Sociodemographic Index (SDI). Changes in incident cases were categorized by changes due to epidemiological vs demographic transition.

Findings: In 2016, there were 17.2 million cancer cases worldwide and 8.9 million deaths. Cancer cases increased by 28% between 2006 and 2016. The smallest increase was seen in high SDI countries. Globally, population aging contributed 17%; population growth, 12%; and changes in age-specific rates, -1% to this change. The most common incident cancer globally for men was prostate cancer (1.4 million cases). The leading cause of cancer deaths and DALYs was tracheal, bronchus, and lung cancer (1.2 million deaths and 25.4 million DALYs). For women, the most common incident cancer and the leading cause of cancer deaths and DALYs was breast cancer (1.7 million incident cases, 535 000 deaths, and 14.9 million DALYs). In 2016, cancer caused 213.2 million DALYs globally for both sexes combined. Between 2006 and 2016, the average annual age-standardized incidence rates for all cancers combined increased in 130 of 195 countries or territories, and the average annual age-standardized death rates decreased within that timeframe in 143 of 195 countries or territories.

Conclusions And Relevance: Large disparities exist between countries in cancer incidence, deaths, and associated disability. Scaling up cancer prevention and ensuring universal access to cancer care are required for health equity and to fulfill the global commitments for noncommunicable disease and cancer control.
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http://dx.doi.org/10.1001/jamaoncol.2018.2706DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6248091PMC
November 2018

Child and Adolescent Health From 1990 to 2015: Findings From the Global Burden of Diseases, Injuries, and Risk Factors 2015 Study.

Authors:
Nicholas Kassebaum Hmwe Hmwe Kyu Leo Zoeckler Helen Elizabeth Olsen Katie Thomas Christine Pinho Zulfiqar A Bhutta Lalit Dandona Alize Ferrari Tsegaye Tewelde Ghiwot Simon I Hay Yohannes Kinfu Xiaofeng Liang Alan Lopez Deborah Carvalho Malta Ali H Mokdad Mohsen Naghavi George C Patton Joshua Salomon Benn Sartorius Roman Topor-Madry Stein Emil Vollset Andrea Werdecker Harvey A Whiteford Kalkidan Hasen Abate Kaja Abbas Solomon Abrha Damtew Muktar Beshir Ahmed Nadia Akseer Rajaa Al-Raddadi Mulubirhan Assefa Alemayohu Khalid Altirkawi Amanuel Alemu Abajobir Azmeraw T Amare Carl A T Antonio Johan Arnlov Al Artaman Hamid Asayesh Euripide Frinel G Arthur Avokpaho Ashish Awasthi Beatriz Paulina Ayala Quintanilla Umar Bacha Balem Demtsu Betsu Aleksandra Barac Till Winfried Bärnighausen Estifanos Baye Neeraj Bedi Isabela M Bensenor Adugnaw Berhane Eduardo Bernabe Oscar Alberto Bernal Addisu Shunu Beyene Sibhatu Biadgilign Boris Bikbov Cheryl Anne Boyce Alexandra Brazinova Gessessew Bugssa Hailu Austin Carter Carlos A Castañeda-Orjuela Ferrán Catalá-López Fiona J Charlson Abdulaal A Chitheer Jee-Young Jasmine Choi Liliana G Ciobanu John Crump Rakhi Dandona Robert P Dellavalle Amare Deribew Gabrielle deVeber Daniel Dicker Eric L Ding Manisha Dubey Amanuel Yesuf Endries Holly E Erskine Emerito Jose Aquino Faraon Andre Faro Farshad Farzadfar Joao C Fernandes Daniel Obadare Fijabi Christina Fitzmaurice Thomas D Fleming Luisa Sorio Flor Kyle J Foreman Richard C Franklin Maya S Fraser Joseph J Frostad Nancy Fullman Gebremedhin Berhe Gebregergs Alemseged Aregay Gebru Johanna M Geleijnse Katherine B Gibney Mahari Gidey Yihdego Ibrahim Abdelmageem Mohamed Ginawi Melkamu Dedefo Gishu Tessema Assefa Gizachew Elizabeth Glaser Audra L Gold Ellen Goldberg Philimon Gona Atsushi Goto Harish Chander Gugnani Guohong Jiang Rajeev Gupta Fisaha Haile Tesfay Graeme J Hankey Rasmus Havmoeller Martha Hijar Masako Horino H Dean Hosgood Guoqing Hu Kathryn H Jacobsen Mihajlo B Jakovljevic Sudha P Jayaraman Vivekanand Jha Tariku Jibat Catherine O Johnson Jost Jonas Amir Kasaeian Norito Kawakami Peter N Keiyoro Ibrahim Khalil Young-Ho Khang Jagdish Khubchandani Aliasghar A Ahmad Kiadaliri Christian Kieling Daniel Kim Niranjan Kissoon Luke D Knibbs Ai Koyanagi Kristopher J Krohn Barthelemy Kuate Defo Burcu Kucuk Bicer Rachel Kulikoff G Anil Kumar Dharmesh Kumar Lal Hilton Y Lam Heidi J Larson Anders Larsson Dennis Odai Laryea Janni Leung Stephen S Lim Loon-Tzian Lo Warren D Lo Katharine J Looker Paulo A Lotufo Hassan Magdy Abd El Razek Reza Malekzadeh Desalegn Markos Shifti Mohsen Mazidi Peter A Meaney Kidanu Gebremariam Meles Peter Memiah Walter Mendoza Mubarek Abera Mengistie Gebremichael Welday Mengistu George A Mensah Ted R Miller Charles Mock Alireza Mohammadi Shafiu Mohammed Lorenzo Monasta Ulrich Mueller Chie Nagata Aliya Naheed Grant Nguyen Quyen Le Nguyen Elaine Nsoesie In-Hwan Oh Anselm Okoro Jacob Olusegun Olusanya Bolajoko O Olusanya Alberto Ortiz Deepak Paudel David M Pereira Norberto Perico Max Petzold Michael Robert Phillips Guilherme V Polanczyk Farshad Pourmalek Mostafa Qorbani Anwar Rafay Vafa Rahimi-Movaghar Mahfuzar Rahman Rajesh Kumar Rai Usha Ram Zane Rankin Giuseppe Remuzzi Andre M N Renzaho Hirbo Shore Roba David Rojas-Rueda Luca Ronfani Rajesh Sagar Juan Ramon Sanabria Muktar Sano Kedir Mohammed Itamar S Santos Maheswar Satpathy Monika Sawhney Ben Schöttker David C Schwebel James G Scott Sadaf G Sepanlou Amira Shaheen Masood Ali Shaikh June She Rahman Shiri Ivy Shiue Inga Dora Sigfusdottir Jasvinder Singh Naris Silpakit Alison Smith Chandrashekhar Sreeramareddy Jeffrey D Stanaway Dan J Stein Caitlyn Steiner Muawiyyah Babale Sufiyan Soumya Swaminathan Rafael Tabarés-Seisdedos Karen M Tabb Fentaw Tadese Mohammad Tavakkoli Bineyam Taye Stephanie Teeple Teketo Kassaw Tegegne Girma Temam Shifa Abdullah Sulieman Terkawi Bernadette Thomas Alan J Thomson Ruoyan Tobe-Gai Marcello Tonelli Bach Xuan Tran Christopher Troeger Kingsley N Ukwaja Olalekan Uthman Tommi Vasankari Narayanaswamy Venketasubramanian Vasiliy Victorovich Vlassov Elisabete Weiderpass Robert Weintraub Solomon Weldemariam Gebrehiwot Ronny Westerman Hywel C Williams Charles D A Wolfe Rachel Woodbrook Yuichiro Yano Naohiro Yonemoto Seok-Jun Yoon Mustafa Z Younis Chuanhua Yu Maysaa El Sayed Zaki Elias Asfaw Zegeye Liesl Joanna Zuhlke Christopher J L Murray Theo Vos

JAMA Pediatr 2017 06;171(6):573-592

Institute for Health Metrics and Evaluation, University of Washington, Seattle.

Importance: Comprehensive and timely monitoring of disease burden in all age groups, including children and adolescents, is essential for improving population health.

Objective: To quantify and describe levels and trends of mortality and nonfatal health outcomes among children and adolescents from 1990 to 2015 to provide a framework for policy discussion.

Evidence Review: Cause-specific mortality and nonfatal health outcomes were analyzed for 195 countries and territories by age group, sex, and year from 1990 to 2015 using standardized approaches for data processing and statistical modeling, with subsequent analysis of the findings to describe levels and trends across geography and time among children and adolescents 19 years or younger. A composite indicator of income, education, and fertility was developed (Socio-demographic Index [SDI]) for each geographic unit and year, which evaluates the historical association between SDI and health loss.

Findings: Global child and adolescent mortality decreased from 14.18 million (95% uncertainty interval [UI], 14.09 million to 14.28 million) deaths in 1990 to 7.26 million (95% UI, 7.14 million to 7.39 million) deaths in 2015, but progress has been unevenly distributed. Countries with a lower SDI had a larger proportion of mortality burden (75%) in 2015 than was the case in 1990 (61%). Most deaths in 2015 occurred in South Asia and sub-Saharan Africa. Global trends were driven by reductions in mortality owing to infectious, nutritional, and neonatal disorders, which in the aggregate led to a relative increase in the importance of noncommunicable diseases and injuries in explaining global disease burden. The absolute burden of disability in children and adolescents increased 4.3% (95% UI, 3.1%-5.6%) from 1990 to 2015, with much of the increase owing to population growth and improved survival for children and adolescents to older ages. Other than infectious conditions, many top causes of disability are associated with long-term sequelae of conditions present at birth (eg, neonatal disorders, congenital birth defects, and hemoglobinopathies) and complications of a variety of infections and nutritional deficiencies. Anemia, developmental intellectual disability, hearing loss, epilepsy, and vision loss are important contributors to childhood disability that can arise from multiple causes. Maternal and reproductive health remains a key cause of disease burden in adolescent females, especially in lower-SDI countries. In low-SDI countries, mortality is the primary driver of health loss for children and adolescents, whereas disability predominates in higher-SDI locations; the specific pattern of epidemiological transition varies across diseases and injuries.

Conclusions And Relevance: Consistent international attention and investment have led to sustained improvements in causes of health loss among children and adolescents in many countries, although progress has been uneven. The persistence of infectious diseases in some countries, coupled with ongoing epidemiologic transition to injuries and noncommunicable diseases, require all countries to carefully evaluate and implement appropriate strategies to maximize the health of their children and adolescents and for the international community to carefully consider which elements of child and adolescent health should be monitored.
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http://dx.doi.org/10.1001/jamapediatrics.2017.0250DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5540012PMC
June 2017

Life expectancy and health expenditure evolution in Eastern Europe-DiD and DEA analysis.

Expert Rev Pharmacoecon Outcomes Res 2016 Aug 17;16(4):537-46. Epub 2015 Dec 17.

c School of Medicine , University of California , San Diego , CA , United States.

Background: Exploration of long-term health expenditure and longevity trends across three major sub-regions of Eastern Europe since 1989.

Methods: 24 countries were classified as EU 2004, CIS, or SEE. European Health for All Database (HFA-DB) 1989-2012 data were processed using difference-in-difference (DiD) and data envelopment analysis (DEA).

Results: The strongest expenditure growth was recorded in EU 2004 followed by SEE and the CIS. A surprisingly similar longevity increase was present in SEE and EU 2004. In 1989, countries that joined EU in 2004 were relatively inefficient in the number of life-years gained yet had a lower life expectancy than the SEE region and was only slightly higher than the CIS region (DEA). By 2012 the revenue spent was roughly linear to additional life-year expectancies.

Conclusion: EU 2004 members were the best performers in terms of balanced longevity increase followed by health expenditure growth. The SEE economies' longevity gains were lagging slightly behind at a far lower cost. An extrapolated CIS expenditure to longevity increase ratio has the fastest-growing long-term promise.
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http://dx.doi.org/10.1586/14737167.2016.1125293DOI Listing
August 2016

Can didactic continuing education improve clinical decision making and reduce cost of quality? Evidence from a case study.

J Contin Educ Health Prof 2015 ;35(2):109-18

Introduction: Administration of human serum albumin (HSA) solutions for the resuscitation of critically ill patients remains controversial. The objective of this study was to assess the effect of continuing medical education (CME) on health care professionals' clinical decision making with regard to HSA administration and the costs of quality (COQ). A quasi-experimental study of time series association of CME intervention with COQ and use of HSA solution was conducted at the Surgery Department of the Hospital Valjevo, Serbia. The CME contained evidence-based criteria for HSA solution administration in surgical patients. The preintervention period was defined as January 2009 to May 2011. CME was provided in June 2011, with the postintervention period June 2011 to May 2012.

Methods: Total mortality rate, the rate of nonsurgical mortality, the rate of surgical mortality, the rate of sepsis patient mortality, index of irrational use of HSA solutions, and number of hospital days per hospitalized patient were collected for each month as quality indicators. Statistical analysis was performed by multivariate autoregressive integrated moving average (MARIMA) modeling. The specification of the COQ was performed according to a traditional COQ model.

Results: The CME intervention resulted in an average monthly reduction of the hospital days per hospitalized patient, the rate of sepsis patient mortality, index of irrational use of HSA solutions, and COQ for $593,890.77 per year.

Discussion: Didactic CME presenting evidence-based criteria for HSA administration was associated with improvements in clinical decisions and COQ. In addition, this study demonstrates that models combining MARIMA and traditional COQ models can be useful in the evaluation of CME interventions aimed at reducing COQ.
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http://dx.doi.org/10.1002/chp.21272DOI Listing
December 2016

BRIC's Growing Share of Global Health Spending and Their Diverging Pathways.

Front Public Health 2015 6;3:135. Epub 2015 May 6.

Faculty of Medical Sciences, University of Kragujevac , Kragujevac , Serbia.

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http://dx.doi.org/10.3389/fpubh.2015.00135DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4421927PMC
May 2015

Growing Burden of Non-Communicable Diseases in the Emerging Health Markets: The Case of BRICS.

Front Public Health 2015 23;3:65. Epub 2015 Apr 23.

Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac , Kragujevac , Serbia.

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http://dx.doi.org/10.3389/fpubh.2015.00065DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4407477PMC
May 2015

Targeted immunotherapies overtaking emerging oncology market value based growth.

J BUON 2015 Jan-Feb;20(1):350-1

Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia.

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April 2015

Accessibility and affordability of alcohol dependency medical care in serbia.

Front Psychiatry 2014 12;5:192. Epub 2015 Jan 12.

Department of Psychiatry and Psychotherapy, Medical University of Vienna , Vienna , Austria.

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http://dx.doi.org/10.3389/fpsyt.2014.00192DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4290475PMC
January 2015

Evolution of the Serbian pharmaceutical market alongside socioeconomic transition.

Expert Rev Pharmacoecon Outcomes Res 2015 Jun 16;15(3):521-30. Epub 2015 Jan 16.

Head of Graduate Health Economics & Pharmacoeconomics Curricula, Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovica 69, 34000 Kragujevac, Serbia.

Introduction: South-eastern European socioeconomic transition followed by extensive health systems reforms has completely changed the pharmaceuticals market landscape in the region. Serbia, as the largest Western Balkans market, may serve as an example of such changes.

Methods: Descriptive trend analysis of national-level dispensing of medicines in Serbia 2004-2012 was performed.

Results: Total public health expenditure in Serbia increased sharply in less than a decade (€1,175,158,679 to €1,847,971,776); public spending on pharmaceuticals doubled (€339,279,304 to €742,013,976). Market growth was primarily driven by statins, novel platelet aggregation inhibitors, monoclonal antibodies and combined preparations indicated in asthma and chronic obstructive pulmonary disease.

Conclusion: The pharmaceutical market of Serbia has undergone thorough and complete transformation from within. Serious crisis of medicine supply sustainability is currently shaking Balkan health systems due to increasing public debt worsened by global recession. More responsible reimbursement policy rooted in cost-effectiveness principle is needed in years to come.
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http://dx.doi.org/10.1586/14737167.2015.1003044DOI Listing
June 2015

10th World IHEA and ECHE Joint Congress: health economics in the age of longevity.

Expert Rev Pharmacoecon Outcomes Res 2014 Dec 10;14(6):781-3. Epub 2014 Oct 10.

Faculty of Medical Sciences University of Kragujevac, Svetozara Markovica 69, 34000 Kragujevac, Serbia.

The 10th consecutive World Health Economics conference was organized jointly by International Health Economics Association and European Conference on Health Economics Association and took place at The Trinity College, Dublin, Ireland in July 2014. It has attracted broad participation from the global professional community devoted to health economics teaching,research and policy applications. It has provided a forum for lively discussion on hot contemporary issues such as health expenditure projections, reimbursement regulations,health technology assessment, universal insurance coverage, demand and supply of hospital services, prosperity diseases, population aging and many others. The high-profile debate fostered by this meeting is likely to inspire further methodological advances worldwide and spreading of evidence-based policy practice from OECD towards emerging markets.
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http://dx.doi.org/10.1586/14737167.2014.967220DOI Listing
December 2014

Contemporary generic market in Japan - key conditions to successful evolution.

Expert Rev Pharmacoecon Outcomes Res 2014 Apr 23;14(2):181-94. Epub 2014 Jan 23.

Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia.

The Japanese pharmaceutical market, the world's second largest, is traditionally renowned for the domination of patented drugs and the weakest generics share among major established economies. An in-depth observation of published evidence in Japanese/English language provided closer insight into current trends in Japanese domestic legislation and pharmaceutical market development. Recent governmental interventions have resulted in significant expansion of the generic medicines market size. Substantial savings due to generic substitution of patent-protected drugs have already been achieved and are likely to increase in future. Nationwide population aging threatening sustainable healthcare funding is contributing to the relevance of generic policy success. Serious long-term challenges to the modest Japanese generic manufacturing capacities will be posed by foreign pharmaceutical industries particularly the ones based in emerging BRIC economies.
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http://dx.doi.org/10.1586/14737167.2014.881254DOI Listing
April 2014

Cross-sectional survey on complementary and alternative medicine awareness among health care professionals and students using CHBQ questionnaire in a Balkan country.

Chin J Integr Med 2013 Sep 24;19(9):650-5. Epub 2013 Aug 24.

Department of Pharmacology and Toxicology, The Faculty of Medical Sciences University of Kragujevac, Kragujevac, Serbia.

Objective: To conduct a study on attitudes, knowledge, and use of complementary and alternative medicine (CAM) therapies in Serbia. Available data about CAM therapies in the region are scarce, opinions lacking from health sector. Balkan region countries had a delay in issuing national policies on CAM therapies.

Methods: The questionnaire used was based on previously validated CAM Health Belief Questionnaire (CHBQ), formulated as 5-item Likert type scale, adjusted for local environment. Health care students and professionals were evaluated. The questionnaire comprehended 10 closed questions on attitudes, knowledge and use of CAM therapies. This survey was conducted in eight cities of Serbia, January 2010-July 2011. A total of 797 participants was included. The second group of participants was 145 healthcare professionals (50 academic staff, 64 clinical staff, 19 pharmacists, 6 other clinical branch specialists and 6 nurses). Data were collected by an interview. Examinees could acquire maximum of 70 points, 35 representing neutral attitude.

Results: Students of dentistry (54.65±6.07) were better informed on CAM therapies than medicine students (50.26±7.92). Pharmacy students (51.16±7.10) accepted low-scientific CAM. Pharmacists scored better than university professors (55.12±6.55 vs. 50.29±9.50). Primary health care professionals had better awareness than pharmacists in dispensing pharmacies. Both groups of participants preferred use of vitamins over any other CAM therapy.

Conclusion: These pioneering efforts in the region exposed weaknesses in CAM attitudes of current and future health care professionals. Nevertheless, awareness on alternative medicine treatment choices is growing among Balkan prescribers. Supportive legal framework would facilitate dissemination of CAM medical practices.
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http://dx.doi.org/10.1007/s11655-013-1434-6DOI Listing
September 2013

Resource allocation strategies in Southeastern European health policy.

Eur J Health Econ 2013 Apr;14(2):153-9

The past 23 years of post-socialist restructuring of health system funding and management patterns has brought many changes to small Balkan markets, putting them under increasing pressure to keep pace with advancing globalization. Socioeconomic inequalities in healthcare access are still growing across the region. This uneven development is marked by the substantial difficulties encountered by local governments in delivering medical services to broad sectors of the population. This paper presents the results of a systematic review of the following evidence: published reports on health system reforms in the region commissioned by WHO, IMF, World Bank, OECD, European Commission; all available published evidence on health economics, funding, reimbursement in world/local languages since 1989 indexed at Medline, Excerpta Medica and Google Scholar; in depth analysis of official website data on medical care financing related legislation among key public institutions such as national Ministries of health, Health Insurance Funds, Professional Associations were applicable, in local languages; correspondence with key opinion leaders in the field in their respective communities. Contributors were asked to answer a particular set of questions related to the issue, thus enlightening fresh legislative developments and hidden patterns of policy maker's behavior. Cost awareness is slowly expanding in regional management, academic and industrial establishment. The study provides an exact and comprehensive description of its current extent and legislative framework. Western Balkans policy makers would profit substantially from health-economics-based decision-making to cope with increasing difficulties in funding and delivering medical care in emerging markets with a rapidly growing demand for health services.
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http://dx.doi.org/10.1007/s10198-012-0439-yDOI Listing
April 2013

[Pharmacokinetic modelling of valproate in epileptic patients].

Med Pregl 2010 May-Jun;63(5-6):349-55

Medicinski fakultet Kragujevac, Katedra za farmakologiju i toksikologiju.

Introduction: The aim of our study was to develop and use a population pharmacokinetic model for assessment of individual valproate clearance in children and young adults suffering from epilepsy.

Material And Methods: The analysis was performed using 52 steady-state concentrations of valproate collected from 26 epileptic patients during the routine clinical practice in our hospital. The mean values of age and total body weight were 19.92 years and 57.12 kg, respectively. NONMEM software with ADVAN 1 subroutine was used for model building and assessing the influence of different covariates. A validation set of 20 epileptic patients (one blood sample per a patient) was used to estimate predicted performances of the pharmacokinetic model.

Results: The typical mean value of the clearance of valproate estimated by the base model in our population was 0.3 77 I/h. Out of five considered covariates (total body weight, age, total daily dose, gender and polytherapy) only the age of the patients was a significant determinant of the clearance of valproate. The final regression model for the clearance of valproate was as following: CL (l/h) = 0.223 + 0.00819 * AGE CONCLUSION: The derived pharmacokinetical model describes the clearance of valproate in relation to patient's age in the observed population. it will help to improve the seizure control in young patients with epilepsy in Serbian population.
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http://dx.doi.org/10.2298/mpns1006349jDOI Listing
January 2011

A nonlinear mixed effects modelling analysis of topiramate pharmacokinetics in patients with epilepsy.

Biol Pharm Bull 2010 ;33(7):1176-82

Department of Biopharmaceutics and Pharmacokinetics, Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia.

Topiramate pharmacokinetics is influenced by individual factors such as patient age, renal function and co-treatment. The aim of this study was to develop a population pharmacokinetic model of topiramate to assist dosage adjustments in individual patients. Steady-state topiramate plasma concentrations in patients with epilepsy were determined by HPLC using fluorescent labelling. Demographic, biochemical data and dosing history including concomitant drug therapy were collected from patients' charts. Nonlinear mixed effects modelling was used to fit a one-compartment pharmacokinetic model. The influence of patient weight and gender, body surface area, age, creatinine clearance, serum transaminases, topiramate daily dose and co-treatment with carbamazepine, valproic acid, benzodiazepines, and risperidone on topiramate pharmacokinetics was evaluated. Additionally, the relationship between topiramate plasma concentration and clinical response was investigated. Volume of distribution of topiramate was 0.518 l/kg. For a typical patient oral clearance was estimated at 1.47 l/h, with interindividual variability of 39.2%. Clearance was 70% higher in patients co-treated with carbamazepine and was found to increase with patient age. Somnolence was the most frequently observed adverse event. Incidence of headache was associated with topiramate plasma concentration. Somnolence, ataxia, tremor, speech disorders and fatigue were associated with adjunctive therapy with carbamazepine, valproic acid, benzodiazepines, risperidone, and clozapine. No association of topiramate plasma concentration with frequency of seizures or patient quality of life was observed. The developed model can be used for Bayesian estimation of pharmacokinetic parameters based on sparse plasma samples and for selection of optimum dosing in routine patient care.
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http://dx.doi.org/10.1248/bpb.33.1176DOI Listing
November 2010

Inverse correlation of valproic acid serum concentrations and quality of life in adolescents with epilepsy.

Epilepsy Res 2008 Aug 20;80(2-3):180-3. Epub 2008 May 20.

Pharmacology Department, Medical Faculty, University of Kragujevac, ul. Svetozara Markovica 69, Kragujevac, Serbia.

Background: Correlation between steady-state serum concentrations of antiepileptic drugs and both seizure control and adverse drug reactions frequency (two major determinants of quality of life in patients with epilepsy) is still matter of controversy.

Objective: The aim of our study was to investigate whether a correlation exists between steady-state serum concentration of valproic acid and quality of life in adolescent patients with epilepsy.

Method: Twenty-one adolescent patients with epilepsy, treated with valproic acid for more than 6 months entered the study. On two occasions, 3 months apart, both through and 2-h-after-the-dose serum concentrations of valproic acid were measured, as well as quality of life, using QOLIE-AD-48 for adolescents. Adverse drug reactions and seizure control were also recorded.

Results: Significant inverse correlation between through serum concentrations of valproic acid and total QOLIE-AD-48 scores was observed, together with correlation between through serum concentrations and adverse drug reactions frequency. The scores of memory/concentration and physical functioning QOLIEAD-48 domains were significantly and inversely correlated with through serum concentrations.

Conclusion: Our study suggests that therapeutic monitoring of valproic acid serum concentrations could be useful predictor and marker of the most important epilepsy treatment outcome--quality of life.
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http://dx.doi.org/10.1016/j.eplepsyres.2008.04.006DOI Listing
August 2008