ObjectiveBetween the years 1993 and 2008, mortality rates from coronary heart disease (CHD) in the Slovak Republic have decreased by almost one quarter. However, this was a smaller decline than in neighbouring countries. The aim of this modelling study was therefore to quantify the contributions of risk factor changes and the use of evidence-based medical therapies to the CHD mortality decline between 1993 and 2008.MethodsWe identified, obtained and scrutinised the data required for the model. These data detailed trends in the major population cardiovascular risk factors (smoking, blood pressure, total cholesterol, diabetes prevalence, body mass index (BMI) and physical activity levels), and also the uptake of all standard CHD treatments. The main data sources were official statistics (National Health Information Centre and Statistical Office of the Slovak Republic) and national representative studies (AUDIT, SLOVAKS, SLOVASeZ, CINDI, EHES, EHIS). The previously validated IMPACT policy model was then used to combine and integrate these data with effect sizes from published meta-analyses quantifying the effectiveness of specific evidence-based treatments, and population-wide changes in cardiovascular risk factors. Results were expressed as deaths prevented or postponed (DPPs) attributable to risk factor changes or treatments. Uncertainties were explored using sensitivity analyses.ResultsBetween 1993 and 2008 age-adjusted CHD mortality rates in the Slovak Republic (SR) decreased by 23% in men and 26% in women aged 25–74 years. This represented some 1820 fewer CHD deaths in 2008 than expected if mortality rates had not fallen. The IMPACT model explained 91% of this mortality decline. Approximately 50% of the decline was attributable to changes in acute phase and secondary prevention treatments, particularly acute and chronic treatments for heart failure (≈12%), acute coronary syndrome treatments (≈9%) and secondary prevention following AMI and revascularisation (≈8%). Changes in CHD risk factors explained approximately 41% of the total mortality decrease, mainly reflecting reductions in total serum cholesterol. However, other risk factors demonstrated adverse trends and thus generated approximately 740 additional deaths.ConclusionOur analysis suggests that approximately half the CHD mortality fall recently observed in the SR may be attributable to the increased use of evidence-based treatments. However, the adverse trends observed in all the major cardiovascular risk factors (apart from total cholesterol) are deeply worrying. They highlight the need for more energetic population-wide prevention policies such as tobacco control, reducing salt and industrial trans fats content in processed food, clearer food labelling and regulated marketing of processed foods and sugary drinks.

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AimsTo investigate the cost-effectiveness of once-daily insulin degludec/liraglutide (IDegLira) versus basal-bolus therapy in patients with type 2 diabetes not meeting glycemic targets on basal insulin from a healthcare payer perspective in Slovakia.MethodsLong-term clinical and economic outcomes for patients receiving IDegLira and basal-bolus therapy were estimated using the IMS CORE Diabetes Model based on a published pooled analysis of patient-level data.ResultsIDegLira was associated with an improvement in quality-adjusted life expectancy of 0.29 quality-adjusted life years (QALYs) compared with basal-bolus therapy. The average lifetime cost per patient in the IDegLira arm was EUR 2,449 higher than in the basal-bolus therapy arm. Increased treatment costs with IDegLira were partially offset by cost savings from avoided diabetes-related complications. IDegLira was highly cost-effective versus basal-bolus therapy with an incremental cost-effectiveness ratio of EUR 8,590 per QALY gained, which is well below the cost-effectiveness threshold set by the law in Slovakia.ConclusionIDegLira is cost-effective in Slovakia, providing a simple option for intensification of basal insulin therapy without increasing the risk of hypoglycemia or weight gain and with fewer daily injections than a basal-bolus regimen.

apy. Methods: Observational, non-interventional, prospective, single-center study of 1 year follow-up from ITB implant onward. Results: 20 consecutive patients with ITB indication were recruited; 13 received an ITB implant during the study period; 1 implant was rejected and thus explanted. 12 patients, of whom 10 had spasticity due to spinal-cord injury, 1 to multiple sclerosis and 1 to adrenoleukodistrophy, provided data for the study and 9 completed follow-up. After 12 months of ITB, mean changes from baseline were: -2.6 on the Penn scale (p= 0.011), -1.1 (p= 0.059) and -2.8 (p= 0.011) on the Ashworth upper and lower scale, respectively and +4.4 on the FIM scale (p= 0.075). Mean utility gain, assessed with the HUI3 scale, was 0.054 (p= 0.091) after 1 year. Mean total ITB test and permanent implant cost per patient were € 528 and € 14,225, respectively. Mean quarterly spending on oral antispastics decreased by € 42 at month 12, while consumption of intrathecal baclofen stabilized after 6 months at € 39. At baseline, 4 patients received botulinum injections, while none did at the end of follow-up. Catheter-related adverse events occurred in 2 out of 12 patients, with a total mean cost per event of € 2.387. While waiting to receive ITB, spasticity-related hospitalizations due to urological complications occurred in 2 out of 20 patients, with a mean cost of € 9.044 per event; no such events were observed after ITB implant. ConClusions: Clinical outcomes of patients with N-FDS improved after ITB. Initial therapy costs were considerable, but were partially offset by savings in drugs and spasticity-related events after 1 year follow-up. Results should be interpreted cautiously because of the small number of observations.

The disabling nature and lifelong impact of multiple sclerosis (MS) imposes considerable socioeconomic burden despite its relative low prevalence compared to other chronic diseases. This is the first study of MS in the Slovak Republic that provides information about healthcare and social expenditures including costs of productivity loss caused by reduced work capacity of patients with MS.Retrospectively direct and indirect costs of MS were investigated by prevalence based "bottomup" approach. The societal and health insurance perspective was used to perform the overall economic burden caused by MS in Slovakia. The human capital method was used for the calculation of indirect costs, as this is the most common method applied in published studies. As not all detailed data on expenditures were available, the missing data were collected in the retrospective patient research.Total annual costs in 2010 for 6.100 dispensed patients with MS in Slovakia were 54.723.592. Indirect costs (31.728.757) prevailed over direct costs (22.994.834). The highest part of both costs were 25.207.512 and 12.641.052 for loss productivity due to patients sickness and invalidity pensions and diseasemodifying drugs respective ly. The average cost per patient independently of disease severity was 8.971.MS causes a high economic burden, with a strong predominance of indirect costs. Documenting and quantifying this burden among patients with MS in different disease stages through costofillness study can lead to better disease management and it can provide valuable information for future cost analysis and for decisionmaking process.