Community acquired pneumonia, especially pneumococcal pneumonia, is a common cause of hospitalization and death in developed countries and is a significant economic burden. Our aim was to assess the epidemiologic and economic burdens of pneumococcal pneumonia (J13 and J18 diagnosis) in Slovakia from 2014 to 2019. We performed a retrospective, prevalence-based cost-of-illness analysis from the third-party payer and societal perspectives. Direct costs consisted of the cost of medications, laboratory investigations, diagnostic procedures, and inpatient stay, while indirect costs consisted of the cost of absenteeism, disability, and loss of productivity due to premature death. Our study showed that the estimated incidence of pneumococcal pneumonia in Slovakia decreased by 19

BACKGROUND:Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. It is also a major risk factor for ischemic stroke. The main objective of our study was to identify direct and indirect costs of AF and AF-related stroke in Slovakia.METHODS:We conducted a retrospective population-based study of AF and stroke related costs both from the third-party healthcare payers and societal perspective. The prevalence and incidence of AF and stroke were determined from central government run healthcare database. Further we estimated both indirect and direct costs of AF and stroke. All costs and healthcare resources were assessed from 2015 through 2019 and were expressed in the respective year.RESULTS:Over the 5-year study period, the prevalence of AF increased by 26% to a total of 149,198 AF cases in 2019, with an estimated total annual economic burden of €66,242,359. Direct medical costs accounted for 94% of the total cost of AF. The total cost of treating patients with stroke in 2019 was estimated at €89,505,669. As a result, the medical costs of stroke that develops as a complication of AF have been estimated to be €25,734,080 in 2019.CONCLUSIONS:Our study shows a substantial economic burden of AF and AF-related stroke in Slovakia. In view of the above, both screening for asymptomatic AF in high-risk populations and effective early management of AF with a focused on thromboprophylaxis rhythm control should be implemented.

BACKGROUND: Prostate cancer is a significant health issue worldwide, with varying incidence and mortality rates across different regions. This study focuses on Slovakia, a country with an increasing trend in number of prostate cancer cases. The manuscript aims to provide a comprehensive overview of the burden of prostate cancer in Slovakia, encompassing epidemiological trends, economic impact, diagnostic approaches, and treatment modalities. The study emphasizes the need for effective management strategies and healthcare policies to address the increasing burden of this disease in the Slovak population. METHODS: This retrospective study utilized data from various Slovak health databases, including the National Cancer Registry, hospital records, and insurance claims from 2009 to 2022. We employed epidemiological measures such as incidence, prevalence, and mortality rates to evaluate the burden of prostate cancer. Economic analysis involved assessing direct costs (hospitalizations, treatments, diagnostics) and indirect costs (lost productivity, disability). Additionally, the study reviewed cost of current diagnostic methods in Slovakia. RESULTS: The study revealed a steady increase in prostate cancer incidence in Slovakia, with a notable rise in cases among men aged 50 and above. Mortality rates showed a moderate increase, highlighting the disease's impact on the healthcare system. The economic analysis indicated substantial direct and indirect costs, with a significant portion allocated to advanced treatments and productivity loss. Diagnostic methods showed improvements over time, with increased utilization of advanced imaging techniques. CONCLUSIONS: The burden of prostate cancer in Slovakia is significant and growing, with rising incidence and economic costs posing challenges to the healthcare system. The study underscores the need for improved and early access to effective diagnostic and treatment options, and robust health policies to manage the rising burden. Additionally, public health initiatives focusing on awareness and early detection could play a crucial role in reducing the impact of prostate cancer in Slovakia. The findings of this study contribute valuable insights for policymakers and healthcare providers in developing targeted strategies to mitigate the burden of prostate cancer in the Slovak population (Tab. 7, Ref. 53). Text in PDF www.elis.sk

e24037 Background: With established efficacy and safety, BNT162b2 was one of the first licensed mRNA vaccines against SARS-CoV-2. However, it is unclear whether vitamin D serum concentrations affect vaccine efficacy after three doses. Methods: This prospective, single-center study included 273 staff members (85.4% females) of the National Cancer Comprehensive Center in Slovakia. Median age of participants was 47 years (range: 22–80) and median body mass index (BMI) was 24.8 (16.3–44.6) kg/m 2 . The primary objective was to determine the efficacy of BNT162b2 defined as no Covid-19 disease ≥7 days after its administration. The secondary objective was to monitor IgG neutralizing antibodies and total vitamin D in serum after vaccination and test the hypothesis on correlation of total vitamin D concentrations with the vaccine efficacy. If appropriate, results were stratified by gender (males vs females) and BMI ( < 30 vs ≥30 kg/m 2 ). Results: At median follow-up of 4.7 (2.9–5.0) months, vaccine efficacy was 86.1%. The most common adverse events (AEs) were injection site pain (73.3%), fatigue (44.0%), and limb pain (33.0%). No grade 3/4 AEs were observed. Median time from vaccine administration to measurement of IgG and vitamin D concentrations was 3.4 (2.1-4.8) months. IgG concentrations were significantly higher in males compared to females, as well as in subjects with high vs low BMI ( p< 0.0004 and p< 0.0001, respectively). Total vitamin D concentrations were significantly lower in individuals with high vs low BMI ( p< 0.0144). No differences in the rate of Covid-19 positivity were identified based on gender, BMI, and total vitamin D concentrations. Conclusions: This study confirmed high efficacy of third dose of the BNT162b2 vaccine with an acceptable safety profile. The vaccine efficacy was not affected by gender, BMI, and total vitamin D concentrations. These results suggest that serum vitamin D monitoring after third BNT162b2 dose is not beneficial for an estimation of its efficacy. This study was supported by the National Cancer Institute, Bratislava, Slovakia & OncoReSearch, Rovinka, Slovakia. Keywords: BNT162b2; total vitamin D; efficacy; safety profile; IgG.

Background: BNT162b2 represents the authorized mRNA vaccine against Severe Acute Respiratory Syndrome Coronavirus 2 (SARS–CoV–2) causing Covid–19. Methods: We conducted a prospective, single–center observational study with 273 employees of a medical facility to determine the efficacy and safety of the BNT162b2 third dose in relation to sex and BMI, and explore the possible determinants of neutralizing IgG and 25–hydroxy (25–OH) vitamin D levels. Results: At the median follow–up of 4.7 months, 38 of the participants had Covid–19 following vaccination. The incidence of adverse events (AEs) was significantly higher in females vs. males (p < 0.0108) and subjects with a high BMI of ≥ 30 kg/m2 vs. low BMI (p < 0.0117). The values of IgG were significantly enhanced in males vs. females (p < 0.0004), participants with high BMI vs. low BMI (p < 0.0003), a high number of ≥3 AEs vs. low number of AEs (p < 0.0003), and following infection with Covid–19 vs. without Covid–19 (p < 0.0005). Multivariate analysis (MVA) showed sex, BMI, number of AEs, and Covid-19 to be of predictive significance. On the contrary, 25–OH vitamin D concentrations in individuals with high vs. low BMI were significantly reduced (p < 0.0144) but this was not evident in MVA. Conclusions: This study confirmed the high efficacy of BNT162b2 in real–world scenario and revealed that its safety was affected by sex and BMI. Higher IgG levels suggesting better protection against infection were present in males, participants with high BMI, a high frequency of AEs, and those who overcame Covid-19 following vaccination.

The main study objective was to calculate direct and indirect costs associated with the Multiple myeloma (MM) in Slovakia. The analysis is the follow-up on previously published results on MM in Slovakia. Currently, we have analysed 5 years costs evolution with potential prediction costs for 2030. Each year, there are more than 2430 patients that receive reimbursed care due to MM and the number of new patients steadily increases with approx. 27 new patients treated each year since 2015. We performed retrospective analysis of the health and social insurance records from 2015 till 2019 with application of the cost of illness (COI) methodology. COI is a summary of the costs of a particular disease to society. This value includes direct costs of treating the disease and indirect costs such as productivity loss resulting from time off employment, in our case absenteeism and disability. We estimated resource utilisation by health insurance and social insurance companies only. MM registry is incomplete from the aspect of Slovak patients. Direct costs including any kind of diagnostics procedures, treatment and/or hospitalisation increased from €19,68 million in 2015 to €24,79 million in 2019. MM pharmacotherapy was responsible for 47% of all direct costs, diagnostic procedures costs were responsible for 40% of total costs and 12% attributed to in-patient care (stay in the hospital longer than 48 hours). Indirect costs associated with absenteeism due to MM slowly declined from €291.001 in 2015 to €271.039 in 2019, but total disability costs climbed from €282.224 in 2015 to €453.130 in 2019. Our estimation is that in 2030 the yearly direct costs will increase to €31,15 million using 2,1% increase rate based on the long term yearly prevalence by WHO. It seems, that more people in productive age suffer from MM, however there is possibly visible trend toward chronicity.

The main study objective was to calculate direct and indirect costs associated with the Chronic Lymphocytic Leukemia (CLL) in Slovakia. Due to continual increase in CLL prevalence and incidence, it is important to have more accurate insight into CLL overall burden. CLL typically progresses more slowly than other types of leukemia and in 2019 we treated more than 4000 patients. We performed retrospective analysis of the health insurance and social insurance records from 2015 till 2019 with application of the cost of illness (COI) methodology. COI is a summary of the costs of a particular disease to society. This value includes direct costs of treating the disease and indirect costs such as productivity loss resulting from time off employment, in our case absenteeism and disability. We estimated resource utilisation by health insurance and social insurance companies only, since there is no current CLL patients' registry. Direct costs including any kind of diagnostics procedures, treatment and/or hospitalisation increased from €8,87 million in 2015 to €13,98 million in 2019. CLL diagnostic procedures were responsible for 64% of all direct costs, treatment costs including pharmacotherapy was responsible for 31% of total costs and 5% attributed to in-patient care (stay in the hospital longer than 48 hours). Indirect costs associated with absenteeism due to CLL climbed from €25 747 in 2015 to €113 781 in 2019 and disability costs climbed from €67 202 in 2015 to €125 833 in 2019. Our estimation is that in 2030 the yearly direct costs will increase to €25,72 million using 5,7% increase rate base on the long term yearly prevalence evolution by WHO. CLL onset is usually in retirement age, however more people in productive age are suffering from this disease. More prudent approach to this diagnosis is needed to manage the future CLL burden.

Background Multiple sclerosis (MS) is a chronic, inflammatory disease of the central nervous system, commonly diagnosed during young adulthood. The proportion of direct and indirect costs of MS vary across settings. The International Multiple Sclerosis Study, involving 1152 patients with MS from 19 countries, reported the average annual costs per patient to be €41,212, with direct medical costs of €21,093, direct non-medical costs of €2110, and €16,318 marked as indirect costs. However, there are no precise data on the economic burden of MS in Slovakia. Therefore, the main objective of this study is to assess the economic impact of MS in Slovakia by identifying and measuring the direct medical costs and indirect costs of this disease. Methods We conducted a retrospective prevalence-based cost-of-illness analysis for MS in Slovakia sourced from the third-party payer and societal perspective. Patient co-payments and out-of-pocket expenses were not included in our study. We analysed all available costs and healthcare resources utilised in a 6-years period, from 2015 to 2020. For each year, all costs (in euro) were specified as total and the average annual cost per patient. Results The estimated total economic burden of MS in Slovakia in 2020 was €57,347,523, with direct medical costs estimated to be €53,348,337 and indirect costs standing at €3,999,186. The total annual cost per patient in 2020 was €6682. Over the 6 years, the total diagnostic and treatment cost of patients with MS was estimated to be €283,974,236. With an average year-by-year increase of 5%, the total direct costs of MS had significantly grown during the examined 6 years. The total cost due to the MS-associated loss of productivity in these 6 years was €16,633,798. The average year-by-year increase of indirect costs of MS was 20%. Conclusions Our study revealed the substantial health and economic burden of MS, with the average annual cost per patient to be approximately €6,682 in 2020. We provide the first extensive assessment of the burden of MS on Slovakian patients, the healthcare system, and society. It indicates the need for a detailed analysis of the employment of patients with MS to assess disability and work performance and the development of allied health policies.

The main objective of our analysis was to model and calculate the productivity loss due to premature deaths due to chronic lymphocytic leukemia (CLL) and multiple myeloma (MM) in Slovakia from 2017 till 2019. We used human capital approach (HCA) applied to the field of health. HCA points out that disease might cause undesirable effects on productivity at work and at home. The workers who leaves the labour market due to premature mortality, the potential labour productivity towards the end of their working life will have been lost by society. We calculated the number of deaths of working-age individuals and detected average wage in industry. The age limit was 64 years, official retirement age. Once the age of individuals at the time of death and their expected gross lifetime wages were known, the present and future flow of productivity lost because of premature death were calculated. Additional attributes such as employment rate and working population rate were used to finalise calculations. Cumulative productivity loss due to premature death using the HCA was increasing from €7,7 million in 2017 (€5,1 million MM; €2,6 million CLL) to €8,8 million in 2019 (€5,8 million MM; €3 million CLL). The average productivity loss on one patient with MM was on average €127.611 and productivity loss due to CLL was €57.282 since majority of patients with CLL is in retirement age or are diagnosed not long before retirement. The average wage increased from €954 in 2017 to €1.092 in 2019 had direct impact on Results: We estimate, that there are more than 30 new patients with MM and 80 with CLL, each year. The results showed that productivity loss is still very high and rising and the best approach to stabilise the trend is early and accurate diagnosis and effective treatment from first treatment lines.

Background Colorectal cancer (CRC) is an ideal disease for screening due to known and detectable precursor lesions and slow progression from benign adenoma to invasive cancer. The introduction of organized population-based screening programs reduces the burden of colorectal cancer and increases the quality of the screening process with a more favorable harm to benefit ratio compared to opportunistic screening. Methods The study used the microsimulation screening analysis-colon simulation model for the estimation of the effect of various factors on cancer incidence and mortality. The model simulated the Slovakian population from 2018 to 2050. Study includes the analysis of two screening strategies the fecal immunochemical test (FIT) every 2 years and annual FIT. Cost-effectiveness parameters were evaluated comparing each simulated screening scenario with no screening. Results Compared to no screening, the biennial FIT would detect 29 600 CRC cases and annual FIT 37 800 CRC cases. Mortality due to CRC showed benefits for both strategies with 17,38% reduction in biennial FIT and 24,67% reduction in annual FIT approach. Both screening programs were more costly as well as more effective compared to no screening. The ICER for biennial FIT strategy was 1776 EUR per 1 QALY and for the annual FIT 3991 EUR per 1 QALY. Conclusions In summary, this is the first cost-effectiveness analysis focusing on multiple national CRC screening strategies in Slovakia. Both strategies demonstrated cost-effectiveness compared to no screening. However, for optimal population-based programmatic screening strategy, the policymakers should also consider human resources availability, acceptability of screening test among the population or additional resources including the screening funding.

Health care costs are continuously increasing.Multiple myeloma represents approximately 1% of all malignancies and the 5-year prevalence is 230,000 patients on average.In addition, there is an annual incidence of 3.8/100,000 in Slovakia.In total economic burden assessment, it is important to focus not only on direct but also on indirect costs, including the lost productivity due to premature death.Based on the data and information obtained from the key stakeholders the Ministry of Health, the Ministry of Labor, the Social Insurance Agency, and NCZI, we provided the assessment of direct and indirect costs.The total cost of the disease for the model patient represents €409,071 from the diagnosis of MM to death.The major cost burden is associated with the treatment, €155,645 followed by the costs of productivity loss due to premature death, €127,611.Cost-of-illness studies provide an important view on the total burden of the disease in specific areas and are necessary for an adequate decision-making process from the regulatory and reimbursement perspective.

The main objective of this study was to calculate the real costs associated with depression in single EU jurisdiction – Slovak Republic from the payers’ perspective in 2018. We cooperated with key state payers and stakeholders (Ministry of Health - MOH, Social Insurance Agency - SIA, General Health Insurance Agency - VsZP) to obtain real-life cost data associated with depression as well as on results verification. We have performed the retrospective analysis of the total direct and indirect costs associated with the depressive disorder in assistance with the MoH, SIA and VsZP. We used the “bottom-up” approach to identify, quantify and value resources in a disaggregated way, so that each element of the costs is estimated individually and summed up at the end. Total costs were calculated at the country level for the year 2018. Based on the data provided by stakeholders, the distribution of the total costs associated with depression in Slovakia in 2018 were as follows (% from overall costs, EUR 1 = USD 1.1237, ECB): direct health care costs were €22 845 756 (32%, $25 671 776) from which €5.8M ($6.5M) were diagnostic costs, €7.7M ($8.65M) were hospitalisation costs, €9.3M ($10.45M) were treatment costs. Total indirect costs were €48 401 825 (68%, $54 389 130) from which €17M ($19.1M) attributed to absenteeism and disability and €31.4M ($35.3M) productivity loss based on the friction costs calculation. Total costs associated with depression in 2018 were €71 247 582 ($80 060 907). We performed unique national cost data analysis associated with patients with depression in partnership with the key state payers and stakeholders. We ensured high accuracy and reliability of our data through the additional verification of the results with mentioned stakeholders. Our results provide first overall picture of the total state funds expenditures on this disease in single EU jurisdiction, Slovak Republic.

The article describes a treatment protocol for pediatric patients with COVID-19 (SARS-CoV-2 virus) in Slovakia according to the recommendations of the Slovakian Pediatric Society The aim of the article is to demonstrate possible treatment ways of pediatric patients with confirmed and probable COVID-19 This protocol is of exploratory nature, since it may be changed due to the large amount of incoming information

The main goal of our analysis was to perform total cost calculations associated with the treatment of patients with the metastatic renal carcinoma (mRCC) diagnosis as the pivotal study of the newly created National Oncology Institute. We also aimed to establish partnership with key national stakeholders to obtain most reliable cost data associated with mRCC: Ministry of Health (MOH), Social Insurance Agency (SIA) and payers. The methodology is based on cost-of-illness study with payer perspective. We performed the retrospective analysis based on data obtained from the MOH, SIA and payers’ databases by using anonymized costs and epidemiology data for the mRCC. For the final datasets from each of our partners, the “bottom-up“ approach was used, to identify, quantify and value resources in a disaggregated way, so that each element of the costs is estimated individually and summed up at the end. Total costs were calculated for all patients with mRCC in 2018. The direct costs associated with mRCC patients were 11,03 mil EUR (1,43 mil EUR diagnostics costs and all medical procedures, 1,98 mil EUR hospitalization, 7,61 mil EUR pharmaco-therapy costs). Total indirect costs were divided into sickness benefits plus disability costs (1,23 mil EUR) and costs associated with productivity loss due to premature death (9,76 mil EUR). Indirect costs associated with mRCC in 2018 were 10,98 mil EUR. Overall, total costs associated with mRCC were in 2018 at the level of more than 22,02 mil EUR. For the first time, we analysed available total costs for all patients with mRCC treated in Slovakia in 2018, in partnership with the key state payers and stakeholders. Cost data accuracy and reliability due to verification of all cost data was very high and create important base for evaluation of existing and new innovations coming to mRCC segment.

The objective was to calculate the indirect costs associated with the depression in single EU jurisdiction and establish the national base for indirect costs for this disease in cooperation with the key state stakeholders, the Ministry of Health (MoH), payers and Social Insurance Agency (SIA). It was the retrospective national analysis, conducted by using real life data obtained directly from state-owned SIA and Ministry of Health of Slovak Republic. We performed the “bottom-up” approach, which helped us identify, quantify and value resources in a disaggregated way, so that each element of the indirect costs was estimated individually and they were summed up at the end. Indirect costs were calculated for the total population of patients with depression in 2018. In 2018, 185 467 patients with depression (F32, F33) received any kind of reimbursed care, 5222 patients were absent in average 119 days from work and 2646 patients were long-term disabled and took disability pension. In cooperation with key stakeholders we identified (% from total indirect costs, EUR 1 = USD 1.1237, European Central Bank) following indirect costs associated with depression: sickness benefit costs €11.09 MIO (23%, $12.46 MIO), disability pension/long term disability €5.87 MIO (12%, $6.60 MIO) and costs associated with productivity loss due to depression based on the friction costs calculation approach €31.43 MIO (65%, $35.31 MIO). Total indirect costs associated with depression in productive patients in 2018 verified with key stakeholders were in 2018: €48 401 825 ($54 389 130). Thanks to cooperation with key stakeholders and payers and additional verification with MoH, we were able to establish important base for the indirect costs associated with depression. Indirect costs – as additional state payer costs – should play important role in complex evaluations of existing and new technologies coming to the segment of the depression treatment.

The main objective of our analysis was to calculate all potential financial and health benefits associated with continual investments into community psychiatric departments (CPD) in Slovakia within next 10 years. In cooperation with key payers, Ministry of Health and Social Insurance Agency, we performed cost-of-illness study with payer perspective aimed at diagnosis of F20-29 and F30-39 which are most frequent among patients in CPD (+80%). Direct and indirect costs were calculated for 2015-2019 period. Additionally, we performed total costs prediction for next 10 year with 3 possible scenarios and implemented potential benefits of CPD adequate funding and the CPD net extension from 18 to 26 in 2025. Health benefits of CPD were taken from local 7 years observation study performed by the authors. Total additional investments into CPD are expected at the level of 40,739 mil EUR within 2020-2030 (extension from 18 to 26 CPD and increase in reimbursement level by 40 EUR for 1 place/day). The total costs savings associated with introduction adequately funded 26 CPD by 2025 predicted to be 43 mil EUR in linear scenario cost evolution, 559 mil EUR in progressive scenario cost evolution and 1075 mil EUR in psychiatry experts' scenario cost evolution. Potential health returns were 4 386 healthy life-years gained and 9129 averted prevalent cases. The benefit to cost ratios for economic and value of health returns were 1,055 for linear, 13,73 for progressive and 26,40 for expert scenario. According to our predictive model, it is expected that adequate long term CPD funding may play substantial economic role when considering costs associated with F20-29 and F30-39 diagnosis in Slovakia. The economic and health benefits of investments into the mental health had been well described and previously published. Our analysis confirmed those findings in local conditions.

To exchange experience, the article describes an interesting clinical case of coronavirus pneumonia in a pediatric patient with diabetes mellitus. This case deserves the attention of pediatricians and anesthetists. A teenager with diabetes mellitus had the clinical and laboratory signs of coronavirus pneumonia caused by COVID-19. The Protocol for the diagnosis, management and treatment of pediatric patients with COVID-19 written by a group of authors from Slovakia, approved by the Slovak Pediatric Society played an important role in the diagnosis and treatment of this patient. The Protocol describes an important role of computed tomography of the lungs in the timely diagnosis of coronavirus disease, since it is not always possible to diagnose viral pneumonia via X-rays. The authors describe the successful experience of intelligent ventilation mode of Adaptive Support Ventilation (ASV) — from intubation to extu-bation. For viral pneumonia, we recommend using the ASV mode to achieve protective ventilation and quickly wean the patient from the ventilator, to avoid complications.

The main objective of this study was to calculate the total direct costs associated with the depression in Slovakia within 3 years, from 2016 to 2018, in cooperation with the key national stakeholders: the Ministry of Health (MoH) and payers. The study had basic cost-of-illness methodology and payer-only perspective. We performed the retrospective national analysis by using the real life data obtained directly from the MoH and payers databases. We used the “bottom-up“ approach, which helped us identify, quantify and value resources in a disaggregated way, so that each element of the total direct costs was estimated individually and they were summed up at the end. Direct costs were calculated for the total population of patients with depression from 2016 to 2018 with any kind of reimbursed care. The total costs associated with diagnostic procedures or special medical procedures increased from 4,85 mil EUR to 5,79 mil EUR (+16%, 2018 vs 2016), costs associated with the hospitalisation (stay in hospital longer than 48 hours) increased from 7,43 mil EUR to 7,71 mil EUR (+4%, 2018 vs 2016) and pharmacotherapy costs including out-patient treatment kept steady or slowly declining evolution from 9,64 mil EUR to 9,34 mil EUR (2018 vs 2016, respectively), mainly due to generic drug price erosion. Total direct costs of depression increased from 21,93 mil EUR in 2016 to 22,85 mil EUR in 2018, by 4%. For the first time, we provided very precise direct costs data associated with depression in Slovakia. We consider this as the base for the future evaluation of depression. Direct costs play important role in complex evaluations and with more than 56% patients with depression without treatment, it gives new perspective on financial burden and important base for strategic planning at this field.