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Chalati W, Crilly P, Fletcher J, Kayyali R. A Comparative Study of the Cost and Uptake of Community Pharmacy "Stop Smoking and Emergency Contraception" Services from the Perspective of the National Health Service. J Res Pharm Pract 2020; 9:73-87. [PMID: 33102381 PMCID: PMC7547741 DOI: 10.4103/jrpp.jrpp_20_35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 03/21/2020] [Indexed: 11/08/2022] Open
Abstract
Objective: The objective was to explore if the community pharmacy (CP) stop smoking service (SSS) and emergency hormonal contraception patient group direction (EHC PGD) meet the needs of the English population and are cost-effective. Methods: This research was completed over 2 years. Public health resources provided details of CPs and provision of SSS and EHC PGD. Questionnaires were sent to smoking cessation/sexual health leads in local authorities to obtain information not available elsewhere. Questionnaires inquired about CP payment for provision of SSS and EHC PGD, overhead costs, successful outcomes, and validation methods. Quit rates at 4-weeks, 52-weeks, and lifetime determined SSS effectiveness. The effectiveness of EHC PGD was based on the probability of unintended pregnancy with/without levonorgestrel. Incremental cost-effectiveness ratio and cost of quality-adjusted life years (QALYs) gained were calculated. Descriptive statistics were determined. A priori of less than 0.05 (P < 0.05) was significant. Findings: SSS provision and uptake did not match local needs (smoking prevalence) even though increased CP SSS provision correlated with increased SSS success. Similarly, the need (based on teenage pregnancy rates) for EHC PGD did not correlate with the rate of CP provision but only with the uptake. Nevertheless, the provision of SSS and EHC PGD from CPs was cost-effective from an NHS perspective. Various assumptions were tested, but in all cases fell well below NICE QALY recommendations for cost-effectiveness. Conclusion: Provision of SSS and EHC PGD from CP does not meet the needs of the population even though the delivery of these services is cost-effective.
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Affiliation(s)
- Wail Chalati
- Department of Pharmacy, School of Life Sciences, Pharmacy and Chemistry, Kingston University, Kingston, United Kingdom
| | - Philip Crilly
- Department of Pharmacy, School of Life Sciences, Pharmacy and Chemistry, Kingston University, Kingston, United Kingdom
| | - John Fletcher
- Department of Pharmacy, School of Life Sciences, Pharmacy and Chemistry, Kingston University, Kingston, United Kingdom
| | - Reem Kayyali
- Department of Pharmacy, School of Life Sciences, Pharmacy and Chemistry, Kingston University, Kingston, United Kingdom
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Rancic N, Mladenovic K, Ilic NV, Dragojevic-Simic V, Karanikolas M, Ilic TV, Stamenkovic DM. Patient-Controlled Intravenous Morphine Analgesia Combined with Transcranial Direct Current Stimulation for Post-Thoracotomy Pain: A Cost-Effectiveness Study and A Feasibility For Its Future Implementation. Int J Environ Res Public Health 2020; 17:E816. [PMID: 32012977 DOI: 10.3390/ijerph17030816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 01/23/2020] [Accepted: 01/25/2020] [Indexed: 12/18/2022]
Abstract
This prospective randomized study aims to evaluate the feasibility and cost-effectiveness of combining transcranial direct current stimulation (tDCS) with patient controlled intravenous morphine analgesia (PCA-IV) as part of multimodal analgesia after thoracotomy. Patients assigned to the active treatment group (a-tDCS, n = 27) received tDCS over the left primary motor cortex for five days, whereas patients assigned to the control group (sham-tDCS, n = 28) received sham tDCS stimulations. All patients received postoperative PCA-IV morphine. For cost-effectiveness analysis we used data about total amount of PCA-IV morphine and maximum visual analog pain scale with cough (VASP-Cmax). Direct costs of hospitalization were assumed as equal for both groups. Cost-effectiveness analysis was performed with the incremental cost-effectiveness ratio (ICER), expressed as the incremental cost (RSD or US$) per incremental gain in mm of VASP-Cmax reduction. Calculated ICER was 510.87 RSD per VASP-Cmax 1 mm reduction. Conversion on USA market (USA data 1.325 US$ for 1 mg of morphine) revealed ICER of 189.08 US$ or 18960.39 RSD/1 VASP-Cmax 1 mm reduction. Cost-effectiveness expressed through ICER showed significant reduction of PCA-IV morphine costs in the tDCS group. Further investigation of tDCS benefits with regards to reduction of postoperative pain treatment costs should also include the long-term benefits of reduced morphine use.
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Reimer J, Vogelmann T, Trümper D, Scherbaum N. Opioid use disorder in Germany: healthcare costs of patients in opioid maintenance treatment. Subst Abuse Treat Prev Policy 2019; 14:57. [PMID: 31842942 PMCID: PMC6916156 DOI: 10.1186/s13011-019-0247-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 12/11/2019] [Indexed: 01/24/2023]
Abstract
Background Opioid Use Disorder (OUD) is a substance use disorder with a chronic course associated with comorbid mental and somatic disorders, a high burden of psychosocial problems and opioid maintenance treatment (OMT) as a standard treatment. In the US, OUD imposes a significant economic burden on society, with annual societal costs estimated at over 55 billion dollars. Surprisingly, in Europe and especially in Germany, there is currently no detailed information on the healthcare costs of patients with OUD. The goal of the present research is to gather cost information about OUD patients in OMT with a focus on maintenance medication and relapses. Methods We analysed health claims data of four million persons covered by statutory health insurance in Germany, applying a cost-of-illness approach and aimed at examining the direct costs of OMT patients in Germany. Patients with an ICD-10 code F11.2 and at least one claim of an OMT medication were stratified into the treatment groups buprenorphine, methadone or levomethadone, based on the first prescription in each of the follow-up years. Costs were stratified for years with and without relapses. Group comparisons were performed with ANOVA. Results We analysed 3165 patient years, the total annual sickness funds costs were on average 7470 € per year and patient. Comparing costs of levomethadone (8400 €, SD: 11,080 €), methadone (7090 €, SD: 10,900 €) and buprenorphine (6670 €, SD: 7430 €) revealed significant lower costs of buprenorphine compared to levomethadone (p < 0.0001). In years with relapses, costs were higher than in years without relapses (8178 € vs 7409 €; SD: 11,622, resp. 10,378 €). In years with relapses, hospital costs were the major cost driver. Conclusions The present study shows the costs of OUD patients in OMT for the first time with a German dataset. Healthcare costs for patients with an OUD in OMT are associated with more than two times the cost of an average German patients. Preventing relapses might have significant impact on costs. Patients in different OMT were dissimilar which may have affected the cost differences.
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Affiliation(s)
- Jens Reimer
- Center for Interdisciplinary Addiction Research, Dept. of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Center for Psychosocial Medicine, Health North, Hospital Group Bremen, Bremen, Germany
| | | | | | - Norbert Scherbaum
- LVR-Hospital Essen, Department of Addictive Behaviour and Addiction Medicine, Medical Faculty, University of Duisburg-Essen, Essen, Germany
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Janicijevic KM, Kocic SS, Radevic SR, Jovanovic MR, Radovanovic SM. Socioeconomic Factors Associated with Psychoactive Substance Abuse by Adolescents in Serbia. Front Pharmacol 2017; 8:366. [PMID: 28659800 PMCID: PMC5468426 DOI: 10.3389/fphar.2017.00366] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 05/26/2017] [Indexed: 01/18/2023] Open
Affiliation(s)
- Katarina M. Janicijevic
- Department of Social Medicine, Faculty of Medical Sciences, University of KragujevacKragujevac, Serbia
| | - Sanja S. Kocic
- Department of Social Medicine, Faculty of Medical Sciences, University of KragujevacKragujevac, Serbia
| | - Svetlana R. Radevic
- Department of Social Medicine, Faculty of Medical Sciences, University of KragujevacKragujevac, Serbia
| | - Mirjana R. Jovanovic
- Department of Psychiatry, Faculty of Medical Sciences, University of KragujevacKragujevac, Serbia
| | - Snezana M. Radovanovic
- Department of Social Medicine, Faculty of Medical Sciences, University of KragujevacKragujevac, Serbia
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Jakovljevic M, Varavikova EA, Walter H, Wascher A, Pejcic AV, Lesch OM. Alcohol Beverage Household Expenditure, Taxation and Government Revenues in Broader European WHO Region. Front Pharmacol 2017; 8:303. [PMID: 28603498 PMCID: PMC5445193 DOI: 10.3389/fphar.2017.00303] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 05/10/2017] [Indexed: 12/21/2022] Open
Affiliation(s)
- Mihajlo Jakovljevic
- Health Economics and Pharmacoeconomics, Faculty of Medical Sciences, University of KragujevacKragujevac, Serbia
| | - Elena A. Varavikova
- Federal Research Institute for Public Health Organization and Information (CNIIOIZ), Ministry of HealthMoscow, Russia
| | - Henriette Walter
- Department of Psychiatry and Psychotherapy, Medical University of ViennaVienna, Austria
| | | | - Ana V. Pejcic
- Faculty of Medical Sciences, University of KragujevacKragujevac, Serbia
| | - Otto M. Lesch
- Department of Psychiatry and Psychotherapy, Medical University of ViennaVienna, Austria
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Jakovljevic MM, Arsenijevic J, Pavlova M, Verhaeghe N, Laaser U, Groot W. Within the triangle of healthcare legacies: comparing the performance of South-Eastern European health systems. J Med Econ 2017; 20:483-492. [PMID: 28035843 DOI: 10.1080/13696998.2016.1277228] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Inter-regional comparison of health-reform outcomes in south-eastern Europe (SEE). METHODS Macro-indicators were obtained from the WHO Health for All Database. Inter-regional comparison among post-Semashko, former Yugoslavia, and prior-1989-free-market SEE economies was conducted. RESULTS United Nations Development Program Human Development Index growth was strongest among prior-free-market SEE, followed by former Yugoslavia and post-Semashko. Policy cuts to hospital beds and nursing-staff capacities were highest in post-Semashko. Physician density increased the most in prior-free-market SEE. Length of hospital stay was reduced in most countries; frequency of outpatient visits and inpatient discharges doubled in prior-free-market SEE. Fertility rates fell for one third in Post-Semashko and prior-free-market SEE. Crude death rates slightly decreased in prior-free-market-SEE and post-Semashko, while growing in the former Yugoslavia region. Life expectancy increased by 4 years on average in all regions; prior-free-market SEE achieving the highest longevity. Childhood and maternal mortality rates decreased throughout SEE, while post-Semashko countries recorded the most progress. CONCLUSIONS Significant differences in healthcare resources and outcomes were observed among three historical health-policy legacies in south-eastern Europe. These different routes towards common goals created a golden opportunity for these economies to learn from each other.
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Affiliation(s)
- Mihajlo Michael Jakovljevic
- a Health Economics and Pharmacoeconomics, Faculty of Medical Sciences , University of Kragujevac , Kragujevac , Serbia
| | - Jelena Arsenijevic
- b Department of Health Services Research , CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University , Maastricht , The Netherlands
| | - Milena Pavlova
- b Department of Health Services Research , CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University , Maastricht , The Netherlands
| | - Nick Verhaeghe
- c Department of Public Health , I-CHER Interuniversity Centre for Health Economics Research, Ghent University , Ghent , Belgium
| | - Ulrich Laaser
- d Section of International Public Health (S-IPH), Faculty of Health Sciences , University of Bielefeld , Bielefeld , Germany
| | - Wim Groot
- b Department of Health Services Research , CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University , Maastricht , The Netherlands
- e Top Institute Evidence-Based Education Research (TIER); Maastricht University , Maastricht , The Netherlands
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Jakovljevic M, Malmose-Stapelfeldt C, Milovanovic O, Rancic N, Bokonjic D. Disability, Work Absenteeism, Sickness Benefits, and Cancer in Selected European OECD Countries-Forecasts to 2020. Front Public Health 2017; 5:23. [PMID: 28289676 PMCID: PMC5327442 DOI: 10.3389/fpubh.2017.00023] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 02/07/2017] [Indexed: 01/02/2023] Open
Abstract
Background Disability either due to illness, aging, or both causes remains an essential contributor shaping European labor markets. Ability of modern day welfare states to compensate an impaired work ability and absenteeism arising from incapacity is very diverse. The aims of this study were to establish and explain intercountry differences among selected European OECD countries and to provide forecasts of future work absenteeism and expenditures on wage replacement benefits. Methods Two major public registries, European health for all database and Organization for Economic Co-operation and Development database (OECD Health Data), were coupled to form a joint database on 12 core indicators. These were related to disability, work absenteeism, and sickness benefits in European OECD countries. Time horizon 1989–2013 was observed. Forecasting analysis was done on mean values of all data for each single variable for all observed countries in a single year. Trends were predicted on a selected time horizon based on the mean value, in our case, 7 years up to 2020. For this purpose, ARIMA prediction model was applied, and its significance was assessed using Ljung–Box Q test. Results Our forecasts based on ARIMA modeling of available data indicate that up to 2020, most European countries will experience downfall of absenteeism from work due to illness. The number of citizens receiving social/disability benefits and the number being compensated due to health-related absence from work will decline. As opposed to these trends, cancer morbidity may become the top ranked disability driver as hospital discharge diagnoses. Concerning development is the anticipated bold growth of hospital discharge frequencies due to cancer across the region. This effectively means that part of these savings on social support expenditure shall effectively be spent to combat strong cancer morbidity as the major driver of disability. Conclusion We have clearly growing work load for the national health systems attributable to the clinical oncology acting as the major disability contributor. This effectively means that large share of these savings on public expenditure shall effectively be spent to combat strong cancer morbidity. On another side, we have all signs of falling societal responsibility toward the citizens suffering from diverse kinds of incapacity or impaired working ability and independence. Citizens suffering from any of these causes are likely to experience progressively less social support and publicly funded care and work support compared to the golden welfare era of previous decades.
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Affiliation(s)
- Mihajlo Jakovljevic
- Health Economics and Pharmacoeconomics, Faculty of Medical Sciences, University of Kragujevac , Kragujevac , Serbia
| | | | - Olivera Milovanovic
- Faculty of Medical Sciences, Department of Pharmacy, University of Kragujevac , Kragujevac , Serbia
| | - Nemanja Rancic
- Faculty of Medicine of the Military Medical Academy, University of Defence , Belgrade , Serbia
| | - Dubravko Bokonjic
- Faculty of Medicine of the Military Medical Academy, University of Defence , Belgrade , Serbia
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Radevic S, Kocic S, Jakovljevic M. Self-Assessed Health and Socioeconomic Inequalities in Serbia: Data from 2013 National Health Survey. Front Pharmacol 2016; 7:140. [PMID: 27303301 PMCID: PMC4881383 DOI: 10.3389/fphar.2016.00140] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 05/12/2016] [Indexed: 12/14/2022] Open
Affiliation(s)
- Svetlana Radevic
- Department of Social Medicine, Faculty of Medical Sciences, University of Kragujevac Kragujevac, Serbia
| | - Sanja Kocic
- Department of Social Medicine, Faculty of Medical Sciences, University of KragujevacKragujevac, Serbia; Center for Informatics and Biostatistics, Institute of Public Health KragujevacKragujevac, Serbia
| | - Mihajlo Jakovljevic
- Health Economics and Pharmacoeconomics, Faculty of Medical Sciences University of Kragujevac Kragujevac, Serbia
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Mihailovic N, Kocic S, Jakovljevic M. Review of Diagnosis-Related Group-Based Financing of Hospital Care. Health Serv Res Manag Epidemiol 2016; 3:2333392816647892. [PMID: 28462278 PMCID: PMC5266471 DOI: 10.1177/2333392816647892] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 03/18/2016] [Accepted: 03/18/2016] [Indexed: 11/17/2022] Open
Abstract
Since the 1990s, diagnosis-related group (DRG)-based payment systems were gradually introduced in many countries. The main design characteristics of a DRG-based payment system are an exhaustive patient case classification system (ie, the system of diagnosis-related groupings) and the payment formula, which is based on the base rate multiplied by a relative cost weight specific for each DRG. Cases within the same DRG code group are expected to undergo similar clinical evolution. Consecutively, they should incur the costs of diagnostics and treatment within a predefined scale. Such predictability was proven in a number of cost-of-illness studies conducted on major prosperity diseases alongside clinical trials on efficiency. This was the case with risky pregnancies, chronic obstructive pulmonary disease, diabetes, depression, alcohol addiction, hepatitis, and cancer. This article presents experience of introduced DRG-based payments in countries of western and eastern Europe, Scandinavia, United States, Canada, and Australia. This article presents the results of few selected reviews and systematic reviews of the following evidence: published reports on health system reforms by World Health Organization, World Bank, Organization for Economic Co-operation and Development, Canadian Institute for Health Information, Canadian Health Services Research Foundation, and Centre for Health Economics University of York. Diverse payment systems have different strengths and weaknesses in relation to the various objectives. The advantages of the DRG payment system are reflected in the increased efficiency and transparency and reduced average length of stay. The disadvantage of DRG is creating financial incentives toward earlier hospital discharges. Occasionally, such polices are not in full accordance with the clinical benefit priorities.
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Affiliation(s)
| | - Sanja Kocic
- Institute for Public Health Kragujevac, Kragujevac, Serbia
- Department of Social Medicine, The Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Mihajlo Jakovljevic
- Health Economics and Pharmacoeconomics, The Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
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Jakovljevic M(M, Lazarevic M, Jurisevic M, Jovanovic MR. When cure becomes an illness-abuse of addictive prescription medicines. Front Pharmacol 2015; 6:193. [PMID: 26441650 PMCID: PMC4584929 DOI: 10.3389/fphar.2015.00193] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 08/25/2015] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Marija Lazarevic
- Department of Pharmacy, Faculty of Medical Sciences, University of KragujevacKragujevac, Serbia
| | - Milena Jurisevic
- Department of Pharmacy, Faculty of Medical Sciences, University of KragujevacKragujevac, Serbia
| | - Mirjana R. Jovanovic
- Department of Psychiatry, Faculty of Medical Sciences, University of KragujevacKragujevac, Serbia
- Psychiatry Clinic, University Clinical Center KragujevacKragujevac, Serbia
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Cupurdija V, Lazic Z, Petrovic M, Mojsilovic S, Cekerevac I, Rancic N, Jakovljevic M. Community-acquired pneumonia: economics of inpatient medical care vis-à-vis clinical severity. J Bras Pneumol 2015; 41:48-57. [PMID: 25750674 PMCID: PMC4350825 DOI: 10.1590/s1806-37132015000100007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 12/05/2014] [Indexed: 12/26/2022] Open
Abstract
Objective: To assess the direct and indirect costs of diagnosing and treating community-acquired pneumonia (CAP), correlating those costs with CAP severity at diagnosis and identifying the major cost drivers. Methods: This was a prospective cost analysis study using bottom-up costing. Clinical severity and mortality risk were assessed with the pneumonia severity index (PSI) and the mental Confusion-Urea-Respiratory rate-Blood pressure-age ≥ 65 years (CURB-65) scale, respectively. The sample comprised 95 inpatients hospitalized for newly diagnosed CAP. The analysis was run from a societal perspective with a time horizon of one year. Results: Expressed as mean ± standard deviation, in Euros, the direct and indirect medical costs per CAP patient were 696 ± 531 and 410 ± 283, respectively, the total per-patient cost therefore being 1,106 ± 657. The combined budget impact of our patient cohort, in Euros, was 105,087 (66,109 and 38,979 in direct and indirect costs, respectively). The major cost drivers, in descending order, were the opportunity cost (lost productivity); diagnosis and treatment of comorbidities; and administration of medications, oxygen, and blood derivatives. The CURB-65 and PSI scores both correlated with the indirect costs of CAP treatment. The PSI score correlated positively with the overall frequency of use of health care services. Neither score showed any clear relationship with the direct costs of CAP treatment. Conclusions: Clinical severity at admission appears to be unrelated to the costs of CAP treatment. This is mostly attributable to unwarranted hospital admission (or unnecessarily long hospital stays) in cases of mild pneumonia, as well as to over-prescription of antibiotics. Authorities should strive to improve adherence to guidelines and promote cost-effective prescribing practices among physicians in southeastern Europe.
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Affiliation(s)
- Vojislav Cupurdija
- University of Kragujevac, Center for Clinical Medicine, Pulmonology Department, Kragujevac, Serbia. Pulmonology Department, University of Kragujevac Center for Clinical Medicine, Kragujevac, Serbia
| | - Zorica Lazic
- University of Kragujevac, Center for Clinical Medicine, Pulmonology Department, Kragujevac, Serbia. Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia; and Head. Pulmonology Department, University of Kragujevac Center for Clinical Medicine, Kragujevac, Serbia
| | - Marina Petrovic
- University of Kragujevac, Center for Clinical Medicine, Pulmonology Department, Kragujevac, Serbia. Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia; and Internist. Pulmonology Department, University of Kragujevac Center for Clinical Medicine, Kragujevac, Serbia
| | - Slavica Mojsilovic
- University of Kragujevac, Center for Clinical Medicine, Pulmonology Department. Pulmonology Department, University of Kragujevac Center for Clinical Medicine, Kragujevac, Serbia
| | - Ivan Cekerevac
- University of Kragujevac, Center for Clinical Medicine, Kragujevac, Serbia. Intensive Care Unit, University of Kragujevac Center for Clinical Medicine, Kragujevac, Serbia
| | - Nemanja Rancic
- University of Defence, Military Medical Academy, Medical Faculty, Belgrade, Serbia. Centre for Clinical Pharmacology, Medical Faculty, Military Medical Academy, University of Defence, Belgrade, Serbia
| | - Mihajlo Jakovljevic
- University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia. Graduate Program in Health Economics and Pharmacoeconomics, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
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Affiliation(s)
- Mihajlo B. Jakovljevic
- Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Mirjana Jovanovic
- Department of Psychiatry, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Otto Michael Lesch
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
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