Influenza affects 5–15% of the population during an epidemic. In Western Europe, vaccination of at-risk groups forms the cornerstone of influenza prevention. However, vaccination coverage of the elderly (>65 y) is often low in Central and Eastern Europe (CEE); potentially because a paucity of country-specific data limits evidence-based policy making. Therefore the medical and economic burden of influenza were estimated in elderly populations in the Czech Republic, Hungary, Kazakhstan, Poland, Romania, and Ukraine. Data covering national influenza vaccination policies, surveillance and reporting, healthcare costs, populations, and epidemiology were obtained via literature review, open-access websites and databases, and interviews with experts. A simplified model of patient treatment flow incorporating cost, population, and incidence/prevalence data was used to calculate the influenza burden per country. In the elderly, influenza represented a large burden on the assessed healthcare systems, with yearly exc...

The fixed-ratio combination (FRC) of a basal insulin and a GLP-1 receptor agonist (GLP-1 RA) has proven to be an effective therapeutic approach. However, physicians face numerous practical questions that cannot be answered by recently published trial results, current guidelines and summaries of product characteristics. In April 2019, a scientific meeting was held with the participation of nine experts from four Central and Eastern European countries to provide expert consensus on the optimal daily use of the insulin glargine and lixisenatide FRC (iGlarLixi). Topics included the positioning and initiation of iGlarLixi and the management of treatment. This paper summarizes the outcomes of the meeting.

Maturity-onset diabetes of the young (MODY) is often misdiagnosed as Type I or II diabetes. This study was designed to assess the cost–effectiveness of MODY screening strategies in Hungary, which i...

Objectives: Transdermal hormone replacement therapy is preferred for menopausal vasomotor symptoms. Our purpose was to compare the efficacy and local tolerability of a patch and a metered-dose transdermal spray that have never been directly compared. Method: The relative change in the number of hot flushes between baseline and week 12 was selected as an efficacy indicator and the frequency of local skin reactions as a tolerability indicator. A network meta-analysis was performed to compare efficacy. Application site tolerability was compared descriptively. Results: Overall 46 studies were identified. In the efficacy analysis, eight active treatment arms and a placebo arm were determined based on the estradiol daily dose (from 14 μg to 50 μg). All but one had a significantly higher effect on relative change in the number of hot flushes than did the placebo. We found no evidence for different efficacy of the patch and the metered-dose transdermal spray. The latter performed better in terms of local skin reactions. Conclusion: The patch and the metered-dose transdermal spray seem to have the same efficacy on vasomotor symptoms in estradiol hormone replacement. The local tolerability of the metered-dose transdermal spray is favorable.

Increasing evidence links elevated serum uric acid levels to adverse cardiorenal outcomes. To date, limited data exist on whether the benefits of urate-lowering therapies (ULTs) depend on timely treatment initiation and sustained adherence in patients at high cardiovascular risk. An economic evaluation was conducted, based on a simulation model populated by Italian real-world patient-level data from the Uric Acid Right for Heart Health (URRAH) cohort to evaluate long-term cardiovascular, renal, and economic outcomes associated with timely allopurinol use. 10,000 patients with hyperuricemia (serum uric acid >5.6 mg/dL) and elevated cardiovascular risk were simulated over a 20-year time horizon. Timely initiation of allopurinol (before the first gout flare) was compared with treatment initiated only after symptomatic disease onset. Scenarios reflecting current and improved adherence to ULTs were assessed. Outcomes included major adverse cardiovascular events, end-stage renal disease onset, and economic outcomes from the payer's perspective. According to our model, timely initiation of allopurinol was associated with modest but consistent health gain (0.04 quality adjusted life years) including reductions in gout flares, cardiovascular- and renal endpoints. Timely allopurinol initiation was cost-saving and, from a health economic perspective, dominant over current practice. Improved ULT adherence amplified these benefits. Our hypothesis-generating research suggests that, in hyperuricemic patients at high cardiovascular risk, the potential benefits of allopurinol also depend on timely initiation and sustained adherence. While these findings do not constitute evidence of causal clinical benefit, they support a broader cardiorenal clinical approach to hyperuricemia management that extends beyond gout prevention.

Annak ellenére, hogy a 2-es típusú cukorbetegségben szenvedő elhízott betegek kezelése népegészségügyi prioritás, és a bariátriai műtétek jelentős egészségnyereséget és egészségügyi költségmegtakarítását eredményeznek e betegeknél, ezek a műtétek csak a magán egészségügyi szektorban elérhetőek egy szűk vagyonos réteg számára. Számos akadály gátolja az elhízott cukorbetegeknél végzett bariátriai műtétek széles körű elterjedését, így az egészségpolitikai döntéshozók támogatásának hiánya, a bariátriai műtétek szerepének meghatározatlansága az egészségügyi rendszerben, ebből következően az ilyen műtétek közfinanszírozásának hiánya, közfinanszírozott kapacitások korlátozottsága, valamint a szakmai kompetenciák kidolgozatlansága. A szerzők ezen korlátok áthidalására tesznek konszenzusos javaslatot.