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Abstracte CNFMS2022

Conferința Națională de Farmacoeconomie și Management Sanitar


Laszlo Lorenzovici1, Ramona Dobre2, Andrea Ildiko Gasparik3, Ana Maria Iordan4, Alina Croitoru 5, Luminita Mihalache 5, Catalina Poiana6
1. Syreon Research Romania, 540004 Tirgu Mures, Romania; lorenzovici@syreon.ro
2. Department of Endocrinology, Carol Davila University of Medicine and Pharmacy, 34-38 Aviatorilor blvd, 011863 Bucharest, Romania
3. Department of Public Health and Health Management, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
4. Medinteractiv Romania. Bucharest
5.Amgen Romania
6.Department of Endocrinology, National Institute of Endocrinology Cl Parhon, 34-38 Aviatorilor blvd, 011863 Bucharest, Romania

To estimate hospitalization costs and productivity lost for osteoporotic fractures (OF) in Romania.
In this retrospective database study we (1) used 2019 claims data for hospitalisations in patients ≥ 50 years old with primary/secondary diagnoses codes of OF; (2) calculated patient level hospitalization costs for these cases from 6 sample hospitals (2 university, 2 county, 2 city); (3) for each sample hospital/fracture type, costs were weighted and extrapolated nationally based on the national level reported cases; (4) calculated the national hospitalization cost for OF; (5) calculated costs of working days lost and life years lost in patients aged 50-64 years using the 2019 average national gross salary (€1,088/per month) and assuming 28 days missed for upper limb/small fractures and 72 work days missed for lower limb/vertebral/other major fractures; (6) converted costs from local currency to Euros (€) using the national average 2019 conversion rate.

We identified a total of 51,744 hospitalisation episodes for OF in 2019 nationwide, including 23,508 hip/femur (45%); 2,538 vertebral (5%) and 25,698 fractures affecting other sites (50%). Actual patient numbers are lower since a patient may have more than one hospitalisation episode for OF. Average length of stay was 9 days. Hospitalization costs were calculated in a sample of hospitals, results were weighted and extrapolated to national level. Sample hospitals recorded a total of 4,290 discharges for OF, including 2,409 [56%] hip/femur, 184 [4%] vertebral and 1,697 [40%] other sites. In the sample hospitals overall mean (95% CI) hospitalization cost was €2,313 (€2,243-2,384) per fracture. This extrapolated to a mean weighted national inpatient cost of €2,222 per fracture, with the highest costs attributed to hip/femur fracture (€2,666) followed by vertebral (€2,547) and other sites (€1,787). Nationwide hospitalization costs for OF care in 2019 were €115.1 million. In patients aged 50-64 years, work days missed and premature deaths (n=112) were estimated to cost €30.5 million and €8.9 million, respectively.

Study results suggest substantial 2019 hospitalization costs and indirect costs associated with OF, which place a considerable pressure on the Romanian healthcare budget. This burden will increase in the future, since it is expected that the share of the population aged ≥ 50 years will increase in the next years.
Key words: osteoporosis, fracture, hospitalisation, productivity lost, indirect costs


The comparative assessment of the strategic pharmaceutical support in a crisis – aqualitative study of Romania and United States of America

Constantin Cristian Popescu1,2,
Mihaela Simona Subtirelu3,*,
Adina Turcu-Stiolica3
1Doctoral School, University of Medicine and Pharmacy of Craiova, Craiova, Romania
2Bucharest Pharmaceutical Center, Ministry of National Defense, Romania
3 Department of Pharmacoeconomics, University of Medicine and Pharmacy of Craiova, Craiova, Romania
Corresponding Author: Mihaela Simona Subtirelu, Department of Pharmacoeconomics, University of Medicine and Pharmacy of Craiova, Craiova, Romania,mihaela.subtirelu@umfcv.ro

The civil medical system is organized and structured in such a way as to respond to case studies under normal conditions. In crisis situations that generate multiple victims, to ensure the efficiency of the medical act, it is vital to have specific procedures, means and resources. American partners have superior experience generated by the challenges they face frequently. From the hurricanes that cross their territory, to the devastating fires, to the military conflicts in which they are involved on the world map. They have thus developed strategies and deployed resources, constantly improved the mode of operation, reaching today exemplary performance. Thus, from the warehouse located in Germany, it provides medicines, equipment and sanitary materials for its own personnel and wounded combatants from three continents. Our analysis identified eight main strategies to improve pharmaceutical chain in United States of America: (1) warehouse of medicines and sanitary materials; (2)available stocks of medicines and sanitary materials (viable strategy for stock refresh); (3) specific strategy for the organization of specialized pharmaceutical support in calamity situations or armed conflicts; (4) specific strategy and procedures for ensuring the flow of pharmaceutical resources in crisis situations; (5) specialized pharmaceutical staff trained and tested to intervene effectively in case of crisis (training programs); (6) availability of specialized mobile means of transport, storage and distribution; (7) preparing the civilian population for medical emergencies; (8) stocks of blood and blood derivatives and specialized transport containers. In Romania, we observed only strategy (1) and partially strategy (6). In conclusion, given the existence of the risk of an earthquake with devastating effects, or Romania’s involvement in an armed conflict, it is necessary to prepare a national strategy, trained human resources and specialized materials – including pharmaceuticals – to respond promptly and effectively to the effects of exceptional crisis.


Analysis of antibiotic consumption in an Anesthesia and Intensive Care Unit

Floriana Elvira Ionica1*, Marina Alina Lungu2, Sandra Alice Buteica1.

1 – University of Medicine and Pharmacy Craiova, Romania
2 – County Emergency Clinical Hospital Craiova, Romania

Keywords: antibiotic consumption, microbial strains, antibiotic resistance.

World Health Organization, estimates that infectious diseases are responsible for 1/3 of global deaths and the major cause of this rate is microbial resistance to antibiotics. According to the 2019 WHO report, antimicrobial resistance is responsible for the deaths of 700,000 people, while it estimates that by 2050 the figure will be increased up to 20 million, costing over $2.9 trillion.
Multidrug resistant microbial strains represent a major risk for health security worldwide.

Materials and method
We analyzed the microbial strains isolated from patients who were hospitalized in the Anesthesia and Intensive Care Unit and the antibiotics consumption in the 1st quarter of 2018 compared to 1st quarter of 2019.

Results and discussion
According to the frequency of isolation, we found that methicillin-resistant Staphylococcus aureus and genus Klebsiella, registered the highest number of isolated strains, both in the 1st quarter of 218 and the similar period of 2019. However, we observed a significant increase in Acinetobacter and Streptococcus pneumoniae strains in 2019, compared to 2018.
We noticed a lack of concordance between the antibiotics tested by the laboratory and those existing in the hospital pharmacy.
The initiation of antibiotic therapy was generally based on the personal clinical experience of the prescriber physician and the antibiotic was subsequently modified according to the antibiogram. The underfunding from 1st quarter of 2019 and the non-supply of some antibiotics (colistin, carbapenems) led to a lower consumption value (231018.9 lei) compared to 1st quarter of 2018 (138967.6 lei).

Antibiotic resistance increases the costs of treatment due to the long duration of hospitalization, the use of treatment with more expensive antibiotics.
The collaboration of the clinical pharmacist and the prescriber/infectious disease physician is absolutely necessary for the development of an antibiotic stewardship plan at the ward/ medical unit level.

Corresponding Author: Floriana Elvira Ionica, floriana.ionica@umfcv.ro



Evelyn Cristescu , Sindicat Promedica,Romania
The issue of necessary medical personnel coverage in various areas of Romania, as well as different medical specialties, directly implicates all the main role players of the healthcare system, including the Health Ministry, the College of Physicians and all the Unions of the medical professions.
Therefore, the Health Ministry has used the Strategic Multiannual Plan for Development of Human Resources in Health (part of the National Plan for Recovery and Resilience) as a framework to allow for developing human resource policies with the purpose of solving this problem.
The Health Ministry and the College of Physicians in Romania are looking for the proper means to successfully attract medical professionals to the geographic areas and medical specialties that lack personnel, and also for them to maintain those positions.
It is no secret that in the absence of the medical infrastructure that would allow for practicing under similar conditions as those found in teaching hospitals, the hospitals/medical facilities in the rest of the country will not be able to attract neither doctors, nor patients. And in this problem, only great collaboration between the manager of the healthcare facility, local and central administrations and the Health Ministry could yield the desired results. 
Identifying step-by-step solutions to uniformly provide medical personnel, considering the particular needs of each local community, can only begin by auditing the actual situation, by quantity as well as quality. It is expected that it be a common effort of all the involved actors.
The Promedica Union, by means of the present paper, aims to contribute to the identification of possible solutions for attracting and retaining medical professionals in the areas and medical specialties that suffer from their absence.


Difficulties in the operation of hospitals from the perspective of using public funds: efficiency, effectiveness and economy (3E)

The present paper represents an investigation into the difficulties in that incur during the operation of hospitals from the perspective of using public funds. This analysis will be conducted from three angles: efficiency, effectiveness and economy (3E). According to the National Health Strategy 2014 – 2020 (Strategy), the Ministry of Health establishes strategic directions and works, in collaboration with relevant actors, to ensure fair access to quality, cost-effective health services, as close as possible to individual and community needs, in order to improve the health status of the Romanian population. The basic principles of the Strategy are the following: equitable access to services, cost-effectiveness, evidence-based, optimization of health services, with an emphasis on preventive services and interventions, decentralization, partnership with all actors that can contribute to improving the state of health. After having conducted the SWOT analysis of the hospitals in Romania and the adjacent econometric analysis , we have identified multiple difficulties faced by the system, such as: the evaluations made so far at the level of health systems treat problems in a non-systemic way, a performance audit of the system is required based on an x-ray, a panoramic image of all its components in order to formulate practical recommendation for the resource management in the healthcare system that still remains a great challenge. As a major conclusion that we draw is the fact that, despite efforts, the Ministry exhibits chaotic behavior at multiple levels, despite the attempts of individual hospitals to optimize their activity, and that, so far, it does not have the ability to achieve its mission for policy coordination.
Claudia BOGHICEVICI* – Corresponding author ,University of Craiova, Doctoral School of Economic Sciences, Craiova, Romania, c.com77@yahoo.com.


Cost-effectiveness of Cerebrolysin Add-on Treatment for Neurorecovery after Ischemic Stroke

Diana Grad(2,3), Ștefan Strilciuc (1,2), Constantin Radu (2) Adina Stan(1,2) , Dafin Mureșanu(1,2)
1. Department of Neurosciences, “Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
2. RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
3. Department of Public Health, Babeș-Bolyai University, Cluj-Napoca, Cluj, Romania

Stroke continues to be one of the leading death and disability causes worldwide (62.4% cases being ischemic stroke cases). Cerebrolysin, a promising biological agent that mimics the biological action of neurotrophic factors, has been recently included in several clinical guidelines and is particularly recommended as add-on treatment in moderate–severe cases. We performed the first cost-utility analysis for the Cerebrolysin agent as add-on treatment for moderate-severe ischemic stroke. Appraisal of the cost-effectiveness of Cerebrolysin add-on therapy for acute ischemic stroke by calculating ICER values for different costing scenarios using deterministic and probabilistic methods was performed based on the following steps: deriving utilities for the intervention and standard of care; extracting acute ischemic stroke costs; calculating the incremental cost-effectiveness ratio of Cerebrolysin add-on therapy for ischemic stroke using a deterministic approach; and probabilistic sensitivity analysis. Our sample of analysis consisted of 193 patients (Cerebrolysin group = 100), mostly male, with a mean age ranged between 64.7 and 63.1 years. The QALYs calculated using the utilities resulted from SF-36 to SF-6D conversion were aggregated by health state valuation model: standard gamble (0.698 Cerebrolysin vs. 0.643 placebo), ordinal (0.704 Cerebrolysin vs. 0.647 placebo), and Bayesian posterior mean (0.653 Cerebrolysin vs. 0.613 placebo). The lowest and highest ICER values were 7,159 EUR/QALY and 37,219 EUR/QALY. Assuming that Cerebrolysin add-on therapy generates no additional costs with extra hospitalization, it can be concluded that the agent is cost-effective in 99% of cases given a higher willingness-to-pay threshold and in 80% of the time considering a lower threshold. This study has several limitations: a mismatch between the populations used to input costs, study design (is neither a full trial-based CEA, nor a pure, model-based CEA, but has elements of both).


Cerebral venous thrombosis: a challenge to hospital management

Hanna Dragos1,2, Adina Stan1,2,3, Stefan Strilciuc1,3,4, Paul Panaitescu5, Dafin F Muresanu1,2,3
1 RoNeuro Institute for Neurological Research and Diagnostic, No. 37 Mircea Eliade Street, 400364, Cluj-Napoca, Romania
2 Emergency County Hospital Cluj-Napoca, Neurology Department, Cluj-Napoca, Romania
3 Department of Neurosciences, “Iuliu Haţieganu” University of Medicine and Pharmacy, No. 8 Victor Babes Street, 400012, Cluj-Napoca, Romania
4 Department of Public Health, Babes-Bolyai University, No. 7 Pandurilor Street, 400376 Cluj-Napoca, Romania;
5 Department of Microbiology, “Iuliu Haţieganu” University of Medicine and Pharmacy, No. 8 Victor Babes Street, 400012, Cluj-Napoca, Romania.
Corresponding author: Hanna Dragos, RoNeuro Institute for Neurological Research and Diagnostic, No. 37 Mircea Eliade Street, 400364, Cluj-Napoca, Romania

Health policies in transitioning health systems are rarely informed by the social burden and the incidence shifts in disease epidemiology. Cerebral venous thrombosis (CVT) is a type of stroke affecting more often younger adults and women with higher incidences reported by recent studies.
A retrospective hospital-based population study was conducted at Cluj-Napoca Emergency County Hospital across a 5-year period between 2017 and 2021. The overall incidence and the rates on distinctive gender and age groups were assessed. Also, length of hospital stay (LHS), modified Rankin Score (mRS) and mortality at discharge and at 3 months were calculated.
Fifty-three patients were included. The median age of 45 years old and 64.2% were women. In our population of 3043998 person-years, 53 CVT cases resulted in an incidence of 1.74 per 100000 (95% CI 1.30-2.27). CVT incidence was higher in women (2.13 per 100000, 95% CI 1.47-2.07). There was a statistically difference in LHS between patients with different intracranial complications (Kruskal-Wallis, p=0.008). Discharge mRS correlated with increasing age (rs=0.334, p=0.015), transient risk factors (Fisher’s exact test, p=0.023) and intracranial complications (Fisher’s exact test, p=0.022). Also, mRS at 3 months was statistically associated with increasing age (rs=0.372, p=0.006) and transient risk factors (Fisher’s exact test, p=0.012). In hospital-mortality was 5.7% and mortality at follow-up was 7.5% with higher rates in women (5.9%, respectively, 8.8%).
To our knowledge, this is the first study on CVT incidence on a Romanian population in the last decade comparing regional data with cross-sectional studies from different income level countries. Our findings may provide insight regarding the epidemiological features of certain patient groups more exposed to develop CVT and its complications, informing local and central stakeholders efforts to improve standards of care.


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