HOMOCYSTEINE TESTING IN PREVENTIVE HEALTHCARE: COMPARATIVE INSIGHTS AND POLICY IMPLICATIONS FOR ALBANIA.

BACKGROUND/OBJECTIVES: There is evidence that suggests a mechanistic link between elevated Homocysteine (Hcy) and Insulin Resistance (IR) through cysteine-homocysteinylation of insulin receptors, impairing receptor maturation and signaling. While testing is available in Albania, it is not reimbursed by the national health insurance scheme, creating inequities in access. The objective of this study was to evaluate the potential of Hcy testing as a preventive biomarker for IR and explore its integration into Albania's health insurance system by comparing it to some of inter-national practices. METHODS: A mixed-methods approach was applied, combining a narrative literature review on the association between Hcy and IR with a comparative policy analysis of testing and reimbursement models in selected European countries (Germany, France, the United Kingdom, Sweden, Greece, and North Macedonia). Data sources included PubMed, Google Scholar, official health insurance documents, WHO country reports, and European Observatory profiles. Clinical thresholds and patient cost estimates were extracted and synthesized. RESULTS: In Albania, routine and preventive laboratory panels are covered by insurance, but specialized tests such as Hcy are excluded, with patients paying privately. In comparison, Germany and Greece provide partial reimbursement under restricted indications, France largely classify testing as self-pay, and the UK covers testing for defined diagnostic contexts but not for screening. Costs varied significantly among countries. CONCLUSIONS: Across Eu-rope, Hcy testing is generally reimbursed only in targeted clinical scenarios rather than for routine screening. Introducing selective reimbursement for high-risk groups in Albania-through a coverage-with-evidence pilot-could enhance preventive strategies against IR, reduce health inequities, and align national practice with European models.