Preview

FARMAKOEKONOMIKA. Modern Pharmacoeconomics and Pharmacoepidemiology

Advanced search

Medical care payment improvement within diagnosis-related groups of patients with severe asthma requiring biologic disease-modifying drugs by regional adaptation mechanism in the Moscow Region

https://doi.org/10.17749/2070-4909/farmakoekonomika.2021.093

Full Text:

Abstract

Objective: scientific rationale of changing approaches to medical care payment for hospitalization of patients suffering from severe asthma (SA) that require the prescription of biologic disease-modifying drugs (bDMDs) within the constraints of diagnosis-related groups (DRGs) on the level of the Moscow Region.

Material and methods. For the federal model regional adaptation, the authors used the mechanism of subgroups selection in the structure of basic DRG No. 336 st36.003 and No. 139 ds36.004 “Treatment with biologic disease-modifying drugs and selective immunosuppressants” in the round-the-clock (RH) and day-time hospital (DH). Budget impact analysis (BIA) was performed to provide scientific and economic feasibility for the improvement of medical care payment for bDMDs proscribed to patients with SA within DRG at the level of the Moscow Region.

Results. The analysis of cost of drug therapy and medical services per 1 case of hospitalization of patients with SA, that required bDMDs therapy, considering the classification criterion (international nonproprietary name of drugs and drug therapy regimens), showed 10 subgroups in DRG No. 336 st36.003 (level 1) and 9 subgroups in DRG No. 139 ds36.004. Expert estimates on the rate of hospitalizations and drug dosage regimen indicated for patients with SA were used to calculate the relative cost weights (CW). The highest CW was observed in the subgroup that received benralizumab in RH (CW=7.46) and in DH (CW=12.08) conditions. BIA demonstrated 110,103,901.53 rubles (or 31%) budget savings for the health care system of the Moscow Region.

Conclusion. The implementation of the adapted DRG federal model in the conditions of the health care system of Moscow Region is an economically feasible approach to the organization of the inpatient medical care provided to patients with SA needing bDMDs prescription.

About the Authors

A. D. Ermolaeva
Scientific and Practical Center for Clinical and Economic Analysis of the Ministry of Health of the Moscow Region; Sechenov University
Russian Federation

Alina D. Ermolaeva – PhD (Pharm.), Senior Researcher, Department of Monitoring and Analysis of Drug Supply; Assistant Professor, Chair of Organization and Economics of Pharmacy, Nelyubin Institute of Pharmacy

4 lit. A Karbysheva Str., Krasnogorsk 143403, Russia
8/2 Trubetskaya Str., Moscow 119991, Russia



V. S. Krysanova
Scientific and Practical Center for Clinical and Economic Analysis of the Ministry of Health of the Moscow Region; Sechenov University; Medical Institute of Continuing Education, Moscow State Food Production University
Russian Federation

Vera S. Krysanova – Researcher, Department of Clinical and Economic Analysis; Postgraduate, Chair of Clinical Pharmacology and Propaedeutics of Internal Diseases, Sklifosovsky Institute of Clinical Medicine; Lecturer, Chair of Therapy with a Course of Pharmacology and Pharmacy. RSCI SPIN-code: 6433-2420

4 lit. A Karbysheva Str., Krasnogorsk 143403, Russia
8/2 Trubetskaya Str., Moscow 119991, Russia
11 Volokolamskoye Shosse, Moscow 125080, Russia



T. N. Ermolaeva
Scientific and Practical Center for Clinical and Economic Analysis of the Ministry of Health of the Moscow Region
Russian Federation

Tatiana N. Ermolaeva – Head of Department of Clinical and Economic Analysis. Scopus Author ID: 57201733836; RSCI SPIN-code: 2573-8990

4 lit. A Karbysheva Str., Krasnogorsk 143403, Russia



K. I. Polyakova
Scientific and Practical Center for Clinical and Economic Analysis of the Ministry of Health of the Moscow Region
Russian Federation

Ksenia I. Polyakova – Аnalyst, Department of Clinical and Economic Analysis. RSCI SPIN-code: 4706-8387

4 lit. A Karbysheva Str., Krasnogorsk 143403, Russia



K. A. Kokushkin
Scientific and Practical Center for Clinical and Economic Analysis of the Ministry of Health of the Moscow Region
Russian Federation

Konstantin A. Kokushkin – Director

4 lit. A Karbysheva Str., Krasnogorsk 143403, Russia



References

1. Zyryanov S.K., Diyakov I.N., Avdeev S.N. Pharmacoeconomic analysis of using biological agents for uncontrolled moderate-tosevere atopic asthma in the Russian Federation. FARMAKOEKONOMIKA. Sovremennaya farmakoekonomika i farmakoepidemiologiya /

2. FARMAKOEKONOMIKA. Modern Pharmacoeconomics and Pharmacoepidemiology. 2019; 12 (4): 268–78 (in Russ.). https://doi.org/10.17749/2070-4909.2019.12.4.268-278.

3. Il’ina N.I. The burden of bronchial asthma. Problems of Russia. Effektivnaya farmakoterapiya / Effective pharmacotherapy. 2014; 33 (2): 28–9 (in Russ.).

4. Anaev E.Kh., Knyazheskaya N.P., Belevskiy A.S. Targeted therapy for severe eosinophilic asthma: choosing the right biologic drug. Prakticheskaya pul’monologiya / Practical Pulmonology. 2019; 3: 15–24 (in Russ.).

5. Nenasheva N.M. Severe eosinophilic bronchial asthma: new therapeutic options. Meditsinskiy sovet / Medical Council. 2018; 15: 44–52 (in Russ.). https://doi.org/10.21518/2079-701X-2018-15-44-52.

6. Hyland M.E., Whalley B., Jones R.C., Masoli M. A qualitative study of the impact of severe asthma and its treatment showing that treatment burden is neglected in existing asthma assessment scales. Qual Life Res. 2015; 24 (3): 631–9. https://doi.org/10.1007/s11136-014-0801-x.

7. Clinical recommendations. Bronchial asthma. 2019. Available at: https://spulmo.ru/upload/kr_bronhastma_2019.pdf (in Russ.) (accessed 04.06.2021).

8. Zyryanov S.K., Butranova O.I. Genetically engineered drugs for treatment of bronchial asthma: recent achievements. Pulmonologiya. 2018; 28 (5): 584–601 (in Russ.). https://doi.org/10.18093/0869-0189-2018-28-5-584-601.]

9. Order of the Government of the Russian Federation No. 2406-r of 12.10.2019 “On the approval of the list of vital and essential medicines for 2020, as well as the lists of medicines for medical use and the minimum range of medicines necessary for the provision of medical care”. Available at: http://www.consultant.ru/document/cons_doc_LAW_335635/ (in Russ.) (accessed 04.06.2021).

10. Letter No. 11-7/I/2-11779, 17033/26-2/i of the Ministry of Health of the Russian Federation and the Federal Fund of Compulsory Health Insurance dated December 12, 2019 “On methodological recommendations on ways to pay for medical care at the expense of compulsory health insurance”. Available at: http://www.ffoms.gov.ru/documents/the-orders-oms (in Russ.) (accessed 04.06.2021).

11. Letter of the Federal Fund of Compulsory Health Insurance dated 21.02.2020 No. 2493/26-1/i “On addition to Methodical recommendations on ways of payment of medical care by means of compulsory health insurance” (with “Instructions on the grouping of cases, including the rules for taking into account classification criteria, and approaches to paying for medical care in outpatient settings”). Available at: http://www.ffoms.gov.ru/news/ffoms/vnimaniyu-uchastnikov-sistemyoms-25-02-2020/ (in Russ.) (accessed 04.06.2021).

12. Sura M.V. Diagnosis-related groups in the system of compulsory health insurance. Possibilities of payment for medical care of patients, who need administration of genetically engineered biological drugs. Medical Technologies. Assessment and Choice. 2016; 1 (23): 24–34 (in Russ.).

13. Sura M.V., Ignatova T.N., Rudneva N.S., Sukhanova Yu.N., Ulyanova N.G., Khudyaev A.S., Shelyakin V.A., Scherbakov D.V. Regional adaptation of the federal model of reimbursement for medical assistance based on clinical statistical groups: hospitalization of patients in need of genetically enginered biological preparations. FARMAKOEKONOMIKA. Sovremennaya farmakoekonomika i farmakoepidemiologiya / FARMAKOEKONOMIKA. Modern Pharmacoeconomics and Pharmacoepidemiology. 2018; 11 (2): 44–52 (in Russ.). https://doi.org/10.17749/2070-4909.2018.11.2.044-052.

14. Omelyanovskiy V.V., Avksentyeva М.V., Sura М.V., et al. Methodological recommendations for assessing the budget impact as part of the implementation of state guarantees program of medical care free provision to citizens. Мoscow; 2016 (in Russ.).

15. Tariff agreement for the implementation of the Moscow Regional Compulsory Health Insurance Program for 2020. Available at: https://xn--d1apaha1c.xn--p1ai/wp-content/uploads/2020/02/ts2020.pdf (in Russ.) (accessed 04.06.2021).

16. Order of the Ministry of Health of the Russian Federation No. 108n of 28.02.2019 (ed. of 25.09.2020) “On approval of the Rules of compulsory health insurance”. Available at: http://www.consultant.ru/document/cons_doc_LAW_324740 (in Russ.) (accessed 04.06.2021).

17. State Register of Medicines. Available at: http://grls.rosminzdrav.ru/Default.aspx (in Russ.) (accessed 04.06.2021).


For citation:


Ermolaeva A.D., Krysanova V.S., Ermolaeva T.N., Polyakova K.I., Kokushkin K.A. Medical care payment improvement within diagnosis-related groups of patients with severe asthma requiring biologic disease-modifying drugs by regional adaptation mechanism in the Moscow Region. FARMAKOEKONOMIKA. Modern Pharmacoeconomics and Pharmacoepidemiology. 2021;14(2):151–166. (In Russ.) https://doi.org/10.17749/2070-4909/farmakoekonomika.2021.093

Views: 260


ISSN 2070-4909 (Print)
ISSN 2070-4933 (Online)