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FARMAKOEKONOMIKA. Modern Pharmacoeconomic and Pharmacoepidemiology

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Vol 8, No 2 (2015)
View or download the full issue PDF (Russian)
https://doi.org/10.17749/2070-4909.2015.8.2

Original Article

3-10 981
Abstract
Orphan drugs are used for treatment of rare life-threatening diseases. There is no universal definition of a rare disease and no universal approach to orphan drugs legislation. As a result, decision-making in this field requires results of pharmacoeconomic analysis, which structure and interpretation need a specific approach due to high costs of the drugs and limited sample size. Cost-utility analysis, risk management, and international rare diseases patient registries could be used to solve these problems.
11-15 477
Abstract

Introduction. In the article the clinical and economic analysis of the use of different systems of venous access in the treatment of children with cancer.

Objective: to conduct clinical and economic analysis systems venous access in order to optimize the cost of treatment of children with cancer.

Materials and Methods. The experience of installing and operating the subclavian catheters and implantable venous port systems installed in 2262 for children between the ages of 2 months up to 17 years. To calculate the cost price were taken «Price list of paid medical services» and Rates of the compulsory health insurance.

Results. As the number of annual primary identified children with cancer is on average 3.000 people, according to the price list prices temporarily, for the installation of each of them for a period of treatment five subclavian catheters necessary to spend 227.25 mln. rubles. And the implantations of venous ports – 156.00 mln. rubles. Thus, the savings of using implantable venous port-systems – 71.25 mln. rubles.

Conclusion. Mass introduction of the implantable venous ports will significantly reduce the cost of budgetary funds for the treatment of children with cancer, while lowering the percentage of complications and improve quality of life.

16-24 2754
Abstract

Magnesium deficiency (MD) as a condition connected with wide spectrum of obstetric pathology is more studied and known than in gynecology. Prevalence of MD in patients with gynecological diseases is unknown. The most interesting is connection with hormonal dependent conditions because magnesium plays important role in hormonal metabolism.

Objective. Describe the profile of outpatient women in hormone dependent conditions with MD and evaluate the effectiveness of therapy against MD including quality of life (QoL).

Materials and methods. Study was performed in 21 cities of 7 Russian regions. The disease part included outpatient women in hormone dependent conditions and the product part included outpatient women in hormone dependent conditions with magnesium deficiency and receiving fixed dose combination of magnesium citrate and pyridoxine. For diagnostic of MD doctors used MD questionnaires and magnesium blood level. For estimation of efficacy of the therapy additionally 10-point scale of changes in the MD symptoms severity as well as quality of life questionnaire the World Health Organization WHOQOL-BREF after 4 weeks therapy were used.

Study results. A total of 9.168 women were enrolled. The disease part included 9.168 women and the product part – 2.101 women. Prevalence of MD in group of patients taken hormonal contraceptives was 67.3%; in women with premenstrual syndrome – 73.8%; in patients with climacteric syndrome without menopausal hormonal therapy (MHT) – 72.3%; in patient with climacteric syndrome taken MHT – 79.4%; in patients with osteoporosis – 82.1%; in women with other hormone depended conditions – 76.2%. Effectiveness of the therapy was estimated as full well and well in 89.4%, tolerability – in 92.4% patients. QoL was statistically improved. The survey results indicate that after 4 weeks of the therapy the satisfaction of patients with their physical and well-being significantly increased from 21.1±4.5 to 26.2±3.5 points (p<0.001), psychological increased from 18.2±3.7 to 22.2±3.6 points (p<0.001), assessment of social relations improved from 24.8±4.9 to 28.1±4.4 points (p<0.001), satisfaction with the environment increased from 9.3±2.7% 11.0±2.8 (p<0.001).

Conclusion. High prevalence of MD was revealed in women with hormone depended conditions. Appointment of fixed dose combination of magnesium citrate and pyridoxine reduces MD, effectively eliminates the major symptoms, subjectively and objectively improves the condition of patients, as well as a positive effect on QoL.

25-28 613
Abstract

The aim of the study was to conduct pharmacoeconomic analysis of treatment of patients with trauma and blood loss in the department of anesthesiology and intensive care.

Materials and Methods. The method of analysis of the cost of the disease, including the payment of medical costs for medical services, medicines, food for patients and their contents in the hospital.

Results. When I degree hemorrhage (ATLS) cost of treating patients with injury severity index 39 points (ISS) exceeded the cost of treating patients with the severity of the injury 31 points and made 11 000 and 5600 rubles. respectively. The cost of treating patients with the same injury severity scores were higher in patients with a large amount of blood loss. Thus, in patients with blood loss IV degree hospital costs accounted for 45,000 rubles., and in the treatment of patients with blood loss of I degree – 7200 rubles.

Conclusion. The value of direct medical costs for this group of patients depends on the severity of the injury and the amount of blood loss

29-37 561
Abstract

Purpose: an assessment of clinical efficiency and carrying out the pharmacoeconomic analysis of allergen immunotherapy at patients with mild and moderate allergic bronchial asthma.

Materials and methods. 108 patients were examined with mild and moderate allergic bronchial asthma, of both sexes who were divided into 4 groups depending on their therapy. The period of observation was 12 months. The 1st group were included 35 patients of mild allergic bronchial asthma receiving allergen immunotherapy in combination with antiinflammatory therapy; the 2nd group were consisted of 22 patients of mild allergic bronchial asthma using only basic therapy; in the 3rd group 17 patients of moderate allergic bronchial asthma receiving allergen immunotherapy in combination with antiinflammatory medicine were observed; the 4th group was made by 34 patients of moderate allergic bronchial asthma receiving only basic therapy. At all patient were investigated the function of external respiration, scarification tests, test АСТтм. For the pharmacoeconomic analysis we used the cost-effectiveness ratio.

Results. Our analysis showed that the scheme of treatment at patients of the 3rd group was economically more profitable in comparison with the scheme of treatment at patients of the 4th group. So at the 3rd group in the end of the period of observation was noted significant improvement of the following indicators: FEV1, decrease of day and night dyspnea attacks, quantity of exacerbations, increase of total point of АСТтм test. Despite the larger value of coefficient of expensive efficiency at patients of the 1st group in comparison with the 2nd group, it is necessary to consider that the allergen immunotherapy interferes the progressing of the disease that will compensate the cost of this method of treatment in the future.

Conclusion. We received the results that showed the efficiency of the timely done allergen immunotherapy at patients with the mild and moderate allergic bronchial asthma, and is able tto reduce financial expenses considerably.

38-42 503
Abstract
This articles is devoted to major principles of import substitution regarding drugs within the scope of restriction lists at various levels of the health care system. The article reviews the methodology of import substitution of drugs represented as a systematic and consistent process aimed at reduction or termination of import of medical and drug products by its substitution with similar domestic products at the domestic market of the country.
43-54 729
Abstract

The purpose of the work performed was assessment of cost efficiency of Raltegravir within the schemes of antiretroviral therapy as compared to the schemes on the basis of drugs from the group of protease inhibitors with adult patients with Type 1 HIV infection (HIV-1) that have no experience of treatment.

Materials and methods. In the Markov's model developed for assessment of long-term clinical and economic indicators of efficiency of Raltegravir with adult patients with HIV-1 that have no experience of antiretroviral therapy, pharmacoeconomic analysis of "costs and benefits" was performed in accordance with recommendations of the Panel on Cost-effectiveness in Health and Medicine and with consideration of requirements of specialized Russian manuals. Direct costs for application of the schemes compared were calculated on the basis of applicable norms of financing of the Russian Federation. Consumptions of health care resources and life standard indicators were determined on the basis of foreign studies regarding each of the 18 states of health provided with Markov's model and distinguished according to the number of CD4 cells and viral load.

Study results. It was demonstrated that Raltegravir within schemes of antiretroviral therapy of the first line, as compared to the schemes on the basis of drugs from the group of protease inhibitors with subsequent second line therapy on the basis of non-nucleoside reverse transcriptase inhibitors (including Raltegravir in addition to the optimized treatment at the last stage), was a more cost efficient alternative as it had clinical benefits with affordable additional expenses. The increment cost efficiency rate (ICER) per a year of saved life with consideration of its quality comprised 1,097,078 rubles without exceeding the threshold of readiness to pay for a year of quality life equal to 3 GDP per capita.

Review articles

55-61 826
Abstract

Type 2 diabetes mellitus (T2DM) is one the socially important diseases in the Russian Federation (RF). Dipeptidyl peptidase-4 (DPP-4) inhibitors alogliptin, vildagliptin, linagliptin, saxagliptin and sitagliptin are registered in the RF and included in both russian and international modern guidelines on T2DM.

Objective: to conduct a systematical review on clinical efficacy and safety of alogliptin in comparison with other DPP-4 inhibitors in adults with T2DM.

Methods. We performed a search on efficacy and safety of alogliptin compared with vildagliptin, linagliptin, saxagliptin and sitagliptin in two electronic databases: Cochrane library and Medline up to June 15th, 2015. We also searched reference lists of the relevant articles. Methodological quality of five included articles was assessed.

Results. Patients on alogliptin plus metformin achieved HbA1c <7% more frequently than those treated with saxagliptin plus metformin: odds ratio (OR) 6.41, 95% confidence interval (CI) (3.15; 11.98) vs. 2.17, 95% CI (1.56; 2.95). Indirect comparison of alogliptin vs. saxagliptin or sitagliptin is not appropriate due to the differences in age and prior cardiovascular diseases severity in patients with T2DM, included in randomized controlled trials (RCT) EXAMINE, SAVOR-TIMI 53 and TECOS.

Conclusion. There were no differences in efficacy in T2DM between alogliptin and other DPP-4 inhibitors, apart from in patients on alogliptin plus metformin who achieved HbA1c <7% more frequently than those treated with saxagliptin plus metformin. Indirect comparison of safety of alogliptin vs. saxagliptin or sitagliptin is not appropriate due to the differences in population of T2DM patients included in relevant RCTs; indirect comparison of safety alogliptin vs. vildagliptin or linagliptin is impossible due to the absence of the evidence base.

62-69 443
Abstract
The article gives a review of international experience of using of cost-sharing mechanism to prevent the risk of patient’s moral hazard. Theoretical background and types of cost-sharing, protection mechanisms for vulnerable social groups, national cost-sharing models are considered.


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