Review articles
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.
Original Article
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.
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
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.
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ISSN 2070-4933 (Online)