FARMAKOEKONOMIKA. Modern Pharmacoeconomic and Pharmacoepidemiology

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Vol 8, No 4 (2015)
View or download the full issue PDF (Russian)


3-9 787

The article analyzes the Russian and foreign approaches to the disclosure of the terms "effectiveness", "productivity", "efficiency". Identified, analyzed concepts are closely related, however, there is currently no generally accepted formulations, which can lead to misunderstandings, errors in managerial decision-making needs to be redressed. Recommendations on fixing these concepts in normative legal and methodical documents regulating, in particular the development of science, and establishing indicators of results, efficiency and effectiveness of research organizations. 

Original Article

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Life expectancy to healthcare spending ratio differs significantly among the Russian regions. The differences could be explained with both non-discretionary factors and the regional management efficiency. The main aim of this article is to evaluate the efficiency of the regional healthcare in Russia employing the formal methodological approach. We use three-step data envelopment analysis (DEA) in order to (1) calculate the technical efficiency scores for regional healthcare systems, (2) determine non-discretionary factors affecting the scores and (3) exclude the non-discretionary component from scores to asses the management efficiency. Using data for 76 Russian regions in 2006-2013 we found approx. 27% regional healthcare spending inefficient, which equals to real 269-435 billion rubles of inefficient spending annually. 

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Introduction. Extent and financial expenses for the delivery of health care in hospitals are planned within the framework of the annual approval of the Program of state guarantees of the free public delivery of health care (PSG), as well as of Territorial programs of state guarantees of the free public delivery of health care (TPSG). The research purpose is to carry out the comparative analysis of norms of extent and financial expenses for the unit of delivery of health care in hospitals, established at the federal and regional levels within the frameworks of PSG and TPSG in 2015. Materials and methods. Comparative analysis of norms of the delivery of health care in hospitals (norms of extent and financial expenses per extent unit), established by PSG and TPSG for 2015. The above regional norms have been analyzed in eight entities of the Russian Federation (Моscow, Saint-Petersburg, Stavropol region, Novosibirsk region, Khabarovsk region, Sverdlovsk region, Volgograd region, Nizhny Novgorod region), representing eight federal districts of the Russian Federation. Results. PSG and TPSG annually undergo changes, including those related to norms of the delivery of health care and extent of financial expenses, including the segment of hospital health care. During the last years, not only values of such indices have changed (reduction of norms of extent, as well as the growth of norms of financial expenditures per extent unit in hospital conditions), but also its measurement units (transition from bed days to hospitalization cases). The extent norm, established by PSG in 2015, was 0,193 case per one resident and 0,172 case per one insurant per year; the norm of financial expenses was 63 743,8 rubles and 22 233,1 rubles per one case of hospitalization at the expense of budgetary funds and of funds of the compulsory health insurance system accordingly. Entities of the Russian Federation establish, within TPSG frame works, norms of extent and financial expenses for the delivery of health care in hospitals. Actually, the values of such indices can differ from norms, established at the federal level. In this connection, the budgetary part of norm, not like the compulsory health insurance segment, can considerably differ from federal norms as to extent of health care and financial expenditures. Тhe territorial financial norm of the hospitalization case at the expense of compulsory health insurance funds was not lower than the federal norm in any of the analyzed entities of the Russian Federation. 

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Atrial fibrillation is a serious social and health problems, the most common arrhythmia in practice, leading to an increased risk of death, stroke, heart failure. The results of pharmacoeconomical studies allow to evaluate the quality of drug therapy for atrial fibrillation, find rational drug usage and identify ways to optimize the consumption of medications. The objective of investigation is to hold ABC-, VENand frequency analysis of atrial fibrillation in out-patients to assess their compliance with national and international recommendations. Materials and methods. To analyze the treatment of atrial fibrillation 98 outpatients with atrial fibrillation were randomly selected. Every patient appealed to the reception to the physician at least twice in 2013. The data was recorded in a special card, and then analyzed using ABC-, VENand frequency analysis. Results. For the treatment of patients with different forms of atrial fibrillation has been used 114 types of drugs to the INN. Patients received from 3 to 12 drugs. For the treatment of patient with atrial fibrillation it spends an average of 11245.2 rubles per patient, for the treatment of heart disease it spends 8379.51 rubles., that is about 74.5%. The study found that received data is satisfied modern recommendations. The results of frequency analysis showed that the most prescribed drugs are medications with proven efficacy to the quality and duration of life. Conclusions. Data analysis revealed that the percentage volume of drugs between the groups as a whole corresponds to the recommended distribution of drugs.

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Objective – to perform economic evaluation of clinical breast pump for inpatient premature infants breastfeeding. Methods. The cost of providing 100 ml of breast milk (BM) using clinical breast pump and 100 ml of artificial formula (AF) for premature infants were calculated. The total cost of providing BM was measured as: the breast pump cost, the individual pumping set cost and staff costs. The cost of providing AF was calculated using the mean cost per 100 ml for powdered AF and staff costs. Also the cost per averted case of necrotizing enterocolitis (NE) for premature infants when breastfeeding instead of the AF was calculated. The cost of the averted NE was obtained using the difference in cost of feeding during the period, required for NE development and number of patients “needed to treat” (NNT) to prevent 1 NE case derived from the clinical trials. Besides we calculated the BM cost when BM fortifier is added for low-weight infants, the BM cost with the use of another model of clinical breast pump and the cost of liquid AF. Sensitivity analyses of the calculation results to fluctuations in the cost of AF, breast pump, individual pumping set and staff salaries size was conducted. Results. The costs per 100 ml of BM and AF were similar (47.17 и 41.14 rubles, respectively). The cost per averted case of NE was 21 115 rubles within 35 days that is less than NE treatment. The use of the more expensive breast pump model did not affect the results significantly (the difference in cost (in favor of AF) increased by 2 rubles per 100 ml and was 8 rubles per 100 ml). The use of BM fortifier increased the cost of BM up to 176 rubles per 100 ml. The results were mostly sensitive to the individual pumping set and AF costs fluctuations: sensitivity analysis showed that BM became more cost-effective when the price of powdered AF was over 937 rubles per package. Conclusion. The cost of BM is comparable to the cost of AF, with a significant BM clinical benefit. 

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Objectives: To determine the clinical and economical effectiveness of influenza and pneumococcal vaccination in working adults without occupational exposures on respiratory diseases from an employer’s perspective. Methods. The study involved about 2,000 employees of the Joint Stock Company «Russian Railways» (JSCo «RZD») followed for 7 months during the 2013-2014 influenza season to collect data on influenza like illness (ILI) and pneumococcal respiratory like illness. Morbidity estimates from different observation groups was calculated using the Pearson χ2 criterion (with Bonferroni correction, if needed) and using the Marascuillo procedure. The calculations are performed in Microsoft Excel (the applied statistical software was not used). The author presented the method of direct and indirect costs calculation. Pharmacoeconomic evaluation for the JSCo «RZD» was defined according to the impact of the 2013 influenza vaccination programme (292.180 employees were vaccinated). Results. Acute respiratory morbidity was significantly lower in vaccinated employees than in nonvaccinated. The vaccine effectiveness was 73.9% against influenza and 84.6% against pneumococcal respiratory infections. The morbidity differences between tobacco smokers and non-smokers is not proven. Due 292.180 employees influenza immunization the direct costs for JSCo "RZD" amounted to 114.2 million roubles (2.54 million EUR), indirect costs estimated at 1.9 billion rubles (42.2 million EUR). According to the generated modelling, the pneumococcal (PPSV23) immunization programme became cost-effective starting from the second year after vaccination and should continue to increase. 

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Aim. Hospital-based economic analysis for the use of thrombopoietin receptor agonists (TRA) Eltrombopag and Romiplostim has been performed in patients with chronic idiopathic thrombocytopenic purpura (ITP) at the background failure of previous treatment options. Materials and methods. Two models for the cost-minimization analysis (model 1) and analysis of the budget impact TRA usage (model 2) are developed on the basis of Microsoft Excel software. The models are based on hypothesis of the difference between the drugs in terms of clinical efficacy and safety and this hypothesis is grounded on the results of randomized controlled trials (RCT) and indirect RCT comparison. The expenditures for drugs of TRA group and for the medical care including the costs for drugs administration, bleeding treatment, "rescue therapy" and follow-up monitoring during treatment are calculated in the mentioned models. The costs of the RF health system have been calculated taking into account the management peculiarities and financing of medical assistance that allows use the models in all regions of Russia. The study was conducted from September to December 2015. The data of state statistical supervision, registered limit transfer drug prices from the list of life-saving and essential medicines (LSEM), the guide price of the manufacturer in the case of application filing for Eltrombopag inclusion to such list, and standards of the financial expenses per medical care volume unit of RF in 2015 are used for calculations. Results. It was shown that Eltrombopag use as compared to Romiplostim is economically expedient in the patients with chronic ITP at the background of previous treatment failure, being not less effective and cheaper alternative that allows reduce the cost of one patient annual therapy by 2.68 mln. rubles. Budget impact analysis evidences that Eltrombopag application can significantly reduce the spending of budgetary funds for the chronic ITP therapy, at least with the same efficacy. Budgetary spending is decreased by 1.68 bln. rubles over 5 years with a gradual increase of Eltrombopag share in purchase of TRA. Conclusion. Despite the comparable efficacy and safety Eltrombopag is economically sound option of chronic ITP treatment as compared to Romiplostim. 

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