FARMAKOEKONOMIKA. Modern Pharmacoeconomics and Pharmacoepidemiology

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Vol 9, No 3 (2016)
View or download the full issue PDF (Russian)

Original Article 

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Objective. The aim was to perform an indirect comparisons of the effectiveness and safety of new oral anticoagulants (NOACs) in the management of venous thromboembolism (VTE).

Material and methods. In the absence of a head-to-head comparisons, indirect comparison was done using the method proposed by Butcher et al.

Results. The indirect comparison included 5 RCTs. Apixaban, rivaroxaban and dabigatran were equally effective in preventing recurrent symptomatic VTE, deep vein thrombosis and pulmonary embolism. Dabigatran increased major bleeding risk compared to apixaban RR=2.36; 95% CI 1.15-4.82 and the risk major or clinical relevant non-major (CRNM) bleedings RR=1.43; 95% CI 1.06-1.93. Dabigatran and apixaban were associated with the significant lower risk of major and CRNM bleeding compared with rivaroxaban RR=1.49; 95% CI 1.17-1.91 and RR=2.13; 95% CI 1.66-2.74.

Conclusions. There were no statistically significant differences between apixaban, dabigatran and rivaroxaban in effectiveness. Apixaban treatment associated with the most favorable safety profile of the NOACs.

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The purpose of our research was to analyze the actual practice of medicine in patients with breast cancer in various regions of the Russian Federation in the framework of state programs of drug provision (procurement of essential drugs (EDPP) and of regional benefits (RBP)).

Materials and Methods. We collected data on dispensed medicines from 42 regions of the Russian Federation, which accounted for 57.58% of the total population and 58.20% of the total number of breast cancer patients who had been registered in the oncological institutions of the Russian Federation in 2013. We collected and studied data on the antineoplastic agents (L01) and hormonal antineoplastic drugs (L02) dispensed through programs of drug supply from federal and regional budgets in 2013 in the regions of the Russian Federation for patients with a diagnosis of «malignant neoplasm of the breast» (C50 International Classification of Diseases, 10th revision).

Results. The number of drugs prescribed to patients with breast cancer in studied regions ranged from 3 to 39 INNs. Among the most commonly used antineoplastic agents were trastuzumab and capecitabine (both used in 92.86% of the regions), and among hormonal antineoplastic drugs were aromatase inhibitors and tamoxifen (95.24% and 100% of the regions of the Russian Federation). Consumption of drugs varied significantly between the

Conclusion. Our study revealed significant differences in the consumption of antineoplastic medications among outpatients with breast cancer in different regions of the Russian Federation whose care was funded by federal and regional budgets.

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Objective. To perform health economic evaluation of several antirheumatic drugs in patients with rheumatoid arthritis (RA) progressed after DMARDs.

Materials and methods. Three consequent line of rheumatoid arthritis therapy in patients progressed after methotrexate were modeled in Russian economic conditions. Markov modelling and CEA accounting for direct medical costs were used. The effectiveness criteria of RA treatment were: patient-years in remission and patient-years in low disease activity. We compared 12 different treatment regimens of second, third and fourth therapy line in patients progressed after methotrexate.

Results. The health economic analysis of different RA treatment regimen after progression on methotrexate showed that evaluated regimens do not differs in terms of effectiveness and safety. At the mean time the model account for the patients compliance and showed that the maximum number of patient-years in remission can be reached with etanercept and tofacitinib treatment. Moreover, above mentioned combination in comparison to adalimumab and infliximab showed the positive budget impact.

Conclusion. The choice of etanercept and tofacitinib in case of similar economics should be done accounting for individual patient features.

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Study objective: pharmacoeconomic evaluation of cephalosporins, protected penicillins and macrolides, most commonly used in the treatment of acute obstructive bronchitis.

Materials and methods. data file of hospitalized patients with acute obstructive bronchitis treatedby antibiotic. The study included 2259 patient’s data files. The age of patients ranged from 0 to 18 years old. «Cost-effectiveness» analysis was used for comparing of the costs and effectiveness for courses of antibiotics, used in therapy of acute obstructive bronchitis.

Results. It is shown that a pharmacoeconomic standpoint, Ceftriaxone (Sintez) was the most effective antibiotic of the cephalosporin group in the treatment of acute obstructive bronchitis in children. The original drug Augmentin (Smithkline Beecham Pharmaceuticals) and generic Amoxiclav (Lek d.d) were used from the group of protected penicillins (combination amoxicillin / clavulanic acid). The effectiveness of Augmentin (0.591) and Amoxiclav (0.530) was comparable. The Augmentin’s course of therapy characterized by a lower value CER in comparison with Amoxiklav. From the pharmacoeconomic point of view treatment course of Azithromycin (Vertex) was the most appropriate of the macrolide antibiotic in the therapy of acute obstructive bronchitis,. The highest value ICER ratio was obtained for Sumamed (Teva), and it amounted to 39 367.50 rubles. Sumamed was characterized by the highest clinical efficacy. Besides Sumamed is original azithromycin. Azitromicin generics Azitral and Hemomitsin had the lowest ICER after Azithromycin (1151.67 rubles and 1812.22 rubles, respectively).

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Aims of study: 1) development of a model for forecasting of impact of Lacosamide administration for antiseizure therapy of local convulsions in patients, who are resistant to previous antiseizure therapy, for the account of healthcare and social security budget of the constituent members of the Russian Federation; 2) assessment of clinical and economical feasibility of Lacosamide administration from the point of view of healthcare and social security budget of the constituent members of the Russian Federation, by example of Kaliningrad region.

Materials and methods. General model of Microsoft Excel was developed for analysis of impact of Lacosamide administration to healthcare and social security budget of the constituent members of the Russian Federation in three scenarios: Lacosamide as concomitant drug to standard therapy in comparison with standard therapy without Lacosamide (scenario 1), Lacosamide in comparison with Perampanel, both as concomitant drug to standard therapy (scenario 2) and early administration of Lacosamide as the first concomitant drug to standard monotherapy in comparison with its late administration (scenario 3). The Model allows calculation of the direct medical costs (for the drugs and medical services) and direct non-medical costs (payment of temporary and permanent disability allowances) from the point of view of healthcare and social security system of a constituent member of the Russian Federation. The simulation uses the results of clinical studies and meta-analyses of the antiseizure drugs under consideration, data of state statistical monitoring, and results of previous epilepsy burden analysis conducted in the Russian Federation. The costs in model are calculated on the basis of registered prices on drugs from the List of vital and essential medicines (VEM), price of public purchases of drugs and regulations of financial costs per unit of medical aid in Russia in 2015. We conducted the analysis of impact of Lacosamide administration to the budget of the constituent member of the Russian Federation by example of Kaliningrad region.

Results. Scenario 1: in case of increase of total costs by 6.75%; 10.42% and 17.38% in the first, second and third year respectively, administration of Lacosamide as concomitant drug, in comparison with standard therapy without Lacosamide, allows to obtain additional therapy response in 4, 6, 11 patients and remission in 1, 1 and 2 patients, who are resistant to the previous antiseizure therapy. Scenario 2: Taking into consideration the commeasurable efficacy and safety, the economic advantages of Lacosamide over Perampanel are 1.64, 2.65, 4.74 million rubles in the first, second and third year respectively. Scenario 3: administration of Lacosamide as the first concomitant drug after the failed monotherapy allows reaching of the increased therapy response rate and remissions number in comparison with Lacosamide administration as the second concomitant drug and reduce the budget expenses for antiseizure therapy by 11.45 and 1.85 million rubles in the first and the second year respectively.

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Objective. Comparative analysis and monitoring of the population’s attitude to medicines through an assessment of their consumer qualities by visitors of pharmacies.

Materials and Methods. Conducted two sociological survey thru the original questionnaires in 2002 and 2015 among pharmacy customers. Each survey included 380 respondents living in the cities of Central Russia. During the interviews, respondents were asked, among other things evaluate the 13 influencing their choice of consumer qualities of medicines. Six of these qualities characterize the pharmaceutical features and merchandising options are seven parameters of medicines. Statistical analysis used a set of indicators of variation statistics, ranking, rank correlation.

Results. Ratings of consumer qualities of medicines are obtained for the studied years and changes in the whole period of monitoring. We have identified the priority characteristics of medicines which are essential for consumers, in particular: efficiency, clear information on the package, low cost, minor side effects, convenient way to receive.

Conclusion. The revealed features of consumer attitudes to medicines should be taken into account pharmaceutical workers in information and consultative dealing with pharmacies visitors.

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Early health technologies assessment (HTA) is a form of HTA, which takes place at early stages of the life cycle of medical technology. This method allows us to optimize the design of clinical trials to prove the economic benefits of new technologies, to assess the need for follow-up phases of clinical trials, to predict the probability of formulary inclusion, and to define socially acceptable price.

Foreign Experience 

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The growth of cost of healthcare services becomes more and more serious problem throughout the world. In the context of no limitations with respect to both scope of consumption and cost of the services, due to application of innovational treatment methods, the cost of medical aid, rendered to the citizens free of charge, has almost no upper limit. In light of this, the alternative strategies of more efficient and fair funding of healthcare, being the subject of this article, are searched throughout the world.

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