Original Article
Recently, an increase in the incidence of severe forms of prostate cancer, in particular castration-resistant prostate cancer (CRPC) has been noticed. Treatment of CRPC patients is associated with increasing expenses and thus impacts the healthcare budgets at various levels. The aim was to study the pharmacoeconomic aspects of using enzalutamide, cabazitaxel and abiraterone for the second-line therapy of CRPC (after treatment with docetaxel) in the Russian Federation. Materials and Methods. A cost effectiveness analysis of patient management was conducted for each of the three drugs. The direct costs included the costs of visiting the doctor, the diagnostic tests and procedures, the best supportive therapy with other drugs in accordance with the standards, the treatment of adverse events, the end-of-life palliative therapy in hospital, and the costs of prescribing one of the three drugs in question. Results. The expenses for diagnosing, maintaining the treatment regimen, consulting, monitoring and nurse caring in patients with CRPC were 15-20% lower with enzalutamide compared to abiraterone and two-fold lower than that with cabazitaxel. The general assessment of direct costs without the cost of the above drugs showed that the use of enzalutamide was 10% less expensive than abiraterone and 35% less expensive than cabazitaxel. The pharmacoeconomic advantages of enzalutamide over the two other agents are supported by the «decision tree» model and by the cost/effectiveness ratio. Conclusion. The use of enzalutamide is associated with lower direct costs of care, treatment, diagnostic and supportive procedures as compared with abiraterone and cabazitaxel.
Review articles
The process of decision modelling in diabetes mellitus (DM) is often complicated by comorbidity among diabetic patients, complexity of endpoint selection, and unclear time horizons. Aim. To review the available recommendations, relevant methods and mathematical approaches to decision modelling in DM. Materials and Methods. We searched through the PubMed database using the ResearchGate and Mendeley networks; we also collected data from the websites of the key opinion leaders in the field of pharmacoeconomics and decision modelling. Results. This review contains up-to-date information on the validity of the most common DM decision models and on the validity of extrapolating the type 2 DM models to patients with type 1 DM. We also provide some clinically relevant comments on the American Diabetes Association’s requirements concerning the decision models in DM. The review incorporates data on the current mathematical approaches to modelling the changes in glycated hemoglobin levels, the body mass index and the quality-adjusted life expectancy – for both type 1 and type 2 DM. Conclusion. Despite recent successes in DM decision modelling, the existing approaches are not always relevant to some groups of DM patients or to some aspects of the disease. Thus, the use of the novel anti-diabetic drugs (liraglutide, semaglutide, empagliflozin) capable of significantly reducing cardiovascular risks in DM patients, require new approaches to decision modelling in diabetes mellitus.
The article reviews national and international publications on various issues of the free healthcare system. We present and discuss recommendations of the UN, the World Health Organization and the International Labor Organization on full coverage of the population with free medical care.
Foreign Experience
A set of criteria for assessing the innovative potential of drugs (therapeutic value) have been developed and are widely used elsewhere. These approaches allow the state (the payer) to assess the clinical significance of a new medical product and make an educated decision on the reimbursement, cost and priority at the stage of registration. In the Russian Federation though, such criteria and methods are not sufficiently developed. This review describes the principle approaches to assessing the drug innovative potential in countries outside Russia.
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ISSN 2070-4933 (Online)