FARMAKOEKONOMIKA. Modern Pharmacoeconomic and Pharmacoepidemiology

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Vol 11, No 2 (2018)
View or download the full issue PDF (Russian)

Original Article 

3-8 567

Breast cancer remains the most common malignant neoplasm in women. According to the current standards, radiation therapy is one of the most important components of the multi-disciplinary treatment. The efficacy of the postoperative radiotherapy in both the traditional fractionation regimen and in the hypofractionation mode is not questioned. Contrary to the conventional fractionation, hypofractionation implies an increase in the daily dose and a reduction in the total treatment time. This approach helps reduce the treatment costs in patients with breast cancer while maintaining a high treatment efficacy and quality of life.

The aim of the study was to analyze the economic efficiency of the dose hypofractionation as compared to the traditional mode of dose fractionation during postoperative radiation therapy in patients with breast cancer.

Materials and methods. The study included 220 patients with breast cancer who received a combined treatment. Of these, 120 patients (study group) received hypofractionated radiotherapy (40.5 Gy in 15 fractions) whereas 100 patients of the control group were treated by the conventional therapy of 50 Gy in 25 fractions. Patients of the both groups were comparable by stages of the disease, systemic treatment, age and molecular type of tumor. The cost of treatment was calculated from the price list of this research center.

Results. The present economic analysis showed that the method of hypofractionation was more (30% on average) cost-efficient than the conventional regimen while both modalities produced similar rates of total and relapse-free survival. We were then able to identify the main items in the list of medical services that contributed to the estimated difference in the treatment costs. Reducing the number of examinations and the treatment duration help reduce the expenditure of this medical organization.

Сonclusion. Hypofractionation of postoperative radiotherapy in patients with breast cancer allows one to reduce the treatment costs as compared to the conventional fractionation regimen. The funds saved by optimizing the costs of postoperative radiation can be directed to the development of additional means of cancer treatment. 

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The aim: to provide a comprehensive pharmacoeconomic evaluation of the maintenance therapy with antipsychotics in outpatients diagnosed with schizophrenia.

Materials and methods. The analysis was conducted by two mutually complementary steps: an epidemiological study on outpatients with schizophrenia, and a subsequent pharmacoeconomic modeling. Two medical technologies were evaluated and compared: treatment with classical antipsychotics (kA) and treatment with atypical antipsychotics (AA). For the clinical and economic analysis of these treatments, we used a number of indices derived from our retrospective study of patients’ medical records. The cost-effectiveness analysis, incremental analysis, and «budget impact» analysis were performed taking into account the direct and indirect costs of the treatments.

Results. We determined the costs of managing outpatients with schizophrenia from the perspective of the healthcare budget and the social burdens; we also looked into the relevance and effectiveness of the current costs at various time intervals – 6, 12 and 24 months. As shown, the treatment strategies involving AA were more budget-consumptive than the kA treatments. even if the treatments were switched to the reproduced AA (up to 100% replacement), the costs would remain to be higher than those for the kA. The «cost-effectiveness» analysis related to «the proportion of stable patients» for the horizons of 6 and 12 months indicated that the reproduced AA would be more economically effective than the kA. However, when the observation period was increased to 24 months, this economic advantage of AA diminished, and the kA drugs had a lower CeR instead. For the «number of hospitalization-free days per year», the use of AA was more cost-effective only versus the 100% use of reproduced AA at the simulated horizon of 12 months. When the use of 100% reference AA or the combined use of reference + reproduced AA was simulated, the treatment with kA remained more economically effective, regardless of the simulated period.

Conclusion. The pharmacoeconomic simulation of the antipsychotic therapy in outpatients with schizophrenia suggests the ways to optimize the treatment. Among them, (a) using AA for the treatment of at least 15.6% of patients (those who are employed); keeping the ≥60% use of kA to ensure the optimal resource-saving effect of the treatment; (b) using reproduced AA at the level of ≥70% (instead of the reference AA similar in efficacy and safety) to keep the treatment economically feasible. 

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Ilmatinib is currently the most widely used tyrosine kinase inhibitor for the treatment of chronic myeloid leukemia (CML) in Russia. When patients develop resistance or intolerance to imatinib, second generation tyrosine kinase inhibitors (Tkis) are used. in Russia, nilotinib, dasatinib and bosutinib are registered in second-line, however only dasatinib is included in the government drug reimbursement program.

The aim of this study was to conduct a pharmacoeconomic comparison of nilotinib, dasatinib and bosutinib as second-line treatments for patients with CML from the Russian healthcare system perspective.

Materials and methods. Using the clinical trial data we developed a Markov model of CML progression on nilotinib, dasatinib or bosutinib second-line therapy and calculated the medical costs per patient. Both costeffectiveness analysis and budget-impact analysis reflected the local practice and the drug reimbursement approval process.

Results. The average medical cost (per year) for nilotinib (1 683 thousand rubles or US$27 075) was 8.4% lower than that for dasatinib and 35.2% lower than for bosutinib. The 4-year total medical cost of treatment with nilotinib was 4 372 thousand rubles (US$ 70 336), which was 13.9% lower compared to dasatinib and 37.3% lower compared to bosutinib. nilotinib also had a lower cost/effectiveness ratio (US$ 1 602, 1 910 and 2 537 per life month for nilotinib, dasatinib and bosutinib, respectively). The estimated number of patients in Russia who need second-line treatment for CML is 996 patients. if nilotinib were included in the Government Reimbursement Program, a saving of 771 million rubles (US$ 12,4 million) over four years would be reached.

Conclusions. When compared with dasatinib or bosutinib, nilotinib is the cost-saving option for the second-line treatment of CML patients in Russia. 

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in the context of optimizing the financial mechanisms of the national healthcare system, introducing the single-channel financial principle and further developing the insurance-based medicine in Russia, a competent financial accounting becomes an important element of the entire healthcare system.

Aim – compare the economic effectiveness of various methods of closing a loop ileostomy.

Materials and methods. The study included 327 patients randomized into 3 groups. in group 1, the closure of an ileostomy was performed manually with the formation of an end-to-end ileo-ileoastomosis; in group 2, the anastomosis was formed in the ”side by side” manner; and in group 3, a semi-automated surgical technique was used for the anastomosis formation.

Results. The average cost of the treatments (per patient) in groups 1 and 2 was 131,704.90 rubles. and 145,473.70 rubles, respectively, while in group 3, the cost was higher – 167,443,60 rubles (p <0,001). This cost increase in Group 3 was mainly due to the cost of a disposable stapler and cassettes.

Conclusion. The formation of a manual ileoileoanastomosis of the end-to-end type was less budget-consuming in comparison with the other methods. The semi-automated procedure based on disposable parts was the most expensive method of closing a loop ileostomy.

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The existing model of financial support of medical assistance for clinical-statistical groups (CSGs) in 2018 provides for the reimbursement for hospital stay expenses by the compulsory medical insurance fund in patients claiming the need for genetically engineered biological products (GiBP) during their stay in a day-care or 24-hour inpatient facility. The payment is made to CSG no. 121 in a day care and to CSG no. 316 in a 24-hour inpatient facility. The heterogeneity of the expenses for therapy with GiBP necessitates further division of the Federal CSGs into subgroups located in the constituent parts of the Russian Federation. This process has been initiated in some parts of the country, and it is seen as a way of regional adaptation of the Federal Medical insurance model. The proposed subdivision of the Federal CSGs allows for setting the tariffs reflecting the real expenses incurred by a local medical organization due to the therapeutic use of GiBP. The models of such specific CSGs proposed by RF subjects (after an expert evaluation) can be taken as a basis for updating the Federal CSG model, taking into account the differences in the costs of different drug therapy regimens.
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This article addresses the implementation of Federal Law no. 2300-1 dated February 7, 1992 «On the Protection of Consumer Rights» regarding the organization and provision of paid medical assistance. We propose recommendations on properly drafting a contract for the provision of these services. The tasks and challenges of providing the paid medical assistance to the public are analyzed. The adequate timelines, the choice of treatment and the optimal strategies, including those in dental practice, are also discussed.

Foreign Experience 

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in the present article, we review the ways of introducing medical products into healthcare practice in countries of the european Union and compare them with the Russian experience. in this analysis, we underscore the existing differences but also identify the common aspects, for example, the mandatory stage of integrated assessment; all those are described in detail in the review. The eU experience should be considered when introducing medical products into the healthcare practice in the Russian Federation. The comprehensive assessment of new technologies will provide for the transparency of the proposed system.
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Departmental medicine as a Russian-specific healthcare system is currently subject to broad discussions on whether its further support and financing is worthwhile. The Defense Ministry of the Russian Federation has one of the most developed healthcare systems in Russia and thus provides medical care to the military personnel and the veterans. This report aims to review the current practice of organizing and financing the medical assistance for the military in seven developed countries (USA, Uk, Canada, Germany, France, Finland and Singapore) in order to use their experience for the optimization of the Russian military departmental healthcare. This review covers the general principles of healthcare in these countries as well as the specific mechanisms of health care provision for the military.  The Departments of Defense in the reviewed counties have special agencies that provide medical services to the military personnel. The primary role of such agencies is to promote, protect and restore the health of servicemen and servicewomen and to ensure they are ready and fit to perform their missions.  As shown in the present review, the specific details of the medical assistance to the military differ between the countries and largely depend on the overall structure of the national healthcare system.

Comments and Opinions 

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The aim – to review and analyze the data on the long-term population-based efficiency of the screening procedures and other measures implemented according to Stage 1 periodical health checkup in the Russian Federation (by Order №36ан of 2015).

Material and methods. This systematic search was carried out independently by two authors who used four databases: Scientific electronic Library, Cochrane Library, Medline/PubMed, and USPSTF. They looked into systematic reviews quoted by these sources. The criteria of the screening efficacy were the total / specific mortality and disability. The quality of the systematic reviews was assessed by the two authors using the international AMSTAR questionnaire.

Results. According to the specific mortality rate, only the fecal occult blood test and the abdominal aorta ultrasonography are found to be efficient as screening methods for certain age and gender groups. The methodological quality of the studied reviews is high or medium to high. As follows from these high quality studies, the efficacy of mammography in female populations remains to be proven. 

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