FARMAKOEKONOMIKA. Modern Pharmacoeconomics and Pharmacoepidemiology

Advanced search
Vol 12, No 1 (2019)
View or download the full issue PDF (Russian)

Original Article 

5-13 2788

Diseases of the musculoskeletal system and connective tissues are becoming more and more common. As these disorders are associated with temporary or permanent disability as well as a costly treatment, this socially-significant issue requires close attention.
Objective: to analyze the prevalence rate of the musculoskeletal and connective tissue disorders in the Russian Federation. The analysis covers the entire country as well as various regional districts with the aim to identify the districts with the most and the least favorable situation and predict the prevalence of these diseases in Russia for 2018-2019.
Materials and methods: we analyzed the prevalence of these diseases among the population of the Russian Federation for the period 2012- 2017. In this, we used the statistical reports on musculoskeletal and connective tissue diseases in Russia over 2012-2017 issued by the Ministry of Healthcare of the Russian Federation. To predict the morbidity rate for 2018-2019, statistical processing of the primary survey data was carried out with the help of the «TREND» software.
Results: in the period from 2012 to 2017, musculoskeletal system and connective tissue diseases ranked third among the most common diseases. According to the calculated average growth rates, the districts with a relatively high prevalence are the Northwestern and North Caucasian Federal Districts (+ 1.85% and + 1.14%, respectively), and the lowest prevalence was found in the Central Federal District (–1.72%). Among the regions of the Central Federal District, the maximum growth rate was recorded in the Orel Region (+1.97), and the minimum – in the Vladimir Region (–5.47). According to the prognostic models, the prevalence of musculoskeletal diseases per 100 thousand population in the Russian Federation may decrease in 2018-2019 with the following variations: from 12,818,398 to 1,305,502 cases in 2018, and from 12,614,398 up to 12,845.474 in 2019.
Conclusion: according to this forecast, the prevalence rates of these diseases will remain high, therefore, further monitoring of this type of morbidity in the Russian Federation is warranted.

14-26 878

The integrated Model of health care for patients with inflammatory bowel disease (IBD) is based on the creation of specialized centers where multidisciplinary teams provide patient-centered care. Recent studies showed that the introduction of such approach into the IBD treatment practice led to faster diagnosis, an increase in the proportion of patients with mild forms of IBD and, as a result, the reduction of medical costs.
The present study aims to assess the economic consequences of the proposed IBD healthcare optimization in the Republic of Tatarstan.
Materials and methods. A budget impact model was created to compare two scenarios: the basic case when IBD patients are treated according to the current practice based on the existing network of clinics versus the simulated scenario when IBD patients receive medical care within a specialized IBD center, organised in accordance with the integrated multidisciplinary approach. The study hypothesis implies that the proportion of patients with severe IBD is gradually decreasing due to the change in the treatment model and the improved diagnostic procedure. The direct medical costs included the cost of visits to doctors, ambulance calls, diagnostic tests, outpatient medications, and the day-time and 24-hour in-patient care. One-way sensitivity analysis of all model inputs was performed.
Results. As a result of the modified practice in the Republic of Tatarstan, the cost of medical care for IBD patients will decrease by 120 million rubles over 5 years. The sensitivity analysis shows the results are robust and not sensitive to fluctuations in the variables. However, the results are shown to be most sensitive to fluctuations in the distribution of patients by IBD severity.
Conclusion. The introduction of the integrated healthcare for patients with IBD will result in lower costs of this service.

27-33 683

Medicine is one of the most important and rapidly developing branches of science. Research and developments projects run by scientific organizations and universities in this field are ultimately aimed at preserving the public health; these projects are expected to be rapidly implemented and become available to consumers. Yet in the area of medicine, the process of implementation can take many years. There is a gap between the developers (scientific organization, university), investors, and manufacturers due to the difficulty in assessing the innovation potential of the scientific results in medicine.
The aim of this study was to determine the inclusion criteria for research conducted in medical universities to be incorporated in the innovation process; such criteria were supposed to be based on other (indirect) indicators ranking the medical universities.
Material and methods. The study included twenty medical universities in Russia, largest in terms of the scientific and teaching staff. These universities were ranked according to the number of citations in the Web of Science over the period 2013-2017. Also, using the SciVal module developed by Elsevier, the number of publications with the participation of industrial partners was estimated. The assessment of the invention activity of medical universities was found in the materials published by the Russian Analytical Center “Expert”.
Results. According to the scientometric analysis, medical universities with the most promising scientific products and scientific developments, have been in low demand by Russian and foreign companies.
Conclusion. Due to the low activity of medical universities in implementing their intellectual production, potential investors and manufacturers should pay more attention to those medical universities, which produce a greater number of high-quality scientific results.

34-41 2565

Aim – analyze the existing systems for assessing the levels of evidence (LE-scales) and grades of recommendation (GR-scales) in the development of clinical guidelines in the Russian Federation.
Materials and Methods. We analyzed the LE- and GR-scales that had been used in developing clinical guidelines up to 01.09.2017; the materials were stored in the Federal Electronic Medical Library. The study included several stages: analysis of the clinical guidelines for the presence and type of LE- and GR-scales; comparison of the LE- and GR-scales between various clinical guidelines including the internationally accepted ones; assessment of using the international scales or their combinations in the development of clinical guidelines in Russia.
Results. More than 150 various LE- and GR-scales used for clinical recommendations were identified; most of them represented modifications of the international assessment systems. The original SIGN technique was found to be most commonly used.
Conclusion. Based on the results of the study, we concluded that at present, there is no unified approach to the assessment of the levels of evidence and grades of recommendation in clinical guidelines developed by professional medical associations in the Russian Federation.

42-47 1573

Photodynamic therapy (PDT) is a relatively new non-surgical treatment for cancer and precancerous conditions. The present review focused on studies using PDT in the treatment of basal cell and squamous cell carcinoma and skin melanoma.
The aim was to obtain evidence on the efficacy of PTD in the treatment of skin cancer in patients over 18 years old. To that end, we screened the PubMed database of medical and biological publications and the Cochrane Library without restricting the depth of search.
Materials and methods. We evaluated the data of meta-analyses, results of randomized controlled trials (RCTs), and systematic reviews on RCTs, where the overall survival, survival without relapse, and survival without progression were assessed.
Results. We have found one systematic review of 27 studies of different designs, one meta-analysis of 5 RCTs, and also five RCTs (1165 participants in total), where the efficacy and safety of PDT in patients with basal cell and squamous cell carcinoma were directly compared to surgical treatment, cryotherapy, and chemo-radiation therapy. In another systematic review, PDT used for squamous cell carcinoma was compared with electro-dissection, cryotherapy, curettage, microsurgery and chemo-radiation therapy. According to our search criteria, no comparative studies on the efficacy and safety of PDT in patients with melanoma were found.
Conclusion. The review underscores the efficacy of PDT in patients with both basal cell and squamous cell carcinoma. However, the use of PDT resulted in a lower 5-year survival and a greater recurrence rate compared to the surgical treatment. PDT can be recommended as an alternative to surgery and other treatments for basal cell and squamous cell carcinoma.


48-54 693

Aim: to assess the clinical efficacy of pharmacotherapy regimens using a software package. The article presents a method for assessing the clinical efficacy of pharmacotherapy regimens in children with exacerbation of bronchial asthma (BA); the method is based on comparing the treatment regimens by their significance using the Fishburn method.
Materials and methods. We retrospectively analyzed the results of pharmacotherapy in 608 pediatric patients with BA treated in the hospital of Nizhny Novgorod in 2014-2015. We adopted the Fishburn method for determining the weights of each of the used regimens and their subsequent distribution by levels of clinical efficacy. The software was developed using high level C ++ language in the Borland Developer Studio 2006 environment.
Results and discussion. The distribution included three levels (high, medium and low) and the subsequent clinical efficacy assessment – two levels (high and low). The high level (0.167-0.250) pertained to the combination of inhaled glucocorticosteroids (IGCS), short-acting
β2- agonists (SABA) and antagonists of leukotriene receptors (ALR), the combination of IGCS, long-acting β2-agonists (LABA) and ALR, and the combination of IGCS and ALR. The average level (0.083-0.167) was given to the combination of SABA and ALR and the combination of IGCS and LABA. The low level (0-0,083) included the combination of IGCS and SABA and IGCS monotherapy. When classified by two levels of clinical efficacy, the following results were obtained: the high level (0.125-0.250) – the combination of IGCS, SABA and ALR, the combination of IGCS, LABA and ALR, the combination of IGCS and ALR, and the combination of SABA and ALR; the low level (0-0,125) – the combination of IGCS and LABA, the combination of IGCS and SABA, and IGCS monotherapy. The calculating algorithm for the software “Computer program for the distribution of drugs by levels of clinical efficacy” is presented.
Conclusion. It has been shown that the combined anti-asthma therapies based on IGCS and ALR are characterized by a high level of clinical efficacy.

55-59 958

In the modern economic conditions, the rational planning of costs and the complex process optimization are essential requirements to all organizations. Knowledge of costs is needed to correctly assess the economic performance of an organization. Competent and timely correction of tariffs for the obligatory medical insurance and rationalization of the requested financing of the medical organization depends on this assessment. In the present study, we analyze various methods of personalized cost accounting: the ratio of costs to charges (RCC); relative value unit (RVU); time-driven activity-based costing (TDABC), and the possibility of their adaptation to the specific needs of medical organizations. The personalized cost accounting incorporated into a medical information system allows for controlling, planning and carrying out a close internal management of financial activity. This function helps decision-makers: control the use of funds for medical care provision; increase the efficiency of management decisions; justify the prices of paid medical services; define the deficit and surplus work units; analyze the treatment cost for each patient, considering the diagnosis, method of treatment, age and other classification signs, including the reference to specialized departments; reduce the unnecessary “paper” work load on the medical personnel; model the future needs of the organization in accordance with the planned changes in the hospitalization policy; optimize, control and plan the budget with regard to the established standards of financial expenses. Implementation of this approach is expected to increase the work efficiency in most medical organizations and the entire healthcare system.

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