FARMAKOEKONOMIKA. Modern Pharmacoeconomics and Pharmacoepidemiology

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Vol 12, No 4 (2019)
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255-266 821

Aim: to conduct a comparative clinical and economic analysis of using three SYSADOA drugs containing chondroitin sulfate or modifying its biosynthesis in patients with stage II knee osteoarthritis in an outpatient setting.

Material and methods. This was a retrospective comparative study, with the inclusion of data from medical records of outpatients with stage II knee arthritis according to the Kellgren & Lawrence classification. We calculated the cost-effectiveness from the direct costs and treatment efficiency based on the dynamics of pain, functional ability of the joint according to the Lequesne index, as well as the VAS index, the WOMAC index, ultrasound results and quality of life according to the EuroQol-5D questionnaire. The medical records of patients (n = 90) with stage II knee osteoarthritis are systematized according to inclusion / exclusion criteria. All patients were divided into 3 groups: group 1 (n = 30) received chondroitin sulfate, 100 mg in 1 ml (Chondroguard® , Sotex, Russia), i /m, every other day, the first 3 injections of 100 mg each with good tolerance starting from the 4th injection of 200 mg, the course of treatment was 25 injections over 50 days; group 2 (n = 30) received an active substance-glycosaminoglycan-peptide complex (Romania), on the 1st day – 0.3 ml, on the 2nd day – 0.5 ml and then 3 times a week for 1 ml, the course of treatment – 20 injections per 44 days; group 3 (n = 30) received the active substance – bioactive concentrate from small sea fish (Romania), 1 ml per day, course of treatment – 20 injections, 20 days.

Results. It is shown that the treatment of stage II osteoarthritis of the knee with Chondroguard® is the most economically feasible in terms of the cost-effectiveness ratio (CER=9182).

Conclusion. The study results are recommended for decision making on the use of SYSADOA at the level of doctors and health care providers.

268-278 890

Objective – to conduct a pharmacoeconomic analysis of using omalizumab, mepolizumab and reslizumab in the treatment of patients with uncontrolled moderate and severe atopic asthma in the healthcare setting of the Russian Federation.

Materials and Methods. A pharmacoeconomic model based on clinical data was created. The cost-effectiveness ratios for omalizumab, mepolizumab and reslizumab were calculated and compared. Budget impact analysis for the partial replacement of omalizumab with mepolizumab and/or reslizumab has been performed.

Results. The use of omalizumab costs 13.3% less than that of reslizumab and 1.6% more than that of mepolizumab. The cost-effectiveness ratio for omalizumab is significantly lower vs the competitors. To prevent asthma exacerbations by omalizumab requires 463 805 rubles, which is 24.80% less than for reslizumab and by 382,640 or 20.89% less than for mepolizumab. The results are robust and resistant to 10% fluctuations in prices for the compared products. According to the budget impact analysis, by introducing reslizumab instead of omalizumab for a 3-year therapy in 210 patients with asthma and blood eosinophilia ≥400 cells/µl, will increase the burden on the budget by 13.25% or by 83.2 million rubles. In a group of 594 patients with eosinophilia ≥150 cells/µl, using mepolizumab instead of omalizumab will increase the budget burden by 1.58% or by 24.0 million rubles. In the total group of 759 patients receiving genetically-engineered products, switching to mepolizumab and reslizumab will increase the budget spending by 3.3% or 67.2 million rubles for 3 years.

Conclusion. The analysis shows that using omalizumab in patients with severe asthma that is uncontrolled by medium and high doses of inhaled corticosteroids, has the lowest burden on the budget of the healthcare system and is more effective compared to mepolizumab and reslizumab.

279-290 842

Cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors palbociclib, ribociclib and abemaciclib are the new treatment options for postmenopausal women with locally advanced or metastatic hormone-receptor (HR) positive human epidermal growth factor receptor 2 (HER2) negative BC.

The aim of the current study is to conduct complex pharmacoeconomic evaluation of using CDK4/6 inhibitors palbociclib and ribociclib that are included in Vital and Essential Drug List (VEDL) in combination with letrozole in first line treatment from the Russian healthcare system prospective.

Methods. Pharmacoeconomic evaluation consisted of two parts: clinical and economic study and budget impact analysis. We used cost minimization method for the clinical and economic study, since palbociclib and ribociclib are equally or comparably effective, according to earlier literature. Time horizon of clinical and economic study was 5 years. Direct medical costs including medications and adverse event treatments were considered. We accounted for treatment discontinuation and CDK4/6 inhibitors dose modifications. Budget impact analysis was performed for the three-year period of 2020-2022. All patients who can be treated with palbociclib or ribociclib were considered.

Results. Mean direct medical costs of using palbociclib + letrozole were 2 082 333 RUB per patient, which were 505 016 RUB or 19.5% lower, compared to ribociclib + letrozole. According to current trends of BC morbidity, 8 098-8 221 newly diagnosed patients will be ready to start treatment with CDK4/6 inhibitors in 2020-2022 in Russia annually. Using palbociclib in this patient population lowers 3-year budget costs by 9 087 million RUB or by 22.5%, compared to ribociclib.

Conclusions. Using palbociclib is the cost-saving treatment option for postmenopausal women with locally advanced or metastatic HR-positive HER2-negative BC, compared to ribociclib.

291-299 640

Objectives. To study the structure of drug purchases by a general hospital considering the names and costs of the purchased drugs as well as their current consumption by various clinical departments.

Materials and Methods. The drug consumption was analyzed using the ABC/VEN and ATC/DDD methods with a simultaneous analysis of case histories.

Results. The analysis of drug purchases in 2014-2018 and the obtained results prompted a reassessment of the drug procurement policy and readjustment of the financial resources between various groups of drugs.

Conclusion. The simultaneous use of the ABC/VEN and ATС/DDD analyzes and the reevaluation of the list of prescribed medications allowed us to propose the ways to optimize the structure of drug consumption in a typical hospital.

300-308 544

The aim was to assess the possibility of optimizing the costs of drugs for cancer patients in a subject of the Russian Federation considering the expiration of patent protection period.

Materials and methods. The possibility of optimizing the costs of antitumor drugs was studied using a model of a hypothetical region with a population of 2 million. A gradual replacement of the reference drugs with expiring patent protection by generics or biosimilars over 5 years was simulated. Two replacement scenarios were analyzed: 1) maintaining the drug consumption at a stable level; 2) increasing the drug consumption to the level identified in a previous retrospective analysis of the pharmaceutical market. The baseline scenario implied that the drug purchases remained unchanged (in physical and monetary terms) at the level of 2018. We calculated the difference between the drug costs in the baseline scenario and the costs of the same drugs replaced with generics or biosimilars for a 5 year period.

Results. By gradually replacing the reference drugs with generics or biosimilars in a region with a population of 2 million and keeping the costs of drugs for solid tumors at the 352.2 million rubles for 5 years (baseline scenario), 69.4 million rubles can be saved. That amount represents 19.7% of the base level if the drug consumption remains at the 2018 level. With an increase in the INN consumption after the release of generics/ biosimilars, no saving is expected; on the contrary, expenses will increase by 14.1% to 400 million rubles, although, an 8.45-fold increase in consumption is projected.

Conclusion. With the appearance of generics / biosimilars for the treatment of solid malignant tumors, the possibility of fund saving depends on the increase in drug consumption.

310-317 614

Introduction. The economic aspects of providing cancer care to the public attract increasing attention of scientists, economists, physicians and other healthcare professionals. Currently, the healthcare economics of oncological institutions is defined as part of the national economy that implements cancer care programs and provide a wide range of medical and pharmaceutical services to the public.

Aim. The study was conducted as part of the program for improvement of financial spending in order to facilitate cancer care for Moscow residents. The aim of this study was to identify the crucial areas of the cost analysis and thus improve the public health service.

Materials and methods. We used the methodology of targeted and consistent search of the literature. The data search and analysis was carried out using the US National Medical Library (PubMed database), National Electronic Library (e-LIBRARY, Russia), and other Internet resources. Whenever possible, articles on the most common and socially significant types of cancer (breast, colon, prostate, lung etc.) were selected. In addition, we focused on significant studies conducted either on the national or international level.

Results and discussion. In principle, the structure of total costs is determined by the health policy regarding the cancer care system. Six main areas of oncological care that require careful economic analysis have been identified: those are prevention, oncoscreening, diagnosis, treatment, rehabilitation, and palliative care. In order to implement the economic goals of the healthcare system, the cost of cancer treatment should be discussed. The relevant programs are expected to be based on 1) prevalence and incidence; 2) impact on health; 3) results of the integrative methodological approach to cancer treatment; 4) implementation of comprehensive measures of medical and social assistance; 5) use of financial mechanisms and their impact on economic indicators.

Conclusion. The set of measures related to the direct costs as identified in this study include the development, planning and provision of cancer care. These specific features of the direct cost analysis are important for organizing medical care in oncological institutions.


318-326 850
Methods of payment to care providers constitute an essential part of the healthcare financing system; these mechanisms determine the motivation of service providers. Throughout the history of public health care, the payment methods have been gradually improved so to stimulate the providers to best match the societal demands (greater access to health services, cost reduction, and better quality) and prevent “moral hazards”. As a result, the most advanced healthcare systems have stopped paying simply for service volume and rigorously restraining the costs. Instead, the updated system is based on the integrated payments combining the elements of cost control with the stimuli that promote a high quality and better access to healthcare service. At present, the new payment mechanisms aiming at improving the long-term treatment outcomes (life expectancy and quality of life) are available. The care provider payment system existing in Russia, by large, corresponds to the best international practices as far as the hospital care is concerned. However, the payment arrangements in the primary care network still lag behind the international standards. To improve the situation, quality indicators should be included in payments for primary care services.
327-332 562

Introduction. The RAND/UCLA system is commonly used in healthcare economics as it allows one to consider both the relevant scientific data and the opinion of leading experts for deciding on the specifics of medical care.

Objective. To analyze the recommendations and practical aspects of the RAND/UCLA and the international experience in using this method; to analyze the feasibility of its application in the Russian Federation, including the basic documents regulating the national medical care.

Materials and methods. We analyzed the information available in the RAND corporation website and the PubMed bibliographic database.

Results. An analysis of the original information provided by the developers of the RAND/UCLA method showed that using this method involves several stages: selecting a subject to be further studied, reviewing the scientific literature on this subject, choosing the expert commission, and preparing documents for its work; the voting stage is followed by a voting results analysis. The international experience on the applications of the RAND/UCLA method in healthcare demonstrates the successful use of this method in different countries. The use of the RAND/UCLA method in the healthcare system of the Russian Federation can contribute to improving the quality of medical care and the rational use of healthcare resources.

Discussion. Currently, the RAND/UCLA method is internationally used to develop clinical guidelines, criteria for assessing the quality of medical care, and feasibility of medical interventions.

Concusion. In the Russian Federation, the application of the RAND/UCLA method can prove useful for developing clinical guidelines and related documentation.


333-341 1191
In Australia, the federal government is in charge of providing the health care to patients. The government agencies determine the list of reimbursable pharmaceuticals and medical services and also define the preferential categories of the population. The states and territories may have their own health care programs in addition to the federal ones. The Pharmaceutical Benefits Advisory Committee (PBAC) is responsible for the health technology assessment (HTA) and decides which technology is eligible for reimbursement by the federal budget. The drug evaluation process includes five stages: a review of general information about the product, assessment of its clinical efficacy, cost-effectiveness analysis, assessment of financial implications of including the drug in the reimbursement list, and consideration of any other factors that may influence the committee decision. In addition to the full reimbursement of pharmaceuticals, the committee may decide to provide funding based on a managed entry agreement.

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