PHARMACOECONOMICS. Modern pharmacoeconomics and pharmacoepidemiology

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Vol 6, No 4 (2013)


3-6 221

Health technology assessment is a fundamental tool while choosing the most cost- and clinical effective technologies that are being introduced into the health system. The basis for assessment is the data of clinical studies. The experts are interested in not only the effect of a new medical technology, but in its comparison with similar therapeutic approaches. The above is the essence of a comparative study. However, such studies are not common. The article considers the problems associated with the use of indirect comparisons of new medical technologies in the absence of direct comparisons. General recommendations on conducting indirect
comparisons are provided. Possibilities of application of the results obtained in the course of indirect comparisons to conducting pharmacoeconomic analysis are shown.

Russian Studies

7-12 238

based on the clinical study FENOC, indicated that there is no significant difference in efficacy AICC and Eptacog alfa therapy in patients susceptible to this treatment. An analysis of the direct and indirect costs shows that the costs of the annual course of treatment of 142 patients in Russia are 66 mil EUR, 60,7 mil EUR and 53,1 mil EUR for treatments Eptacog alfa monotherapy, «Eptacog alfa + AICC» and «AICC + Eptacog alfa» schemes respectively. It is determined that the regimen «AICC + Eptacog alfa», will reduce reduces costs relative to the current treatment regimen for 12,9 mil EUR (19,54%) or provide additionally treat of 34 patients of this disease.

13-20 368

The analysis goal is to determine the cost-effectiveness of liraglutideas add-on to metformin in for patients with type 2 diabetes in condition of the Russian health care system. Total medical expenses and effectiveness in terms of QALY are compared for liraglutide, glimepiride and rosiglitazone, all in combination with metformin, and metformin monotherapy. Methods: Data were sourced from a clinical trial comparing liraglutide vs. glimepiride (in combination with metformin), and a clinical trial comparing liraglutide vs. rosiglitazone (as add-on to metformin). From them data on clinical effectiveness in form of impact on HbA1(c), body mass index and blood pressure are extracted. Utility values are mostly taken from the UK Prospective Diabetes Studies supplemented with other published sources. The analysis is conducted from the perspective of the Russian health care system. Respectively the cost of the following resources is accounted: comparing of alternatives, concomitant pharmacotherapy, cost of medical manipulation, cost of ambulatory visits. Both future costs and clinical benefits are discounted at 3 percent. Sensitivity analysis is performed. Results of this analysis are shown in the incremental cost-utility rate (ICUR). Results: the data of the analysis illustrates that liraglutide therapy for type 2 diabetes patients provides a significant health improvement from the perspective of quality adjusted life-years. Simultaneously liraglutide demonstrates better cost-effectiveness than the compared alternatives. The ICUR index of 1.2 mg liraglutide in combination with metformin equal to 1 348368 rub, 1 161874 rub and 537331 rub for QALY in comparison with metformin monotherapy, glimepiride and rosiglitazone, both in combination with metformin, respectively. Conclusions: liraglutide 1,2 mg has turned to be cost-effective therapeutic alternative for treatment of type 2 diabetes in adult patients in conditions of Russian health care system over a 10-year time horizon.

21-25 277

the research work was conducted for the pharmacoeconomic evaluation and optimization of fluid therapy for patients, suffering from peritonitis disease. Reamberin, Ringer's solution, Plasma-Lyte and Sterofundin drugs were compared during the analysis. A cost analysis, cost-effectiveness analysis, budget impact analysis and sensitivity analysis were conducted. The survival rate of patients was used as the effectiveness criterion. The CER amounted to 440,759 roubles for Reamberin, 543,991 roubles for the Ringer's solution, 529,498 roubles for Plasma-Lyte and 502,842 roubles for Sterofundin. The analysis showed that the scheme of peritonitis therapy included Reamberin is the dominant. The « budget impact» analysis was carried out from the perspective of health care facilities. The budget impact analysis shown that the 100% switching patients to Reamberin saves respectively: from the Ringer’s solution 5,654,594 roubles, from Plasma-Lyte 2,215,117 roubles and from Sterofundin 2,218,280 roubles. For the interpretation of the survey data for a particular health facility pharmacoeconomic simulation model was designed.

26-34 609

for the first time in the Russian conditions the pharmacoeconomic analysis examined the application dalteparin in comparison with other low-molecular-weight heparins in patients with high risk of venous tromboembolism at the multifield hospital. On the basis of the systematic analysis of literature, two pharmacoeconomic models were constructed. The main model evaluated efficacy of thromboprophylactic strategy in surgical and therapeutic patients. The additional model included the patient with signigicant renal insufficiency with high risk of development of venous tromboembolism at hospitalization. This study estimated the cost of illness, probability of development different events in varied strategy of prevention, including side effects. In addition the sensitivity analysis was carried out. As a result, this study shown that the use of dalteparin in comparison with other low-molecularweight heparins in patients with high risk of venous tromboembolism in the conditions of the multifield hospital is economically rational medical technology.

38-45 284

Abstract: the acute disturbances of cerebral circulation incidence accounts for nearly 70-80% of all such diseases in population, while this annual rate in Russian health care is about 2,19 cases on 1000 individuals. Pharmacoeconomic evaluation of this pathology contributes to the improvement of approaches to treatment policy of this group of patients. We performed cost-effectiveness analysis on the basis of сerebrolysin in acute disturbances of cerebral circulation treatment on the top of standard therapy compares with only standard therapy. As a result treatment with сerebrolysin on the top compared with standard therapy is characterized as dominant according to cost-effectiveness analysis data. Finally, the results of budget impact analysis illustrate that including сerebrolysin into the standard therapy of acute disturbances of cerebral circulation in comparison with only standard therapy has potential to reduce Russian healthcare system total costs for acute disturbances of cerebral circulation treatment.

46-52 262

Objectives: Definition of the most rational method of nutrition support (comparison of three methods – enteral, parenteral and mixed nutrition) applied during therapy among different patients depending on their health condition on means of carrying out the pharmacoeconomic study. Methods: Pharmacoeconomic analysis: «budget impact analysis» and «lost opportunities analysis» was provided. Only direct costs were taken into account: expenses for drug therapy, hospitalization (intensive care unit and medical division) and late complications (pneumonia, sepsis, catheter and wound infection) treatment. Effectiveness data was taken from Russian clinical trial: Popov T.S., Shestopalov A.E., Tsvetkov D.S., Nechaev D.S., Kuz’min M.A. Nutrition Day in intensive care units of the Russian Federation. National association of parenteral and enteral nutrition – Moscow (Russia), 2011. Four types of treatment were compared: intensive treatment (IT) + enteral nutrition (EN); IT + parenteral nutrition (PN); IT + mixed nutrition (MN) and IT without nutrition support (NS). Results: When carrying out comparative pharmacoeconomic study all calculations were made for 3 groups of patients depending on their health condition: lightly-severe, moderately severe and severe. According to the results of calculations transfer of patients from IT without NS to IT carrying out NS leads to reduction of total expenses, therefore economy of money for the state. Independent from patient health condition – the greatest economy of money arises when EN is used during IT. Further on degree of expressiveness of positive economic effect there is PN and the least NS economic type is MN. Results of «lost opportunities analysis» showed that transfer of 1 000 patients from IT without NS, to therapy taking into account EN, provides an opportunity to over treat 496; 660 and 473 patients of the following health conditions: lightly-severe, moderately severe and severe. The results gained at all steps of research maintained the multiple-factor sensitivity analysis (+/-20% of the cost of secondary complications of the main disease therapy standards, the hospitalization cost and NS cost) that proves stability of the received results. Conclusions: Method of NS - EN independent from patients health condition is the most economic and practic for application during IT. That is why, it can be recommended as a dominant alternative. Thus IT without NS, is associated with considerable financial expenses, therefore, economically not viable.

53-58 261

approximately 5-7% of people in Russia have diabetes. In addition, the number is growing every year. Diabetes treatment schemes mostly focused on normalizing the blood glucose level. To achieve it patients use the glucose meters. However, there are some technique differences between meters that could influence on the cost and effectiveness of diabetes and its complications treatment. This pharmacoeconomic research compared the cost-effectiveness and the budget impact results of using Contour TS, Accu-Chek Active and OneTouch Select. Research outcomes demonstrate the pharmacoeconomic advantages of using Contour TS as blood glucose meter in diabetes treatment schemes.

Drug Utilization

35-37 179

cerebral infarction – is serious medical and social problem. Results of pharmacoepidemiological studies provide an objective assessment of the quality of pharmacotherapy of brain infarction, and find out the rational use of drugs and to identify ways to optimize the consumption of drugs. The results of pharmacoepidemiological analysis of drugs used for the treatment of cerebral infarction in hospitals of various types, are presented. An assessment of compliance with national and international recommendations «is carried out».

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