Научно-практический журнал Медицинские технологии. Оценка и выбор
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Issue № 2 | 2019 (36)

DOI: https://doi.org/10.31556/2219-0678.2019.36.2.069-074 meta

Abstract

The article tells about the transplantology birth, about the first organ transplants, about Alexis Carrel and Vladimir Demikhov pioneering works and about the first heart transplant from person to person the famous surgery made in 1967 in Cape Town by Christiaan Barnard and forever in the medicine history.

Keywords

transplantology, first heart transplant, Alexis Carrel, Vladimir Demikhov, Christiaan Barnard, transplant rejection, ciclosporin.

For citations

I.V. Opimakh One life – two hearts Medical Technologies. Assessment and Choice. 2019; 2 (36) 69–74.

Issue № 2 | 2019 (36)

DOI: https://doi.org/10.31556/2219-0678.2019.36.2.059-068 meta

Abstract

Therapy of metastatic renal cell carcinoma (mRCC) involves the use of a number of alternative targeted drugs that demonstrate high clinical efficacy, but at the same time, require substantial costs of the health care system.

Purpose of the study: cost-effectiveness assessment for axitinib and everolimus as a second-line target therapy in patients with mRCC.

Materials and methods: The assessment was carried out by minimizing costs and budgetary impact from the standpoint of the health care system based on the results of meta-analyzes of randomized clinical trials (RCTs). The time horizont of study was 1 year.

Results: in accordance with the results of meta-analyzes of RCTs, axitinib and everolimus provide improved patient prognosis compared with sorafenib and do not significantly differ in terms of overall survival (HR = 1,3 [0,46–3,67]) and progression-free survival (HR = 1,09 [0,7–1,68]). At the same time, the manufacturer’s maximum price for everolimus and the manufacturer’s recommended price for inclusion in the list of vital and essential drugs for axitinib – the use of the latter will reduce the cost of treatment for the patient by 451,516 rubles. (20,2%) per year. Also, the treatment with axitinib was characterized by the best safety indicators (OR = 0,14 [0,05–0,38]), allowing to reduce the associated costs of the health care system for stopping adverse events. The results of the analysis of the impact on the budget demonstrated the possibility of achieving savings in the resources of the health care system with the inclusion of аxitinib in the restrictive lists of drugs, demonstrating savings of 640,51–778,82 million rubles (11,5–14,0%) based on the target patient population – 2,659 people per year. The results of the sensitivity analysis showed the sustainability of the obtained results of the minimization of costs and the budget impact of the fluctuation of the drugs cost evaluated and the volume of the target population of patients, as well as indicators of PFS.

Findings: Considering the results obtained, we can conclude about the clinical and economic advantage of axitinib in comparison with the everolimus and recommend it for inclusion in the list of vital and essential drugs.

Keywords

metastatic renal cell carcinoma; axitinib; everolimus; cost effectiveness.

For citations

Zyrianov S.K., Diakov I.N. Clinical and economic analysis of the axitinib as a second-line target therapy for patients with advanced renal cell carcinoma. Medical Technologies. Assessment and Choice. 2019; 2(36): 59–68.

Issue № 2 | 2019 (36)

DOI: https://doi.org/10.31556/2219-0678.2019.36.2.049-058 meta

Abstract

Relevance. Since 2010, in Moscow a plan for the reorganization of the psychiatric service is carried out. In accordance with the WHO plans, reforms is including the reduction of inpatient types of care and expansion of the outpatient unit.

Aim. The analysis of the specialists and users opinions of mental health service on its reform.

Materials and methods. Specialists and users of mental health services opinions survey regarding the ongoing changes was conducted (900 respondents).

Results. Most respondents gave a positive assessment of the reforms. Interviewees believe that reform was necessary, optimization of the number of psychiatric beds and expansion of community-based care were justified, the formation of territorial associations was appropriate, and that the quality of psychiatric care, the work of clinics and day hospitals, the amount of care provided by dispensaries, the territorial availability of outpatient psychiatric care, the availability of outpatient facilities, and the number of places in day hospitals increased. According to the survey, reorganization of the psychiatric service first of all should include the development of psychosocial rehabilitation and psychotherapy, a decrease in the level of hospitalizations, the development of inpatient technologies and continuity in the provision of care. According to respondents, the mental health service needed to improve funding and develop outpatient care.

Conclusion: Respondents positively assess the mental health service reforms in Moscow. The psychiatric service reorganization should include the development of psychosocial rehabilitation and psychotherapy, reduction hospitalizations level, inpatient technologies and continuity care provision development. According to respondents, the mental health service needs to improve the funding and development of outpatient care.

Keywords

community-based psychiatry, health care economics and organizations, hospitals, psychiatric, health care reform.

For citations

Masyakin A.V. Results on sociological survey of healthcare specialists and consumers about their opinion on reforms of psychiatric service in Moscow, conducted in 2010–2017. Medical Technologies Assessment and Choice. 2019; 2(36): 49–58.

Issue № 2 | 2019 (36)

DOI: https://doi.org/10.31556/2219-0678.2019.36.2.042-048 meta

Abstract

Purpose is to develop and test an approach to the improvement of automated electrocardiogram (ECG) computer analysis systems, which increases physician productivity.

Materials and methods. The existing prototype of the ECG computer analysis system developed by the authors is used as materials. Dynamic time warping (DTW) method, as well as structural and object-oriented software development techniques were used.

Results and discussion. The main idea of improving automated computer-assisted ECG analysis systems is to provide the doctor with convenient software tools that allow you to: set various templates for QRS complexes; select templates and automatically find QRS complexes in ECG that are most similar to the selected template. The main result of the work is an algorithm that allows to quantify the degree of similarity of a QRS complex isolated from an ECG and a given pattern. The algorithm is based on the DTW method. The proposed improvement was tested when modifying the existing ECG computer analysis system. As a result of the modification, convenient interactive tools were added to the system, which allow the doctor to navigate the QRS complexes while viewing the ECG, taking into account their degree of similarity to the selected template. This gave the doctor the opportunity to quickly assess the patient’s condition and make a conclusion.

Conclusion. The proposed approach allows you to modify the automated computer-aided analysis of the ECG in order to increase the productivity of the doctor.

Keywords

ECG, ECG annotation, QRS complexes, method DTW, automated ECG computer analysis system.

For citations

Muromtsev V.V., Nikitin V.M., Efremova O.A., Kamyshnikova L.A. Approach to Improving the Automated System Computer Analysis of the Electrocardiogram. Medical Technologies. Assessment and Choice. 2019; 2(36): 42–48.

Issue № 2 | 2019 (36)

DOI: https://doi.org/10.31556/2219-0678.2019.36.2.035-041 meta

Abstract

The concept of a unified territorial approach to improving the quality and safety of medical activities (QSMA) in the Republic of North Ossetia – Alania through the implementation of the «Quality Management and Safety Program of Medical Activities» (Program) and the creation of the «Road Map» is disclosed in present article. The main leitmotif of it is to consistently increase the information-legal, educational-motivational, clinical, control-administrative and organizational components of a systematic approach to improving QSMA in all medical institutions (MI) of the region. The program is designed to create conditions for the formation of a new type of MI in the framework of the implementation of the national «Healthcare» project in the region and the training of specialists – QSMA managers.

Keywords

quality management, safety, medical activity, unified approach, program.

For citations

Karsanov A.M., Astakhova Z.T., Gogichaev T.K., Tuaeva I.B., Remizov O.V. The Concept of a Single Territorial Approach to Improving the Quality and Safety of Medical Activities on the Example of the Republic of North Ossetia – Alania. Medical Technologies. Assessment and Choice. 2019; 2 (36): 35–41.

Issue № 2 | 2019 (36)

DOI: https://doi.org/10.31556/2219-0678.2019.36.2.024-034 meta

Abstract

Government spending are the basic of the health economics of any developed countries. We are overwhelmingly confident that an increase in the financing of the health care system makes it possible to improve the population’s access to medical care, which, accordingly, it is reflected on an increasing quality of life and its duration. Undoubtedly, investments in the healthcare industry should lead to the creation of new jobs, the development and introduction of advanced medical technologies and innovative drugs into clinical practice. In recent years, in the Russian Federation, there has been a positive trend in the volume of funds allocated by the state to protect public health. The article is devoted to the study of possible factors causing this growth. The authors made an attempt to answer the questions whether the increase in health care costs is due only to the political will of decision makers at the federal level, whether unhealthy lifestyles of the country’s citizens affect health care costs, which primarily depend on the costs of health care resources and others. To answer these questions, the authors analyzed the behavior of individual indicators reflecting health care expenditures and population health indicators for the Russian Federation in comparison with the countries of the Organization for Economic Development and Cooperation (OECD) – Australia, Canada, Denmark, France, Germany, Japan, Netherlands, New Zealand, Norway, Sweden, Switzerland, the UK and the USA.

Keywords

health care costs, GDP share for health care, per capita health care costs, quality of care, expensive medical technologies, five-year survival, tobacco use, obesity.

For citations

Kuftova Y.V., Obukhova O.V., Bazarova I.N. Growth of Health Costs: Myths and Reality. Medical Technologies. Assessment and Choice. 2019; 2 (36): 24–34.

Issue № 2 | 2019 (36)

DOI: https://doi.org/10.31556/2219-0678.2019.36.2.016-023 meta

Abstract

Sweden is one of the first countries who establish health technology assessment (HTA) agency. Nowadays, there are two HTA organizations in the country. The first is one of the oldest in the world – the Swedish agency for health technology assessment and assessment of social services (SBU), and the second is the Council The Dental and Pharmaceutical Benefits Agency (TLV). Having similar tasks, organizations are created for different purposes. TLV assesses medical technologies within state reimbursement system, its purpose is to ensure the efficient use of budget funds. The SBU does not participate in the reimbursement system and does not have any regulatory functions, its purpose is to respond to public inquiries regarding the use of any medical technology. Agencies differ in the number of annually published reports, their types and objects of evaluation. Wherein the work of both institutions is characterized by a wide involvement of independent experts, outside organizations and particular attention to the economic component of the assessment.

Keywords

HTA, reimbursement, Sweden healthcare system.

For citations

Omelyanovskiy V.V., Gorkavenko F.V., Saybel Y.S., Khachatryan G.R. Health Technology Assessment System in Sweden. Medical Technologies. Assessment and Choice. 2019; 2(36): 16–23.

Issue № 2 | 2019 (36)

DOI: https://doi.org/10.31556/2219-0678.2019.36.2.010-015 meta

Abstract

Three-dimensional printing has several significant advantages over traditional methods of production: simplification and acceleration of the production process, versatility, low cost and a few others. As a result, additive technologies have quickly become a highly promising area with great potential in many areas of human activity, finding more and more points of application. Medicine is no exception. The development of three-dimensional printing in the field of medicine can not only solve a few pressing health problems, but also stimulate the progress of technology. To date, three-dimensional medical printing is used in the following areas: individual prostheses both temporary and permanent wear, surgical instruments, simulation manuals for training medical students and preoperative training of surgeons. Of interest is the joint application of additive technologies with cellular technologies – bioprinting. Despite its great potential, this activity is not sufficiently regulated, which is a serious obstacle to its development. The introduction into practice of the principles proposed in this work of the device and functioning of a specialized service – laboratory of additive medical production – should solve this problem and contribute to the rapid development of medical three-dimensional printing in the Russian Federation.

Keywords

additive technologies, medical production, 3D printing, healthcare organization, import substitution.

For citations

Prikhodko A.A., Vinogradov R.A., Vakhrushev S.G. Measures for the Development of Medical Additive Technologies in the Russian Federation. Medical Technologies. Assessment and Choice. 2019; 2 (36): 10–15.

Issue № 1 | 2019 (35)

DOI: https://doi.org/10.31556/2219-0678.2019.35.1.087-102 meta

Abstract

Aim. To assess the economic outcomes of using vinflunine in combination with the best supportive therapy (BST) in the treatment of patients with urothelial transitional cell carcinoma (UTCC) and ineffectiveness of chemotherapy with a cisplatin-containing combination of drugs and the inability to use immuno-oncological drugs.

Methods. The economic impact assessment was carried out using cost-effectiveness analysis and budget impact analysis. Cost-effectiveness and budget impact analyses were performed in Microsoft Excel models.

Results. The use of vinflunine in combination with BST in the second-line chemotherapy of UTCC, compared with using BST only, increases the life expectancy of patients – overall survival (OS) with vinflunine + BST was 6.9 months, only with BST was 4.3 months. The amount of additional costs to achieve one unit of efficiency (ICER) when using vinflunine in combination with BST amounted to 190 920 rubles for one added month of life, which is 61.7% lower compared to the reference ICER for pembrolizumab (the drug is included in the drug list). As a result of the analysis of the “impact on the budget”, it was shown that the use of therapy with vinflunine requires additional financial costs for a course of treatment in the amount of 49 639 191 руб. (57,76%) for the first year, 138 516 980 руб. (80,03%) for the second year and 263 841 866 руб. (88,91%) for the third year of the analyzed introduction of vinflunine into the structure of drug provision for patients with UTCC in the Russian Federation, based on the calculation of the need for 586 patients per year.

Conclusion. Based on the analysis, it was shown that therapy with vinflunine combination with BST is a cost-effective and preferred alternative compared to BST for treating patients with urothelial transitional cell carcinoma and ineffectiveness of chemotherapy with a cisplatin-containing combination of drugs and the inability to use immuno-oncological drugs.

Keywords

urothelial transitional cell carcinoma, vinflunin, chemotherapy, maintenance therapy, budget impact analysis, cost-effectiveness analysis.

For citations

Nedogoda S.V., Rogov V.A., Salasyuk A.S., Frolov M.Yu. Pharmacoeconomic Analysis of Vinflunine in Patients With Urothelial Transitional Cell Carcinoma Resistant to Platinum-Based Regimens. Medical Technologies. Assessment and Choice. 2019; 1(35): 87–102.

Issue № 1 | 2019 (35)

DOI: https://doi.org/10.31556/2219-0678.2019.35.1.074-085 meta

Abstract

Objective: Based on the cost-effectiveness analysis (CEA) to determine economic and clinical consequences of using mepolizumab instead of omalizumab in adults with severe eosinophilic asthma, when omalizumab is administered once every 2 weeks or mepolizumab is administered once every 4 weeks.

Methods: Effectiveness and safety analysis was conducted based on the published network meta-analysis, because head-to-head clinical trials of omalizumab versus mepolizumab were not identified during targeted scientific literature search. Direct medical costs were calculated using information from the register of manufacturers` maximum selling prices for vital and essential drugs (VED), instructions for medical use, the unit cost of healthcare services.

Results: Effectiveness and safety of the compared drugs were determined based on the results of the network meta-analysis. Frequency of clinically significant asthma exacerbations (risk ratio = 0,19; 95% CI: 0,02–2,32) and withdrawals due to adverse events (risk ratio = 0,05; 95% CI: 0,002–0,95). Therefore, despite the tendency to mepolisumab benefits, it was concluded that there are no statistically significant differences in the effectiveness and safety of the compared drugs due to the insufficient statistical power of the result. Direct medical costs were 870130 rubles and 1852063 rubles for mepolizumab and omalizumab respectively. Saving of direct medical costs for mepolizumab treatment was 959170 rubles per patient per year or 52%.

Conclusion: treatment with mepolizumab versus omalizumab in patients with severe eosinophilic asthma, when omalizumab is administered once every 2 weeks or mepolizumab is administered once every 4 weeks, leads to saving of direct medical costs for drug treatment.

Keywords

cost-effectiveness analysis, pharmacoeconomic analysis, budget impact analysis, cost-effectiveness, omalizumab, mepolizumab, severe asthma.

For citations

Tolkushin A.G., Pogudina N.L., Ivanov D.A., Demko I.V. Cost-Effectiveness Analysis of Treatment for Severe Eosinophilic Asthma in Adults: Mepolizumab and Omalizumab. Medical Technologies. Assessment and Choice. 2019; 1(35): 74–85.