Научно-практический журнал Медицинские технологии. Оценка и выбор
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Issue № 3 | 2019 (37)

DOI: https://doi.org/10.31556/2219-0678.2019.37.3.022-031 meta

Abstract

This article describes the rationale for methodology of comprehensive assessment of drug consumption in real clinical practice. The proposed methodology includes three stages: 1) epidemiological monitoring – disease epidemiology assessment; assessment of the role of factors leading to the disease; 2) pharmacoepidemiological monitoring – assessment of pharmacotherapy in real clinical practice; clinical efficacy analysis of drugs; cost-effectiveness analysis; 3) long-term clinical and economical evaluation of various treatment options. Comprehensive assessment of drug consumption should result in optimal pharmacotherapy regimens, decrease of the drug load, increasing of the therapy effectiveness and cost reduction. The scheme of comprehensive assessment of drug consumption is universal and can be used for clinical guidelines development, treatment standards, for the optimal formation of drugs lists at the federal level. Separate stages and sub-steps of an integrated assessment also can be used at the territorial and local levels, medical institution, to optimize pharmacotherapy.

Keywords

comprehensive assessment of drug consumption, epidemiological monitoring, pharmacoepidemiological monitoring, optimal pharmacotherapy regimens, drugs prescription and consumption audit.

For citations

Zhukova O.V. Comprehensive assessment of drug consumption as a basis for pharmacotherapy optimization. 2019;(3):22–31. DOI: 10.31556/2219-0678.2019.37.3.022-031

Issue № 3 | 2019 (37)

DOI: https://doi.org/10.31556/2219-0678.2019.37.3.016-021 meta

Abstract

The aim of the study is to develop the assessment technology and forecasting heterogeneity of regional incidence for differentiated healthcare management.

Material and methods. The incidence of skin and subcutaneous tissue diseases in children aged 0–14 years in 2009–2017 in Russia was used as a material. The sources of information were the data of state statistics. Generally accepted statistical methods were used for the analysis.

Results. The expressed heterogeneity of regions of the Russian Federation on children’s dermatological morbidity with a coefficient of variation of 28% is revealed. The marked size of heterogeneity steadily persisted in the 8-year follow-up. The stable predisposition of subjects to a certain rank place is proved. The territories were ranked according to the total 9-year rank. The classification of territories into types of low, medium and high risk of morbidity is carried out. Long-term stability of regional trajectories allows extrapolating them for prediction.

Conclusion. The complex of statistical calculations forming the standard “forecast of regional heterogeneity technology assessment” is carried out. Used methods is universal and it could be used in assessment of any sign heterogeneity: morbidity, mortality, fertility, crime, unemployment, etc.

Keywords

heterogeneity of morbidity, regions of Russia, differentiated approach, standard technology, assessment and prognosis, population health, ranking of territories.

For citations

Gundarov I.A., Pilguy E.I. Heterogeneity of regional population morbidity in Russia – assessment and prognosis principals. Medical Technologies. Assessment and Choice. 2019;(3):16–21. DOI: 10.31556/2219-0678.2019.37.3.016-021

Issue № 3 | 2019 (37)

DOI: https://doi.org/10.31556/2219-0678.2019.37.3.008-015 meta

Abstract

The article describes the methodology for the standardized modules (SM) of healthcare development, which are functional elements of standards of healthcare allowing to increase the functionality of the development and updating of the diagnosis related groups model and objectifying the process of its development. The methodology for the development of SM allows taking into account medical services, drugs, implantable medical devices and medical nutrition, including specialized medical nutritional products necessary for the provision of medical care using a specific treatment method. A distinctive feature of the methodology is the use of not only actual data on the costs of medical organizations, but also expert estimates and regulatory documents existing in the healthcare system.

Keywords

diagnosis related groups, healthcare payment, standardized modules of healthcare, clinical guidelines.

For citations

Ledovskikh Y.A., Semakova E.V., Omelyanovskiy V.V. Methodology for the development of diagnosis related groups based on clinical guidelines using standardized modules of healthcare. Medical Technologies. Assessment and Choice. 2019;(3):8–15. DOI: 10.31556/2219-0678.2019.37.3.008-015

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/10.31556/2219-0678.2019.35.1.008-017 meta

Abstract

Results of the assessment of methodological quality of economic evaluations (EE), submitted to justify the inclusion/exclusion of drugs in the lists of drugs for medical use (list of vital and essential drugs, additional medication supply list and expensive drug list), are given in the article. The study was conducted in 2018 in the FSBI “Center for healthcare quality assessment and control” of the Ministry of Health of the Russian Federation. Assessment was performed based on 12 criteria in accordance with the requirements to the methodological quality of economic evaluations, described in the draft Order of the Government of the Russian Federation, No. 871, and then were approved in the Order of the Government of the Russian Federation, No. 871, state on 20.11.2018. The distribution of EE based on the number of criteria they did not meet, and also the frequency of made mistakes for each criterion are presented. Main reasons for EE not meeting the requirements to methodological quality, prescribed by the Order of the Government of the Russian Federation, No. 871, are analyzed.

Keywords

comprehensive assessment, Order of the Government of the Russian Federation, No. 871, lists of drugs, economic evaluations, methodological quality.

For citations

Khachatryan G.R., Ivakhnenko О.I., Sura M.V., Avxentyeva М.V. Assessment of the Methodological Quality of Economic Evaluations: Main Mistakes. Medical Technologies. Assessment and Choice. 2019; 1(35): 8–17.

Issue № 4 | 2018 (34)

DOI: https://doi.org/10.31556/2219-0678.2018.34.4.011-018 meta

Abstract

The article provides the results of the assessment of methodological quality of budget impact analysis (BIA) submitted as a justification for the inclusion/exclusion of drugs into the drugs lists for medical use (Vital and Essential Drug list, List of Drugs for Certain Categories of Citizens, List of High-Cost Drugs) in 2018.The assessment was performed by the Center of Healthcare Quality Assessment and Control of the Ministry of Health of the Russian Federation according to the requirements, described in the Order of the Government of the Russian Federation, № 871 (version from 29.10.2018), which consist of 11 criteria. The information on distribution of BIA studies in regards to the number of criteria not meeting the requirements and proportion of mistakes on every criterion is presented. Besides, the authors analyzed main causes of non-meeting the requirements for methodological quality of BIA studies described in the Order of the Government of the Russian Federation, № 871.

Keywords

comprehensive assessment, Order of the Government of the Russian Federation № 871, drug list, budget impact analysis, methodological quality.

For citations

Ivakhnenko O. I., Khachatryan G. R., Sura M. V., Avxentyeva M. V., Omelyanovskiy V. V. Results of Methodological Quality Assessment of Budget Impact Analysis: Main Mistakes. Medical Technologies. Assessment and Choice. 2018; 4(34): 11–18.

Issue № 33 | 2018 (3)

DOI: https://doi.org/10.31556/2219-0678.2018.33.3.009-017 meta

Abstract

The paper discusses the issues of normative and legal regulation for creation of drug lists (List of Vital and Essential Medicines, List of Medical Drugs for Certain Categories of Citizens, List of High-Cost Medical Drugs (Seven Nosologies list). It also considers historical aspects, current state and planned changes of these rules. The stages of expertise, evaluation criteria, and rules of decision making in the process of inclusion of medical drugs (MD) into the lists according to the RF Government Decree no. 871 on 28 August 2014 and the project on the amendment of this decree are thoroughly considered. The proposed changes address the terms of submission of proposals for the inclusion and exclusion of MDs into the lists, and the terms of expert procedures. Changes in expert procedures (complex evaluation) of MD are proposed; a new stage (analysis of methodological quality of pharmacoeconomic studies and budget impact analysis) is introduced. Integral scales of clinical and pharmacoeconomic evaluation of MD are substituted with complex evaluation scales. The requirements for methodological quality of pharmacoeconomic studies and budget impact analysis are created. A further stage of the development of the rules for creating the lists can be the performance of complex evaluation within a single expert body with the participation of expert organizations and leading specialists.

Keywords

drug list, FR Government Decree no. 871 on 28 August 2014, complex evaluation, complex evaluation scale.

For citations

Omelyanovskiy V. V., Sura M. V., Avxentyeva M. V., Khachatryan G. R. The Rules for Creation of Federal Drug Lists: Current State and
Development Prospects. Medical Technologies. Assessment and Choice. 2018; 2(32): 9–17.

Issue № 32 | 2018 (2)

DOI: https://doi.org/10.31556/2219-0678.2018.32.2.008-022 meta

Abstract

The article explains the prerequisites, principles and steps of the developing in 2018 new diagnostic related groups (DRG) for inpatient cancer pharmacotherapy in Russian healthcare. New DRGs were developed in 5 steps: 1) most prevalent malignant tumors were revealed based on statistical data on the cancer incidence rate in 2016; 2) all recommended schemes of drug therapy for the most prevalent tumors were extracted from clinical guidelines made by Russian Oncology Association; 3) standards of medical care were created for the cases of hospital treatment with the use of each scheme of drug therapy; 4) the costs of hospital treatment with the use of each scheme were calculated; 5) cases with similar costs were combined into DRGs. 10 DRGs were formed for inpatient treatment and 8 – for treatment in the day hospitals. The cost-based relative weights were determined for each DRG. The system for coding drug regimens was developed for computerized assignment of cases to the DRGs in the Russian regions. The new DRGs are more homogeneous than previous ones in terms of clinical and economic characteristics, thus the main principle of DRG development is followed to a greater extent than before. Authors underline the necessity to monitor the results of the new DRGs implementation at the regions for minimizing the risks of imbalance in the payment system.

Keywords

provider-payment method in healthcare; diagnostic related group (DRG), cancer; standard of medical care; clinical guideline.

For citations

Avxentyeva M. V., Omelyanovskiy V. V., Petrovskiy A. V. et al. New Approaches to the Development of Diagnostic Related Groups for Cancer Pharmacotherapy in Russian Federation. Medical Technologies. Assessment and Choice. 2018; 2(32): 8–22.

Issue № 32 | 2018 (2)

DOI: https://doi.org/10.31556/2219-0678.2018.32.2.024-033 meta

Abstract

The classification algorithm is one of the key elements of the provider-payment system based on diagnostic related groups (DRG). Current version of the algorithm in Russian DRG system is described in a manual approved by the Federal Fund of Compulsory Medical Insurance. The algorithm determines the steps of computerized assignment of each hospital case to the DRG. Each region of Russia creates its own information system for classification of cases based on the approved algorithm. The article provides a brief analysis of the case-mix classification criteria and the classification algorithms in the Russian DRG model. The problems of the current algorithm are underlined and illustrated by the examples. Finally, the authors propose the ways for improving the algorithm.

Keywords

provider-payment methods in healthcare, diagnostic related groups (DRG), classification algorithm.

For citations

Fedyaev D. V., Akimov O. V., Zuev A. V. Algorithm of Hospital Cases Classification in the Russian Model of Diagnostic Related Groups: Need for Improvement. Medical Technologies. Assessment and Choice. 2018; 2(32): 24–33.

Issue № 31 | 2018 (1)

Abstract

In the last decade, the interest of the Russian and international scientific and medical communities and pharmaceutical companies in the research of routine clinical practice has increased significantly. In addition to the already usual term «non-intervention study», «real world data» and «real world evidence» came; role of health technology assessment is being emphasized more often and more actively, more attention is being paid to patient-oriented approach. The objectives of this article are: updating information in the field of routine clinical practice, discussing new terms for the Russian-language scientific literature and the role of real world data in health technology assessment.

Keywords

non-interventional study, real-world data study, health technology assessment.

For citations

Goldina T. A., Suvorov N. I. Real-World Data Studies: from Data to Health Technology Assessment and Decision-Making in Healthcare. Medical Technologies. Assessment and Choice. 2018; 1(31): 21–29.