Научно-практический журнал Медицинские технологии. Оценка и выбор
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Issue № 1 | 2019 (35)

DOI: https://doi.org/10.31556/2219-0678.2019.35.1.066-073 meta

Abstract

Introduction. In 2018 the Federal Order of 03.08.2018 No. 299-FO was adopted, whereby the provision of drugs for the treatment of systemic juvenile idiopathic arthritis (sJA) was delegated to the federal level.

Aim. In accordance with the requirements for the development of formularies of medicines, approved by Decree of the Government of the Russian Federation No. 871, the budget impact analysis of inclusion in the expensive drugs list of canakinumab for the treatment of sJA was conducted.

Material and methods. The drug costs were calculated based on the manufacture`s maximum selling price inclusive of all taxes and additional charges according to the legislation of the Russian Federation. Characteristics and the size of the target population of patients diagnosed with sJA were determined based on the data from different sources – clinical trials, registries, standards, of medical care, experts` judgment. The time horizon of the analysis is 1 year and 3 years. The sensitivity analysis was performed to test how results affected by changes in key assumptions such as drug price and size of the target population.

Results. The budget impact analysis revealed that provision for the target population of canakinumab for the treatment of sJA does not require a significant increase in the programme budgeting of costly diseases. The insignificant increase is required for the programme budgeting equal to the amount of 1,588 billion per year, which is 4% less than the 2018 budget.

Conclusions. Assurance of centralized purchasing of canakinumab from federal budget resources is in harmony with the financing capacity of costly diseases programme, extended from 2019, to cover canakinumab reimbursement for patients with sJA.

Keywords

systemic onset juvenile arthritis (sJA), canakinumab, costly diseases programme, budget impact analysis.

For citations

Derkach E.V. Budget Impact Analysis of Inclusion in the Expensive Drugs List of Canakinumab for Treatment of Systemic Onset Juvenile Arthritis. Medical Technologies. Assessment and Choice. 2019; 1(35): 66–73.

Issue № 1 | 2019 (35)

DOI: https://doi.org/10.31556/2219-0678.2019.35.1.056-065 meta

Abstract

The authors have developed and formed a holistic “Quality management and patient safety in surgery program” (Program) structural components and technological elements of a systematic approach to the safety of surgical patients. The Program is based on the coordinated implementation of a wide range of modern sections of the health care system: from the introduction of the principle of standardization, the use of advances in evidence-based medicine, the use of advanced surgical technologies, the development of innovative forms of management and informatization, to issues of efficiency and high social efficiency. The Program is designed to be the base for ensuring the proper quality and the highest possible level of safety in the treatment of surgical patients in any health facilities with surgical services, by optimizing the quality management process.

Keywords

patient safety, quality management, surgery, program.

For citations

Karsanov A.M., Polunina N.V., Gogichaev T.K. Patient Safety in Surgery. Part 2: Surgical Treatment Quality Management Program. Medical Technologies. Assessment and Choice. 2019; 1(35): 56–65.

Issue № 1 | 2019 (35)

DOI: https://doi.org/10.31556/2219-0678.2019.35.1.050-055 meta

Abstract

Introduction. Modern health care is a leader in the social sector in terms of the number of public-private partnership projects. Monitoring of the implementation of strategic projects proves that the targets on the key indicators of the road map are reached. However, experts give a negative assessment
of the availability and quality of medical care.

Methods. The article describes the experience of using the balanced scorecard as an instrument for linking the key health care indicators and performance indicators of individual health facilities. Principles underlying cohesion and balance of the separate elements of the system are justified. Methods for identifying a statistically significant causal relationship between indicators are analyzed. A general model for the assessment of the attainment of the strategic goals by taking into account the three-level healthcare system is proposed.

Results. The presented details on the structure of indicators could be used by managers of health facilities for the development of their own strategies. The article concluded that further specification on the methodology of obtaining objective information to assess the success in health care strategic management is necessary.

Keywords

strategic management; efficiency; a health facility; evaluation; factors; balanced scorecard.

For citations

Dvojnikov S.I., Arhipova S.V. To the Problem of Increased Efficiency in Health Care Strategic Management. Medical Technologies. Assessment and Choice. 2019; 1(35): 50–55.

Issue № 1 | 2019 (35)

DOI: https://doi.org/10.31556/2219-0678.2019.35.1.043-049 meta

Abstract

The European region WHO policy on the prevention of non-communicable diseases, and also the development of national efforts to combat non-communicable diseases in the Russian Federation, are considered in the article. The strategic directions in the evolvement of the prevention of non-communicable diseases are described from the middle of the XX century until now. The relevance of scheduled preventive activities with the population and identification of effective ways to implement the prevention strategies, to diagnose at earlier stages and to reduce the impact of behavioral risk factors for the non-communicable diseases are justified. The need for further developments in the work on the formation of a healthy lifestyle, active involvement of each individual in the process of the formation of a responsible attitude to the health are proved.

Keywords

prevention of non-communicable diseases, risk factors, health promotion, the formation of a healthy lifestyle.

For citations

Zadvornaya O.L., Borisov K.N. Development of Prevention Strategies for Non-Communicable Diseases. Medical Technologies. Assessment and Choice. 2019; 1(35): 43–49.

Issue № 1 | 2019 (35)

DOI: https://doi.org/10.31556/2219-0678.2019.35.1.032-042 meta

Abstract

Clinical Decision Making Support Systems (CDMSS) are becoming increasingly popular in the wake of the introduction of information technology in medicine and the development of medical information systems. The potential benefits of using the CDMSS are forcing you to look for ways to create such a system that would allow you to solve not only clinical problems, but also analytical ones, planning tasks, training medical personnel, and digging new knowledge in medicine. It has been almost 50 years since the creation of the first MYCIN CDMSS, but the developers of such systems, the systems that provide intellectual support for clinical decision-making (ICDMSS), still face the problems of imitating reflexion and building an adequate inference machine that would provide the doctor with detailed explanations regarding proposed options for further action. This article is devoted to describing the experience of developing an algorithm for the operation of the solver of ICDMSS for diagnosing angina, which using mathematical methods would allow adequately evaluating the options offered to the doctor, as well as explaining them in detail using custom user stories.

Keywords

Angina pectoris, clinical decision making support systems, CDMSS, solver algorithm.

For citations

Kiselev K.V., Noeva E.A., Vyborov O.N., Zorin A.V., Potekhina A.V., Osyaeva M.K., Martynyuk T.V., Zarubina T.V. Development of a Reasoning Solver Algorithm for Instrumental Diagnostics of Angina Pectoris in Intelligent Clinical Decision Support System. Medical Technologies. Assessment and Choice. 2019; 1(35): 32–42.

Issue № 1 | 2019 (35)

DOI: https://doi.org/10.31556/2219-0678.2019.35.1.018-031 meta

Abstract

The article is a systematic review of the research devoted to the study of epidemiology, mechanisms of adverse events associated with the provision of medical care, as well as the principles of patient safety management. The meta-analysis allowed to establish that cases of harm in the provision of medical care (adverse events) are recorded in 10.6% of patients. At the heart of the development of adverse events are systemic causes – latent threats, the management of which is the basis of the modern strategy of ensuring the safety of medical care.

Keywords

medical care; patient safety; adverse events; latent threats, active threats, incident; unexpected death.

For citations

Voskanyan Yu.E., Shikina I.B. Health Care Safety Management in Modern Health Care. Medical Technologies. Assessment and Choice. 2019; 1(35): 18–31.

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/10.31556/2219-0678.2018.34.4.083-086 meta

Abstract

Modern data on cicatricial pathology of the skin is presented. Scar classifications, features of clinical manifestations of their pathomorphological aspects are analyzed in detail. The problem of correctly assessing the outcome of cicatricial deformities of the skin at an early stage of its formation is relevant, since in most cases patients with cicatricial deformities need surgical or conservative treatment at the early stages of its formation. A new version of the classification with a qualitative and quantitative assessment of the scar tissue should be developed using the study of its microcirculation and endogenous fluorescence at different periods of scar tissue formation to select clear indications and scar correction time.

Keywords

scar, classification, hypertrophic scar deformation, keloid cicatrix, pathogenesis of cicatrix.

For citations

Andreeva V. V., Kuzmina E. N. Modern View on Classification of Cicatricial Skin Deformations. Medical Technologies. Assessment and Choice. 2018; 4(34): 83–86.

Issue № 4 | 2018 (34)

DOI: https://doi.org/10.31556/2219-0678.2018.34.4.077-081 meta

Abstract

For thousands of years, people tried to fight against devastating epidemics that killed millions of people and spared no one – neither young nor old nor rich nor poor. Diseases such as cholera, plague, smallpox destroyed cities, villages and sometimes even whole countries. An article presents an overview of the history of the vaccination, an approach that allowed liberating humanity from dying of smallpox, plague and other deadliest diseases.

Keywords

smallpox, cowpox, vaccination, Edward Jenner, Henry Bedson.

For citations

Opimakh I. V. Edward Jenner and History of Vaccination. Medical Technologies. Assessment and Choice. 2018; 4(34): 77–81.

Issue № 4 | 2018 (34)

DOI: https://doi.org/10.31556/2219-0678.2018.34.4.063-075 meta

Abstract

The aim of this study was to estimate the socio-economic burden of lung cancer (LC) in the Russian Federation.

Methodology: the social burden of LC is defined as the number of patients newly diagnosed with LC in 2016, those who are followed-up in oncology clinics, disabled and deceased persons. The economic burden consists of total direct and indirect costs associated with LC and estimated from a government perspective. Direct medical costs include costs for diagnosis, inpatient and outpatient treatment, palliative care, follow-up costs, and expenditures for the subsidized drug coverage. Direct non-medical costs include payments for sickness and disability caused by LC. Indirect costs were calculated as a loss of a gross domestic product due to LC morbidity and mortality. Calculations were based on the methods described in Ignatieva V. I. et al. (2014) and adapted by the authors of this study to new methods of inpatient medical care payment. Indirect costs were calculated by the friction cost method. The sensitivity analysis was conducted to estimate the impact of initial parameters` variations, as well as the impact of indirect costs estimation with the human capital methods, on the results.

Results. In 2016, medical care was provided to 185,631 patients with LC, of whom 51,768 (27.9%) were newly diagnosed during the year. Direct medical costs were about 6.83 billion rubles. Most costs were incurred in inpatient care (4.09 billion rubles, 60.0%) and for the subsidized drug coverage (1.49 billion rubles, 21.8%). Direct non-medical expenses were about 5.76 billion rubles, 5.16 billion (89.7%) were disability-related payments. Indirect costs were about 14.77 billion rubles (friction cost method).

Keywords

socio-economic burden, lung cancer, cost of illness, direct medical costs, direct non-medical costs, indirect costs, subsidized drug coverage.

For citations

Avxentyeva M. V., Gorkavenko F. V., Nikitina A. V., Savilova A. G., Gerasimova К. V., Musina N. Z., Omelyanovskiy V. V. Estimation of Socioeconomic Burden of Lung Cancer in the Russian Federation. Medical Technologies. Assessment and Choice. 2018; 4(34): 63–75.