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

DOI: https://doi.org/10.31556/2219-0678.2019.37.3.081-089 meta

Аннотация

Diabetes – a disease in which the effect of the treatment substantially depends on the patient. Known a study showed that the use of glucometers with the technology of three-color display of test results facilitates self-monitoring of blood sugar and leads to a decrease in glycated hemoglobin (HbAlc).

Purpose of the study: to modeling the impact of using of a glucometer with a color-coded display on the clinical outcomes of diabetes mellitus and calculating, the potential economic benefits of reducing the hospitalization rate of patients with diabetes.

Material and methods. Based on data from two studies (O. Schnell et al. and M. Baxter et al.) simulation of the reduction in the number of complications with the use of a glucometer with a color indication. In a study by O. Schnell et al. a decrease of HbA1c by 0.69 percent is shown when using the considered type of glucometers, which was the basis of the model.

Results. In the model, the use of a glucometer with a color-coded display for type 1 diabetes led to a decrease in the total number of complications by 9.2 thousand over 5 years per a cohort of 40 thousand patients with different initial levels of HbA1c. In a cohort of 40 thousand patients with type 2 diabetes, the simulated number of prevented complications was 1.7 thousand over 5 years. When extrapolating these data to all patients with diabetes included in the federal register of diabetes mellitus (FRD), the number of prevented complications was 55.4 thousand cases for type 1 diabetes and 67.1 thousand cases for type 2 diabetes. The possible economic effect from the use of the device by all patients with a diagnosis of diabetes, which are included in the FRD, estimated at 1.5 billion rubles for a cohort of patients with type 1 diabetes and 5.3 billion rubles for patients with type 2 diabetes.

Conclusion. Improving the effectiveness of self-monitoring, which is the result of the use of glucometers with color indicators, can potentially significantly reduce the incidence of complications in diabetes and thereby provide significant economic benefits to society.

Keywords

diabetes, complication of diabetes, self-control, colorimeters with color indication of test results, economic effect.

For citations

Popovich L.D., Svetlichnaya S.V., Moiseev A.A. Model estimates of the results of diabetes patients using modern glucometers with tri-color technology for displaying test results. Medical Technologies. Assessment and Choice. 2019;(3):81–89. DOI: 10.31556/2219-0678.2019.37.3.081-089

Issue № 3 | 2019 (37)

DOI: https://doi.org/10.31556/2219-0678.2019.37.3.071-080 meta

Аннотация

Objective: budget impact assessment on the healthcare system use of teriparatide in the treatment of severe osteoporosis in comparison with antiresorptive drugs.

Material and methods. Study Design – retrospective literature analysis. Methods of pharmacoeconomic analysis: cost analysis, the “budget impact” analysis, sensitivity analysis. In the study, patients were considered as a target group for prescribing the drug teriparatide or antiresorptive therapy with severe postmenopausal osteoporosis with the presumed development of two compression fractures requiring surgical reconstruction.

Results. The use of teriparatide in patients with two low-traumatic vertebral fractures will require a cost 1.4% less than treatment with zoledronic acid and 33.07% less than the treatment with alendronic acid and 13.6% less in comparison with the use of denosumab. At a weighted average frequency of 3 clinically significant fractures per year, the use of teriparatide will require 15.0%, 42.9% and 24.7% less cost, respectively. For a group of 1000 patients with 2 fractures per year, the savings over 4 years will amount to 13.7 million rubles, 483.0 million rubles, respectively and 154.1 million rubles. With a more severe course, expressed in an increase in the number of fractures to 3 per year, budget savings over 4 years per 1000 patients will amount to 219.0 million rubles, 930.9 million rubles and 406.0 million rubles, respectively. A sensitivity analysis showed that on a 4-year horizon, the use of teriparatide remains economically feasible with a decrease in the frequency of fractures to 1.95 per year compared to zoledronic acid, to 1.4 per year compared to denosumab and to 0.95 per year compared alendronic acid.

Conclusion. Teriparatide is more cost effective than antiresorptive drugs for severe osteoporosis, when an average of 2 clinically significant vertebral fractures per year can be expected in untreated patients requiring surgical reconstruction. In this way, the appointment of teriparatide as the first line of therapy for osteoporosis in patients at high risk of fractures, having more than one clinically significant fracture of the vertebral body in a history is justified from a pharmacoeconomic point of view.

Keywords

severe osteoporosis, vertebral fracture, antiresorptive therapy, bone-anabolitic therapy, budget impact, teriparatide, zoledronic acid, alendronic acid, denosumab.

For citations

Diakov I.N., Belaia ZH.E., Zyrianov S.K., Mazurov V.I. Budget impact analysis of teriparatide in comparison with antiresorptive drugs in severe osteoporotic patients. Medical technologies. Assessment and Choice. 2019;(3):71–80. DOI: 10.31556/2219-0678.2019.37.3.071-080

Issue № 3 | 2019 (37)

DOI: https://doi.org/10.31556/2219-0678.2019.37.3.062-070 meta

Abstract

Objective. To evaluate comprehensively the websites of health facilities (HFs) of various forms of ownership that provide information for consumers of medical services, and develop recommendations for optimizing the placement of this information on HFs websites.

Material and methods. The list containing 417 unique HFs websites records were received from Moscow City Compulsory Medical Insurance Fund register. Based on the requirements of regulatory enactments of the Russian Federation for the content of HF websites, 9 categories were formulated, including 43 conformity assessment criteria. The overall content of HFs websites evaluated as ratio of compliant criteria to total number of criteria. We used IBM SPSS Statistics 24 and Microsoft Excel 2016 for the comparison of two groups of HFs.

Results. The overall fulfillment of HFs websites was 95% with interquartile range (IQR) from 91% to 98%. The fulfillment of public and private HFs websites was 95% with IQR 92.5%–98% and 91% with IQR 56%–95%, respectively. Only 18.5% of Moscow HFs websites fully met the requirements of regulatory legal acts (24.0% of public and 5.6% of private HFs). Compared with the websites of private HFs, those of public HFs were more likely to comply with each criterion.

Conclusions. One fifth of HFs websites fully meet the basic requirements of regulatory legal acts. The problem of patients’ awareness about HF services require organizational actions. Those may include stimulation of integrative processes of information exchange between different departments and sufficient theoretical training of HFs managers about regulatory legal acts requirements for HFs websites.

Keywords

website, health facility, Internet, marketing, marketing communications, regulatory legal acts.

For citations

Ekkert N.V., Polukhin N.V. Presentation of information for consumers of medical services on the websites of health facilities: problems and solutions. 2019;(3):62–70. DOI: 10.31556/2219-0678.2019.37.3.062-070

Issue № 3 | 2019 (37)

DOI: https://doi.org/10.31556/2219-0678.2019.37.3.053-061 meta

Abstract

Purpose of the study. Healthcare budget impact analysis in the Russian Federation of providing adult patients with chronic obstructive pulmonary disease (COPD) with basic therapy for outpatient treatment.

Material and methods. The hypothesis of reducing costs for the treatment of exacerbations of COPD was tested while providing all patients with basic therapy on an outpatient basis. The model calculates the direct medical costs of drug provision and treatment of exacerbations in patients with COPD in the current situation and when all patients with COPD are covered with basic therapy as part of a program of preferential drug provision. The simulation period is 1 year. The analysis does not take into account social losses associated with disability, payment of disability certificates, reduced labor productivity and mortality.

Results. The cost of providing all patients with COPD with the recommended basic drug therapy on an outpatient basis is substantially offset by a decrease in the cost of treating exacerbations: drug costs should increase by 14.1 billion rubles compared with the current situation, while the cost of providing medical care to patients with exacerbations is reduced by 9.7 billion rubles. As a result, the difference in direct medical costs, or the necessary additional investments, is 4.4 billion rubles. The price of drugs used for basic therapy has the greatest impact on the size of the required additional investments.

Conclusion. Providing all patients with COPD with the recommended basic drug therapy on an outpatient basis, we can expect a decrease in the number of moderate exacerbations per year by 14.7% and severe exacerbations by 31.2%. Taking into account not only medical, but also socio-economic costs can not only offset additional investments, but also demonstrate significant savings. When implementing a pilot project of preferential drug provision for patients with COPD in a specific region of the Russian Federation, it is possible to reduce the cost of purchasing medicines when forming a municipal order.

Keywords

chronic obstructive pulmonary disease (COPD), budget impact analysis, drug provision, basic therapy.

For citations

Maliavin A.G., Dzanaeva A.V., Avxentyeva M.V., Babak S.L. Medical and economic analysis of the consequences of expanding the drug supply program for patients with chronic obstructive pulmonary disease in the Russian Federation. Medical technologies. Assessment and Choice. 2019;(3):53–61. DOI: 10.31556/2219-0678.2019.37.3.053-061

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 № 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.

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.