Научно-практический журнал Медицинские технологии. Оценка и выбор
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Issue № 4 | 2018 (34)

DOI: https://doi.org/10.31556/2219-0678.2018.34.4.056-062 meta

Abstract

To improve the management of patients with diabetes mellitus (DM), a change to the current system of reimbursement for completed case treatment of this group of patients, followed-up in the outpatient departments of the hospitals, based upon obligatory health insurance fund was introduced. A new Diagnosis-Related Group (DRG) «Follow-up of patients» was proposed and proved to be listed in the medical register. Calculations based on the model of a patient with DM, who needs to be followed up and potentially has been diagnosed with complications of the disease. The model includes a patient’s stay in an outpatient department of the hospital for three days to be diagnosed and treated.

Keywords

diabetes mellitus, management and follow-up of patients, medical register, reimbursement for completed case treatment, diagnosis-related group.

For citations

Shestakova M. V., Zelenova O. V., Yarek-Martynova I. Ya., Abramov S. I., Vikulova O. K., Karpov O. I. Modelling of Healthcare Expenditures on Management of Patients with Diabetes Mellitus for Reimbursement under Diagnosis-Related Groups. Medical Technologies. Assessment and Choice. 2018; 4(34): 56–62.

Issue № 4 | 2018 (34)

DOI: https://doi.org/10.31556/2219-0678.2018.34.4.047-055 meta

Abstract

The article is devoted to the search for the fundamental bases for the effective solution of the problem of the safety of surgical patients (SSP), which becomes a key direction in improving the surgical services of each medical organization. The definition of SSP is proposed as a complex concept combining progressive educational, clinical and managerial technologies aimed at preventing the negative consequences of surgical treatment, based on their internal connections and general development prospects. This allowed to justify the implementation of an integrated approach to its solution in practice.
Obligatory components of the organizational structure of such an approach are: informational-legal, educational-motivational, surgical (perioperative), control-administrative and organizational. The necessary technological processes for this are considered by the authors: standardization, creation of a single legal and educational platform for all subjects of medical law, personnel management, the process principle of technology implementation, risk management, improvement of information support. The unity of the components and elements of the SSP program is harmonized with the principle of mutual potentiation of their specific requirements, which are consistent with the main goal – the restoration of the patient’s health.

Keywords

patient safety, surgery, conceptual framework, integrated approach, system organization, program.

For citations

Karsanov A. M., Polunina N. V., Gogichaev T. K. The Safety of Patients in Surgery. Part 1: Conceptual Basis of the Problem. Medical Technologies. Assessment and Choice. 2018; 4(34): 47–55.

Issue № 4 | 2018 (34)

DOI: https://doi.org/10.31556/2219-0678.2018.34.4.039-046 meta

Abstract

Aim. To measure comprehensive indicators of consumption in order to assess their correlation with the level of resistance of S. aureus, K. pneumoniae, E. coli in multidisciplinary hospitals of St. Petersburg in 2014–2016.

Materials and methods. We extracted data on the public procurement of antimicrobial drugs for systemic use (ATC code J01) in multidisciplinary hospitals of St.-Petersburg in 2014–2015 from IMS Health database. Prevalence of resistant strains was assessed based on the results of bacteriological surveys, St. Petersburg Medical Information-analytical Center (MIAC). The indicators of antimicrobial drugs consumption, drug resistance, drug resistance index were calculated.

Results. The structure of public procurement of antimicrobial drugs does not correlate with the the prevalence of multi-resistant infections in St. Petersburg hospitals as a result of out-dated standards for specialized medical care. Current epidemiological situation requires purchasing of the the expensive antimicrobial drugs of limited access and performing epidemiological control measures that demand additional investments.

Conclusion. The existing standards for specialized medical care should be timely updated with regard to recommendations on antibacterial treatment in accordance with the current epidemiological situation.

Keywords

antimicrobial drug, bacterial resistance, drug resistance index.

For citations

Gomon Y. M., Kolbin A. S., Svetlichnaya Y. S., Proskurin M. A. Comprehensive Assessment of Antimicrobial Drug Consumption at the St. Petersburg Hospitals in 2014-2016. Medical Technologies. Assessment and Choice. 2018; 4(34): 39–46.

Issue № 4 | 2018 (34)

DOI: https://doi.org/10.31556/2219-0678.2018.34.4.025-038 meta

Abstract

Objective. Cost-effectiveness analysis (CEA) of elbasvir in combination with grazoprevir (EBR/GZR) for the treatment of patients with chronic hepatitis C (CHC), infected with genotype 1 subtype b, who previously did not receive antiviral therapy (AVT), without cirrhosis or with compensated cirrhosis, from a Russian healthcare system perspective.

Methods. In a model, developed in MS Office (Microsoft Excel® package), the differences in direct medical costs were determined (using cost minimization analysis) by comparing EBR/GZR and 3D (the combination of ombitasvir, paritaprevir, ritonavir, and dasabuvir), which have comparable effectiveness in patients with chronic hepatitis C (genotype 1b). Besides, changes in costs for the treatment of patients with CHC (genotype 1b), if EBR/GZR are reimbursed, are analysed under the State-guaranteed benefit package (SGBP) for free medical care for the citizens of the Russian Federation (budget impact analysis). Frequencies of long-term consequences of CHC (number of cases of decompensated cirrhosis and hepatocellular carcinoma) were projected in the long run depending on whether AVT is administered or not, for 20 years or lifetime time horizon. For calculations, data from literature and standard financial expenditures in Russian healthcare system in 2018 were used. Univariate (one-way) sensitivity analysis was conducted to assess the impact in the price change of EBR/GZR package on the results of the analysis.

Results. Average cost per patient for therapy with EBR/GZR was 510 142 rubles, or 21% less than for therapy with 3D that was 645 614 rubles. If EBR/GZR are included in Vital and Essential Drugs List (VED), expenditures under SGBP for treatment of CHC (genotype 1b) are expected to decrease by 16,1% in three years: by 9,4% in the first year, 15,7% in the second year and by 21% in the third year.

Conclusions: Using EBR/GZR in clinical practice is efficient and leads to an improvement in the competitiveness in the field. It also allows reducing the additional healthcare system expenditures on direct-acting antiviral agents (DAAA) in AVT of CHC, and provides highly-effective therapeutic regimes under SGBP for patients without increasing the budget. Greater accessibility of DAAA (EBR/GZR and 3D) within the Russian healthcare system and increased availability of these drugs for the patients will lead to a significant decrease in incidence of such severe and costly consequences of hepatitis as decompensated cirrhosis and hepatocellular carcinoma in comparison with no treatment in the long run.

Keywords

chronic hepatitis C, antiviral therapy, direct-acting antiviral agents, elbasvir, grazoprevir, ombitasvir, paritaprevir, ritonavir, dasabuvir, cost-effectiveness analysis.

For citations

Pyadushkina E. A., Derkach E. V., Boyarskaya T. V., Zhdanov K. V., Kozlov K. V. Cost-effectiveness analysis of elbasvir and grazoprevir for treatment of adult patients with chronic hepatitis C (genotype 1b) from Russian Healthcare system perspective. Medical Technologies. Assessment and Choice. 2018; 4(34): 25–38.

Issue № 33 | 2018 (3)

DOI: https://doi.org/10.31556/2219-0678.2018.33.3.062-074 meta

Abstract

Enzalutamide, abiraterone plus prednisone and cabazitaxel plus prednisone (hereafter referred to as abiraterone and cabazitaxel, respectively) are approved for the post-chemotherapy treatment of metastatic castration-resistant prostate cancer (mCRPC) in Russia. Currently, none of these treatments are
included in the Government Drug Reimbursement Program (GDRP).

The aim of this pharmacoeconomic evaluation is to comapre enzalutamide, abiraterone and cabazitaxel used after chemotherapy in patients with mCRPC from the Russian healthcare system perspective.

Materials and methods. Based on data from clinical trials – AFFIRM (enzalutamide), COU-AA-301 (abiraterone) and TROPIC (cabazitaxel) – and indirect comparisons of considered drugs, we proposed an mCRPC Markov chain model and calculated medical costs associated with three options. We used the 5-year time horizon as proposed by the national guidelines for pharmacoeconomic research. Budget impact, cost-effectiveness and cost-utility analyses were conducted.

Results: Use of enzalutamide, abiraterone and cabazitaxel resulted in 1.04, 0.94 and 0.96 quality-adjusted life years, respectively. Monthly medication costs for enzalutamide were 183 550,71 RUB per patient, 15% less than for abiraterone and 49% less than for cabazitaxel. Five-year total medical costs were 3 330 982 RUB, 3 331 998 RUB and 4 434 624 RUB per patient for enzalutamide, abiraterone and cabazitaxel, respectively. The smaller difference in total medical costs resulted from longer progression-free survival on enzalutamide compared to abiraterone or cabazitaxel. If included in GDRP, enzalutamide results in the lowest budget impact: 6 524,6 RUB million, compared to 6 526,6 RUB million for abiraterone and 8 688,4 RUB million for cabazitaxel.

Conclusions: Enzalutamide is more effective compared to abiraterone and cabazitaxel and requires the same or less additional budget expenditure in Russia.

Key words

prostate cancer, enzalutamide, abiraterone, cabazitaxel, pharmacoeconomic evaluation, cost-effectiveness analysis, cost-utility analysis, budget impact.

For citations

Avxentyev N. A., Derkach E. V., Makarov A. S. Pharmacoeconomic Evaluation of Enzalutamide, Abiraterone and Cabazitaxel for the Treatment of Post-Chemotherapy Patients with Metastatic Castration-Resistant Prostate Cancer. Medical Technologies. Assessment and Choice. 2018; 3(33): 62–74.

Issue № 33 | 2018 (3)

DOI: https://doi.org/10.31556/2219-0678.2018.33.3.075-088 meta

Abstract

The article presents the results of pharmacoeconomic study of umeclidinium bromide/vilanterol compared with tiotropium bromide/olodaterol and glycopyrronium bromide/vilanterol for the treatment of patients with chronic obstructive pulmonary disease (COPD). It was found that the use of umeclidinium bromide/vilanterol reduces the cost of therapy (26 and 29% respectively) and direct medical costs (23 and 25% respectively), and also increases the
effectiveness in respect of the criteria that characterise external respiration in patients with obstructive pulmonary diseases based on the measurement of
volume that has been exhaled at the end of the first second of forced expiration (FEV1). It is also the most convenient and simple in use and maintenance.

Key words

umeclidinium bromide/vilanterol, tiotropium bromide/olodaterol, glycopyrronium bromide/vilanterol, pharmacoeconomic analysis, pharmacoeconomic study, budget impact analysis, cost-effectiveness analysis.

For citations

Tolkushin A. G., Pogudin N. L. Pharmacoeconomic Analysis of Drug Therapy of Chronic Obstructive Pulmonary Disease: Umeclidinium Bromide/Vilanterol Compared with other Combinations of Long-Acting β-Antagonists and Anticholinergics. Medical Technologies. Assessment and
Choice. 2018; 2(32): 75–88.

Issue № 32 | 2018 (2)

DOI: https://doi.org/10.31556/2219-0678.2018.32.2.048-059 meta

Abstract

The use of highly effective methods of restoring blood fl ow (reperfusion) in ischemic stroke (IS) is still limited. In general, the frequency of thrombolytic therapy (TLT) in the Russian Federation does not reach the minimum recommended target level (5%) – mainly because of late delivery of patients to medical organizations, i.e., when the TLT is no longer indicated. Mechanical thromboextraction (MTE), which can be performed for a longer period after the onset of the disease, improves the outcome of IS, but its use is limited by a high cost.

Study objective: to evaluate the efficacy and efficiency of the use of MTE in patients with IS from the Russian healthcare system perspective.

Methods. The economic burden of IS was modelled for different patient management options. The target population of IS patients consisted of two subgroups: 1) those delivered to the hospital in the first 4.5 hours after the development of IS (candidates for TLT or TLT + MTE), 2) delivered in the first 6 hours after the development of IS, when TLT is not indicated already (candidates for isolated MTE). The economic burden of IS was calculated for the different scenarios of treatment in the acute phase of stroke: the absence of reperfusion (scenario 1.1), TLT (scenario 1.2) or TLT + MTE (scenario 1.3) for the subgroup 1; the absence of reperfusion (scenario 2.1) or MTE as an independent reperfusion method (scenario 2.2) for subgroup 2. The incidence of three possible IS outcomes (functional independence, disability or death) was modelled, based on the meta-analysis of Campbell B.C. et al., 2016. Direct medical, direct non-medical and indirect costs, due to IS and its consequences, were calculated for each of the scenarios. The time horizon was 4 years.

Results. The use of MTE + TLT or MTE only leads to a reduction of direct non-medical costs due to the decrease of social payments for IS-caused disability, and to the reduction of indirect costs caused by GDP losses due to temporary disability, permanent disability and mortality of the economically active population after IS. As a result, the use of MTE + TLT or MTE only reduces the overall economic burden of IS beginning from the 2nd year after IS. The investments into MTE are compensated by the reduction of direct non-medical and indirect costs on the 4th year.

The conclusion. The MTE in combination with TLT or as an independent reperfusion method in the acute period of IS is an effective and efficient
method.

Keywords

ischemic stroke, mechanical thromboextraction, economic analysis.

For citations

Dombrovsky V. S., Ivakhnenko O. I., Avksentyeva M. V., Omelyanovskiy V. V., Musina N. Z. Efficacy and Efficiency of Mechanical Thromboextraction in Combination with Thrombolytic Therapy or as an Independent Method of Intravascular Treatment in Patients with Ischemic Stroke. Medical technologies. Evaluation and selection. 2018; 2 (32): 48–59.

Issue № 32 | 2018 (2)

DOI: https://doi.org/10.31556/2219-0678.2018.32.2.060-066 meta

Abstract

Objective of the study: to evaluate the efficiency of digital radiography at the departments of radiology in Moscow city medical organizations.

Methods. We compared the costs of material resources used in the process of analogous and digital radiography in 2015 in one of the average Moscow city outpatient clinic. Only variable costs were taken into account, i.e. the costs directly depending on the volume of services. The cost of X-ray equipment was not considered, since it was purchased centrally for all municipal organizations, without using the financial resources of medical organizations. At the same time, we considered the cost of a purchased digital image conversion system (digitizer), which is available to every medical organization at the expense of both budgetary and own funds. We analyzed the costs of analogous images and the costs of images provided with the use of digital equipment (digitizer) during 2015 in a single outpatient clinic in Moscow, as well as in all outpatient clinics of the Moscow City Healthcare Department. The number of diagnostic tests was derived from the statistical surveillance form from the year 2015.

Results. The current costs for each analog image are almost 2 times higher than those of the image made with the use of digitizing equipment (digitizers). Therefore, the savings of consumables, and financial resources in general would be 1,019,528.40 rubles. When comparing the material costs for X-ray images made in all Moscow outpatient clinics the financial savings for consumables would be about 140.0 million rubles. We assumed that all film shots were made with the help of existing developing machines and there is an opportunity to replace them with digitizers. The cost savings after replacing one machine would be 158.5 thousand rubles, after replacing 612 automatic machines (in outpatient clinics) – 97,0 million rubles, and after replacing all 862 machines in Moscow – 136.6 million rubles.

Keywords

analog radiography, digital radiography, radiology, digitizers.

For citations

Udakova S. I., Morozov S. P., Vetsheva N. N., Kim K. A. Advantages of Digital Radiography in Improving the Efficiency of Radiology Departments. Medical Technologies. Assessment and Choice. 2018; 2(32): 60–66. (In Russ.).

Issue № 32 | 2018 (2)

DOI: https://doi.org/10.31556/2219-0678.2018.32.2.067-080 meta

Abstract

Lung cancer is the most common malignant tumor and the most prevalent cause of cancer-related deaths in Russian men. Programmed-cell-death 1 (PD-1) inhibitors pembrolizumab and nivolumab are the new treatment options for metastatic non-small cell lung cancer (NSCLC) that improve treatment outcomes compared to docetaxel.

Objective of the study: the pharmacoeconomic evaluation of PD-1 inhibitors for the 2nd line treatment of patients with metastatic NSCLC with disease progression on or after platinum-containing chemotherapy or anti-EGFR/ALK targeted therapy drugs in Russia.

Methods. We compared two treatment options: use of pembrolizumab (for patients whose tumors express PD-L1) or docetaxel (for other patients) vs use of nivolumab regardless of PD-L1 expression level. We proposed a Markov chain model of NSCLC progression based on data from clinical trials. We calculated direct medical costs associated with two treatment options, and conducted budget impact and cost-effectiveness analyses.

Results. Medication cost of pembrolizumab or docetaxel option were 3,980,925.27 RUB per patient per year, which was 27 % less than for nivolumab (5,436,657.87 RUB). Five-year direct medical costs of using pembrolizumab (for a patient whose tumor expresses PD-L≥1%) or docetaxel (for other patients) were 2,775,253 RUB, or 35.2% less than for nivolumab. Pembrolizumab or docetaxel option also had lower (better) cost/effectiveness ratio. Compared to nivolumab, pembrolizumab or docetaxel can save up to 11.9 billion RUB (32.5%) budget expenditures in three years.

Keywords

non-small cell lung cancer, pembrolizumab, nivolumab, docetaxel, pharmacoeconomic evaluation, cost-effectiveness analysis, budget impact analysis.

For citations

Avxentyev N. A., Zhuravleva M. V., Makarov A. S., Semiglazova T. Yu., Frolov M. Yu. Pharmacoeconomic Evaluation of PD-L1 Receptor Inhibitors for the Second Line Treatment of Metastatic Non-Small Cell Lung Cancer. Medical Technologies. Assessment and Choice. 2018; 2(32): 67–80.

Issue № 32 | 2018 (2)

DOI: https://doi.org/10.31556/2219-0678.2018.32.2.081-093 meta

Abstract

Objective of the study: to perform economic evaluation of tiotropium bromide + olodaterol (T + O) fixed combination in comparison with other medications included into Vital and Essential Drugs List (VEDL) and used for the maintenance therapy of chronic obstructive pulmonary disease (COPD).

Methods. Cost-minimization, cost-effectiveness and budget impact analyses were performed. The global budget impact model was used for cost calculations. The model was adjusted for Russian Federation being filled with Russian healthcare costs. A decision tree and Markov model were used for estimation of direct medical costs associated with different medications.

Results. Drugs costs for T + O were the lowest among all compared treatment strategies. Costs savings in favor of T + O were 23.7% which also led to the decrease of cost-effectiveness ratio for T + O by 23,65% vs other treatment strategies. T + O led to the decrease of total direct medical costs under State Program of Guarantees of Free Medical Care by 27.24%.

Conclusion. T + O fixed combination is a preferred cost-saving option for maintenance treatment of patients with COPD vs other drugs from VEDL, because it requires less total costs with equal efficacy.

Keywords

chronic obstructive pulmonary disease, maintenance therapy, bronchodilators, tiotropium, olodaterol, fixed combination, cost-minimization analysis, budget impact analysis, cost-effectiveness analysis, pharmacoeconomic modeling.

For citations

Nedogoda S.V., Barykina I. N., Salasyuk A. S. et al. Pharmacoeconomic Analysis of Tiotropium Bromide and Olodaterol Fixed Combination as Maintenance Therapy in Patients with Chronic Obstructive Pulmonary Disease in Russian Federation. Medical Technologies. Assessment and Choice. 2018; 2(32): 81–93.