Yagudina Roza Ismailovna - Pharmacoeconomics: theory and practice

Yagudina Roza Ismailovna

Serpik V.G., Yagudina R.I. 910

The limited financing of the program of pharmacological support of high-cost nosologies emphasizes the importance of more effective use of the available resources. In order to improve the efficiency of use of the available resources of pharmacological support of inhibitor hemophilia patients receiving therapy in the prophylactic regimen, a budget impact analysis of prophylactic treatment by BPA anti-inhibitor coagulant complex and eptacog alfa [activated] was performed. In accordance with the instructions for use of eptacog alfa, this medicinal product is not indicated for long-term preventive treatment of bleedings, however, as eptacog alfa is used in the said regimen, it was included in the analysis. The analysis horizon period made 1 year and 75 patients were included in the analysis. The analysis shows that prophylactic anti-inhibitor coagulant complex therapy offers better control over the disease and reduces the costs. The incidence of bleedings in prophylactic anti-inhibitor coagulant complex therapy is reduced by 72.5%, while the incidence of bleedings in prophylactic treatment by eptacog alfa is reduced by 59% as compared to on demand therapy. The annual costs of prophylactic anti-inhibitor coagulant complex therapy per patient make 58.8 million rub (per adult patient) and 23.5 million rub (per pediatric patient), while the annual costs of bleeding prophylactic eptacog alfa treatment proved to be higher by 37.4% and made 94 million rub per adult patient and 37.6 million rub for pediatric patient. Transfer of all patients who respond to anti-inhibitor coagulant complex therapy and receive therapy with this medicinal product in prophylaxis regimen will save 765 million rub or 17.3% of the budget, provided that the current distribution of patients is preserved. Thus, the budget impact analysis demonstrates that the transfer of patients receiving therapy with eptacog alfa in prophylaxis regimen to AICC will improve the control over disease and save the budget funds under the 7N Program.

Ugrekhelidze D.T., Yagudina R.I. 909

This article touches upon the main methodological aspects of conducting pharmacoeconomic analysis of treatment of spasticity in patients with cerebral palsy. The authors evaluated the relevance of conduct of such studies basing on epidemiological and social and economic data. The stages of information retrieval and inclusion criteria in the effectiveness analysis are covered in detail. Special attention is paid to assessing the methodological quality of the studies. The authors highlighted the components of the cost analysis and assessment of the economic burden of this disease and describes the features of assessing the quality of life in children with cerebral palsy using a variety of methods.

Beltukov E.K., Skorohodov I.S., Ugrekhelidze D.T., Yagudina R.I. 870

This work included a pharmaeconomic study of the efficacy of treatment of primary immunodeficiencies (PID) with antibody formation defects using normal human immunoglobulin medicinal products for intravenous administration in the Sverdlovsk Region health care system. Four treatment regimens were compared: 10% intravenous immunoglobulin (IVIG) Privigen and 5% IVIGs Octagam, Intratect, I.G.Vena. It appeared that, from the pharmacoeconomic analysis point of view, the use of 10% normal human immunoglobulin for intravenous administration, Privigen, is the most cost-effective regimen (per patient) of primary immunodeficiency therapy among the pediatric (n=9) and adult (n=20) populations of PID patients with impaired antibody formation in the Sverdlovsk Region. In per annum terms, one pediatric patient switched to Privigen from Octagam saves 65 605 roubles; from Intratect, 183 625 roubles; from I.G.Vena, 68 949 roubles. Over the same period, one adult patient switched to Privigen from Octagam saves 170 870 roubles; from Intratect, 459 911 roubles; from I.G.Vena, 68 958 roubles. The budget impact analysis, within the Sverdlovsk Region health care system, showed that a 70% increase in Privigen procurement due to 70% reduction in Intratect procurement for PID patients helps save a total of 6 076 471 roubles per year. The lost opportunity analysis showed that the 70% increase in Privigen purchases would have provided additional funding for treatment of 11 pediatric or 3 adult PID patients with antibody formation defects.

Makarova E.I., Yagudina R.I. 693

This article presents a methodology for calculating QALY using questionnaires to study the quality of life of a patient. The review and classification of the most frequently used questionnaires of quality of life measurement validated to QALY are presented, their main features, advantages and disadvantages are highlighted. The main elements of universal questionnaires, as well as the stages of obtaining the utility index, are described in detail. In addition, alternative methods to obtaining health state utility values for generic questionnaires have been explored, using forecasting (mapping) based on data on other indicators of the patient’s health status.

Krylov A.B., Serpik V.G., Skulkova R.S., Yagudina R.I. 665

This publication discusses the problem of choosing a comparison technology for pharmacoeconomic analysis. The relevance of this issue stems from the fact that the pharmacoeconomic analysis is based on a comparative competitive approach and that the comparison technology sets the point of reference and determines the sensitivity of the assessment. Pharmacoeconomic assessment is most needed for innovative drugs. In this context, the choice of comparison technology predetermines the results of the pharmacoeconomic evaluation of an innovative drug. The traditional approach used in choosing a comparison technology in a pharmacoeconomic analysis based on the evidence of medical use between the drug being investigated and the comparison technology has some limitations, especially when the drug of a new class is evaluated. In this case, the comparison technology often uses long-running medications, which are not comparable with the innovative drug, either in terms of efficiency (usually to a large extent) or at the cost of an innovative drug, which is often more high-priced. In these circumstances, the results of the pharmacoeconomic assessment of innovative drug will possibly be negative. The negative results may be a sign of not likely unacceptability of an innovative drug but the consequence of the incorrect choice of comparison technology, which sets the level of sensitivity of the pharmacoeconomic analysis, in which the innovation drug is known to be beyond its borders. For a solution to the situation, the authors suggest an alternative approach to the choice of comparison technology in the pharmacoeconomic analysis.

Glushchenko A.A., Kulikov A.Y., Yagudina R.I. 661

This paper is devoted to assessment of economic burden of excessive alcohol consumption in Russian Federation. In the course of analysis, we gathered data about direct costs of treatment of conditions, directly or indirectly caused by excessive alcohol consumption, and indirect costs. A total burden of excessive alcohol consumption is more than 547 billion rubles, which makes up to 0,68% of Russia’s GDP for the year 2015. Since 2010 the burden has decreased by nearly 100 billion rubles, and the decrease of burden in relative values from 1,98% to 0,68% of GDP, which gives the evidence of the effectiveness of the government policy in the sphere of alcohol consumption control.

Serpik V.G., Yagudina R.I. 242

Abstract: We provided a pharmacoeconomic evaluation of the treatment of gastric cancer in the second line of therapy with ramucirumab, using the relative value analysis method. Ramucirumab is the only anti-angiogenic drug registered for the treatment of advanced gastric cancer. In comparison with the standard regimens of the second line of chemotherapy for gastric cancer, the use of the ramucirumab has a statistically significant advantage, increasing the median overall survival by 30%. Ramucirumab (Cyramza) cost of treating per one patient is 1 761 564 RUB. From the perspective of relative value analysis the cost of an additional unit of effectiveness of ramucirumab is comparable or even lower than the same criteria of other antitumor drugs of monoclonal antibodies already included in the national EDL. Consequently, ramucirumab can be characterized as an acceptable technology. The budget impact analysis showed that providing patients with advanced gastric cancer with the ramucirumab is characterized by a lower burden on the drug support budget for oncological patients than bevacizumab, trastuzumab and cetuximab in the therapy of the oncology nosologies, at the their approval date. According to the results of the budget impact analysis on the drug supply of ramucirumab, 200 patients will additionally require 329.19 million rubles, which is only 0.64% of the budget for the treatment of cancer in 2016. Key words: gastric cancer, pharmacoeconomics, cost-effectiveness analysis, budget impact analysis, relative value analysis, bevacizumab, cetuximab, ramucirumab, trastuzumab.

Davydovskaya M.V., Ermolaeva T.N., Kokushkin K.A., Tolkushin A.G., Yagudina R.I. 235

1 Clinical Trials and Healthcare Technology Assessment Centre of Moscow Department of Healthcare, Moscow, Russia 2 First Moscow State Medical University I.M. Sechenov (Sechenov University), Moscow, Russia

Ryagina V.A., .., Yagudina R.I. 221

First Moscow State Medical University I.M. Sechenov (Sechenov University), Moscow, Russia

Kostina E.O., .., Yagudina R.I. 218

Moscow State Medical University I.M. Sechenov (Sechenov University), Moscow, Russia

Krylov A.B., Yagudina R.I. 223

Moscow State Medical University I.M. Sechenov (Sechenov University), Moscow, Russia

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Serpik V.G., Yagudina R.I. 993

This article is devoted to the evaluation of the use of dalbavancin (Xydalba) in the treatment of skin and soft tissue infections in hospital settings in the Russian Federation. The main methods of pharmacoeconomic analysis in the study were the following: cost-minimization analysis and budget impact analysis. The results of the pharmacoeconomic evaluation of dalbavancin treatment of patients with skin and soft tissue infection in Russia hospitals showed its stable advantage from the point of view of cost analysis and budget impact analysis in comparison with telavancin and tigecycline. The results of the cost-minimization analysis indicate of the dominance of dalbavancin in comparison with telavancin. At the same time, a comparative cost-minimization analysis of dalbavancin and tigecycline showed the advantage of the former, which, however, is not preserved when assessing the stability of the results through a one-factor sensitivity analysis with an increase in the price of dalbavancin by 15%. In accordance with the quantitative assessment of clinical and economic effectiveness, regulated by Decree of the Government of the Russian Federation N871 dated August 28, 2014, dalbavancin obtains +8 points on the pharmacoeconomic criterion.

Babiy V.V., Serpik V.G., Ugrekhelidze D.T., Yagudina R.I. 923

The article aims to review issues of choice of drugs clinical effectiveness evaluation during pharmacoeconomic studies. It also includes effectiveness criteria classification in pharmacoeconomics. Special attention is paid to the description of the effectiveness criteria using both duration and quality of life: description of their methodological basis, advantages and limitations. The authors provide recommendations for the choice of effectiveness criteria, depending on pharmacoeconomic analysis method; the target audience for results of pharmacoeconomic analysis, and the characteristics of nosology.

Beltukov E.K., Skorohodov I.S., Ugrekhelidze D.T., Yagudina R.I. 870

This work included a pharmaeconomic study of the efficacy of treatment of primary immunodeficiencies (PID) with antibody formation defects using normal human immunoglobulin medicinal products for intravenous administration in the Sverdlovsk Region health care system. Four treatment regimens were compared: 10% intravenous immunoglobulin (IVIG) Privigen and 5% IVIGs Octagam, Intratect, I.G.Vena. It appeared that, from the pharmacoeconomic analysis point of view, the use of 10% normal human immunoglobulin for intravenous administration, Privigen, is the most cost-effective regimen (per patient) of primary immunodeficiency therapy among the pediatric (n=9) and adult (n=20) populations of PID patients with impaired antibody formation in the Sverdlovsk Region. In per annum terms, one pediatric patient switched to Privigen from Octagam saves 65 605 roubles; from Intratect, 183 625 roubles; from I.G.Vena, 68 949 roubles. Over the same period, one adult patient switched to Privigen from Octagam saves 170 870 roubles; from Intratect, 459 911 roubles; from I.G.Vena, 68 958 roubles. The budget impact analysis, within the Sverdlovsk Region health care system, showed that a 70% increase in Privigen procurement due to 70% reduction in Intratect procurement for PID patients helps save a total of 6 076 471 roubles per year. The lost opportunity analysis showed that the 70% increase in Privigen purchases would have provided additional funding for treatment of 11 pediatric or 3 adult PID patients with antibody formation defects.

Glushchenko A.A., Kulikov A.Y., Yagudina R.I. 661

This paper is devoted to assessment of economic burden of excessive alcohol consumption in Russian Federation. In the course of analysis, we gathered data about direct costs of treatment of conditions, directly or indirectly caused by excessive alcohol consumption, and indirect costs. A total burden of excessive alcohol consumption is more than 547 billion rubles, which makes up to 0,68% of Russia’s GDP for the year 2015. Since 2010 the burden has decreased by nearly 100 billion rubles, and the decrease of burden in relative values from 1,98% to 0,68% of GDP, which gives the evidence of the effectiveness of the government policy in the sphere of alcohol consumption control.

Krylov A.B., Serpik V.G., Skulkova R.S., Yagudina R.I. 665

This publication discusses the problem of choosing a comparison technology for pharmacoeconomic analysis. The relevance of this issue stems from the fact that the pharmacoeconomic analysis is based on a comparative competitive approach and that the comparison technology sets the point of reference and determines the sensitivity of the assessment. Pharmacoeconomic assessment is most needed for innovative drugs. In this context, the choice of comparison technology predetermines the results of the pharmacoeconomic evaluation of an innovative drug. The traditional approach used in choosing a comparison technology in a pharmacoeconomic analysis based on the evidence of medical use between the drug being investigated and the comparison technology has some limitations, especially when the drug of a new class is evaluated. In this case, the comparison technology often uses long-running medications, which are not comparable with the innovative drug, either in terms of efficiency (usually to a large extent) or at the cost of an innovative drug, which is often more high-priced. In these circumstances, the results of the pharmacoeconomic assessment of innovative drug will possibly be negative. The negative results may be a sign of not likely unacceptability of an innovative drug but the consequence of the incorrect choice of comparison technology, which sets the level of sensitivity of the pharmacoeconomic analysis, in which the innovation drug is known to be beyond its borders. For a solution to the situation, the authors suggest an alternative approach to the choice of comparison technology in the pharmacoeconomic analysis.

Makarova E.I., Yagudina R.I. 693

This article presents a methodology for calculating QALY using questionnaires to study the quality of life of a patient. The review and classification of the most frequently used questionnaires of quality of life measurement validated to QALY are presented, their main features, advantages and disadvantages are highlighted. The main elements of universal questionnaires, as well as the stages of obtaining the utility index, are described in detail. In addition, alternative methods to obtaining health state utility values for generic questionnaires have been explored, using forecasting (mapping) based on data on other indicators of the patient’s health status.

Serpik V.G., Yagudina R.I. 242

Abstract: We provided a pharmacoeconomic evaluation of the treatment of gastric cancer in the second line of therapy with ramucirumab, using the relative value analysis method. Ramucirumab is the only anti-angiogenic drug registered for the treatment of advanced gastric cancer. In comparison with the standard regimens of the second line of chemotherapy for gastric cancer, the use of the ramucirumab has a statistically significant advantage, increasing the median overall survival by 30%. Ramucirumab (Cyramza) cost of treating per one patient is 1 761 564 RUB. From the perspective of relative value analysis the cost of an additional unit of effectiveness of ramucirumab is comparable or even lower than the same criteria of other antitumor drugs of monoclonal antibodies already included in the national EDL. Consequently, ramucirumab can be characterized as an acceptable technology. The budget impact analysis showed that providing patients with advanced gastric cancer with the ramucirumab is characterized by a lower burden on the drug support budget for oncological patients than bevacizumab, trastuzumab and cetuximab in the therapy of the oncology nosologies, at the their approval date. According to the results of the budget impact analysis on the drug supply of ramucirumab, 200 patients will additionally require 329.19 million rubles, which is only 0.64% of the budget for the treatment of cancer in 2016. Key words: gastric cancer, pharmacoeconomics, cost-effectiveness analysis, budget impact analysis, relative value analysis, bevacizumab, cetuximab, ramucirumab, trastuzumab.

Kostina E.O., .., Yagudina R.I. 218

Moscow State Medical University I.M. Sechenov (Sechenov University), Moscow, Russia

Krylov A.B., Yagudina R.I. 223

Moscow State Medical University I.M. Sechenov (Sechenov University), Moscow, Russia

Ryagina V.A., .., Yagudina R.I. 221

First Moscow State Medical University I.M. Sechenov (Sechenov University), Moscow, Russia

Davydovskaya M.V., Ermolaeva T.N., Kokushkin K.A., Tolkushin A.G., Yagudina R.I. 235

1 Clinical Trials and Healthcare Technology Assessment Centre of Moscow Department of Healthcare, Moscow, Russia 2 First Moscow State Medical University I.M. Sechenov (Sechenov University), Moscow, Russia

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