Pharmacoeconomics: theory and practice
№2, 2016, Vol.4
It is the first time a comparative pharmacoeconomic analysis of telavancin (Vibativ®) use for treatment of patients suffering from nosocomial infections caused by resistant bacterial flora using the example of patients with nosocomial pneumonia was performed in Russia. The study was carried out using mathematical modelling with a one-month horizon. Cost-benefit analysis, budget-impact analysis, and sensitivity analysis were used. The study found that telavancin use showed high clinical efficacy and one of the best safety profiles among other medical treatment technologies for such groups of patients. Telavancin use makes economic sense in terms of cost-efficacy ratio as compared to vancomycin and linezolid. According to the results of analysis of budget impact, for wide use estimated strategy requires additional investment to the extent of 13% when compared with the strategies of the use of vancomycin and linezolid.
It is the first time a comparative pharmacoeconomic analysis of telavancin (Vibativ®) use for treatment of patients suffering from nosocomial infections caused by resistant bacterial flora using the example of patients with complicated skin and soft tissue infections was held. The study was carried out using mathematical modelling with a one-month horizon. Cost-benefit analysis, budget-impact analysis, and sensitivity analysis were used. The study found that telavancin use showed high clinical efficacy and one of the best safety profiles among other medical treatment technologies for such groups of patients. Telavancin use makes more economic sense in terms of cost-efficacy ratio than daptomycin, tigecycline and linezolid. Telavancin use is more advantageous in terms of budget impact analysis as compared to linezolid and daptomycin use: saving up to 32,705,178 rubles from the budget, which enables to treat up to 126 more patients.
Breast cancer is a malignant neoplasm that develops from the epithelial cells of ducts and lobules of the glandular parenchyma, which according to the World Health Organization (WHO) is the most common form of cancer among women (16% of all cases) in the world. In 2014, in Kaluga, Lipetsk, Smolensk and Tula regions the mortality from breast cancer reached 3.2%, 3.1%, 4% and 4.7%, respectively. One of the aggressive forms of breast cancer is a HER2positive (HER2+) subtype (14 to 20% of all subtypes), which is treated with targeted therapy. The appearance of trastuzumab for subcutaneous administration has a number of advantages compared to the intravenous formulation. A pharmacoeconomic analysis of treatment of HER2+ breast cancer was performed by comparing trastuzumab in two formulations in Kaluga, Lipetsk, Smolensk and Tula regions. According to the “cost minimization” analysis in the analyzed regions, the use of trastuzumab for subcutaneous administration compared to intravenous administration saves from 29.7 to 34% of funds. The forecasted budget savings as a result of the budget impact analysis for 10 patients is 8,068,360 rubles in Kaluga region, 7,047,430 rubles in Lipetsk region, 6,534,750 rubles in Smolensk region, and 7,188,980 rubles in Tula region for the treatment course with trastuzumab in subcutaneous formulation as compared to the intravenous formulation. The results showed that the use of trastuzumab therapy in the subcutaneous formulation allows treatment of 4 additional patients with HER2+ breast cancer in Smolensk region, and 5 patients in Kaluga, Lipetsk and Tula regions within a fixed budget.
A pharmacoeconomic study of cerebrovascular accident treatment with Cellex was conducted at the background of routine clinical practices in comparison with routine clinical practices only. It was found that in the first case the therapy is dominant in comparison with the second one as it shows better therapeutic effectiveness and is characterized by a lower cost-effectiveness ratio. It was also defined that transfer of one patient from routine clinical practices to Cellex treatment at the background of routine clinical practices is supported with the economy of 7 313 rubles.
Budget impact analysis of teriflunomide inclusion as first-line disease modifying drugs (DMD) therapy in the List to ensure patients with relapsing-remitting multiple sclerosis (RRMS) within the programme ‘7 high-cost nosologies’ on the budgets of Russian Federation (RF) federal and regional public authorities in the field of health care.
A pharmacoeconomic evaluation of follitropin alpha (Gonal-F®), follitropin beta (Puregon) and menotropin (Menopur) to stimulate ovulation during the in vitro fertilization procedure has been performed. The results of the effectiveness analysis demonstrated the superiority of follitropins over menotropin in terms of the number of oocytes obtained, occurrence of pregnancy and live birth, all three taken as effectiveness criteria. There were no data to support statistically significant differences in effectiveness between follitropin alpha and follitropin beta. In this connection the main method of pharmacoeconomic analysis to compare follitropin alpha and menotropin was the “cost-effectiveness” analysis while for pharmacoeconomic evaluation of follitropin alpha and follitropin beta the “cost-minimization” analysis was applied. The results of “cost-effectiveness” analysis has shown that follitropin alpha (Gonal-F®) is more cost-effective across all three above criteria compared to Menopur. The “cost-minimization” analysis has revealed that administration of Gonal-F® instead of Puregon enables to save on treatment between 1,973 rubles and 4,861 rubles. Therefore, from the pharmacoeconomic standpoint, Gonal-F® is characterized as a dominant (strictly preferable) drug for ovarian stimulation during assisted reproductive technology (ART) as compared to Menopur and Puregon.
This article presents an overview of the main performances at the X National Congress with international participation “Development of pharmacoeconomics and pharmacoepidemiology in the Russian Federation”, Nizhny Novgorod, Russia, April 4-5, 2016
Cost analysis is an essential step of pharmacoeconomic research. It is the basis for carrying out special methods of pharmacoeconomic analysis: “cost-effectiveness” and “budget impact”. This article deals with methodological basis of cost analysis in pharmacoeconomic studies. In particular, the authors describe the classification of costs and various methods of their calculation. In the publication the attention is paid to sourcing prices and cost structure in conducting pharmacoeconomic studies. Thus, the possibilities and limitations of using different types of prices depending on the position of pharmacoeconomic studies. The advantages and disadvantages of cost analysis based on standards of medical care, clinical and statistical groups and evaluation of real clinical practice are also described. The article deals with the features that must be considered when calculating direct and indirect costs. The authors list the problems of accounting the intangible costs.