Pharmacoeconomics: theory and practice
№2, 2018, Vol.6

The authors carried out a comparative analysis of the economic consequences of smoking in the Russian Federation (from 2009 to 2016). The calculations are carried out as direct costs the cost of economicburden of tobacco-related diseases) and indirect costs (losses due to premature disability, premature death, reduced productivity, damage from fires due to smoking). During the simulation it was determined that the total economic damage from smoking in 2016 amounted to 3.86 trillion rubles, which amounted to about 4.5% of GDP for the year. Compared to 2009, the economic burden of smoking has decreased by 16% (adjusted for inflation).

OBJECTIVE: To compare and identify differences in the economic burden of multiple sclerosis amount and structure in European countries and in Russia. MATERIALS AND METHODS: The results of the cross-sectional observational retrospective study of the socio-economic burden of multiple sclerosis “New insights into the burden and costs of multiple sclerosis in Europe” were taken as an input data for the current article. The study was held in 16 European countries: Austria, Belgium, Hungary, Great Britain, Germany, Denmark, Spain, Italy, Netherlands, Poland, Portugal, Russia, France, Czech Republic, Switzerland, Sweden. The study reported data was divided by the following groups: direct costs (healthcare costs: inpatient care, day admission, consultations, tests, medication, disease-modifying treatments (DMTs), services and informal care costs) and indirect (short-term absence, long-term absence, invalidity, early retirement). We conducted an in-depth comparative cost structure analysis in the countries examined. As the costs were presented in terms of severity according to the EDSS scale, the average weighted cost was calculated considering the proportion of patients with different severity. We analyzed costs per patient, including direct medical costs, costs of DMTs, as well as indirect costs, and besides that the total cost for each country (total damage) based on the prevalence of multiple sclerosis was calculated. To describe the cost structure, the following ratios were developed: DMTs share of total cost, total cost to GDP per capita. With the help of the range ranking minimum, maximum, average, median, and also standard (mean square) deviation values were determined. RESULTS: The total average cost per patient with multiple sclerosis per year for any European country examined was about 2 million rubles. ± 882 thousand rubles, for Russia - 671 thousand rubles. (minimum value). The average direct costs per patient reaches 949 ± 370 thousand rubles in general, in Russia it is 464 thousand rubles (the minimum value). The DMTs costs in the structure of total costs were highest in Russia (57.16%) with an average value of 30.97% ± 14.36%. The lowest DMTs costs were in the UK (11.49%), Netherlands (10.07%) and Sweden (10.04%). The total multiple sclerosis burden for the country with an allowance for the prevalence of the disease, ranged from 393 billion rubles in Germany to 8.8 billion rubles in Hungary (in Russia - 78.8 billion rubles). The average of total costs to GDP per capita ratio for all countries was 84.64% ± 23.06%, for Russia - 41.05% (minimum value). CONCLUSION: In Russia, the economic burden of multiple sclerosis (including direct and indirect costs) is relatively small in comparison with European countries; while the share of DMTs costs in Russia is the highest among the countries surveyed.

High lability of the clinical aspect of asthma, poor observation of medical recommendations and low treatment adherence, make it necessary to search ways to optimize approaches to regimens of asthma therapy. According to GINA, not only correctly selected therapy but also the correct use of an inhalation device, increases control of the disease. Incorrect inhalation techniques affect the effectiveness of treatment and can lead to increased health system costs and a decrease in the patients’ quality of life. Objective. In this regard, the objective of this study was to conduct a comparative pharmacoeconomic evaluation of the use of vilanterol + fluticasone furoate (Relvar Ellipta) and budesonide + formoterol (Symbicort® Turbuhaler®) delivered with various inhalation devices. Materials and methods. Based on the clinical trials data on the effectiveness of the comparative treatment regimens, data on the cost of medical products, medical services, and the frequency of their provision, the effectiveness criteria were selected, their final values were modeled, cost analysis, cost-effectiveness and budget impact analysis were conduct- ed. Results. The cost analysis educed that the amounts of direct costs of asthma therapy with vilanterol + fluticasone furoate 22 μg + 184 μg / dose is 49% lower than the costs of treatment with high doses of budesonide + formoterol, the use of vilanterol + fluticasone furoate 22 mcg + 92 mcg / dose is 36% lower than the costs of asthma with medium doses of budesonide + formoterol, and is equal to the sum of direct costs of treating asthma with low-dose budesonide + formoterol. The «cost-effectiveness» analysis demonstrated that the therapy of vilanterol + fluticasone furoate in both dosages is dominant compared to therapy with equiv- alent medium and high doses of budesonide + formoterol. The budget impact analysis showed that the switching of 186,394 patients suffering from asthma from budesonide + formoterol to vilanterol + fluticasone furoate would result in savings of total direct costs of up to 6.2 billion rubles per year. Conclusion. Based on the results of the study, the pharmacoeconomic reasonability of use of vilanterol + fluticasone furoate, delivered by the Ellipta inhalation device, was established in the treatment of patients suffering from asthma.

The article presents updated and advanced results of a pharmacoeconomic study conducted in 2016 on the treatment of patients with pulmonary arterial hypertension II and III functional classes with ambrisentan and bosentan preparations in Russia. The evaluation was provided through cost analysis, “cost minimization” analysis, “cost-utility” analysis, “budget impact” analysis. Еhe cost of pharmacotherapy with Volibrys (ambrisentan) of arterial pulmonary hypertension, regardless of the functional class, was 1 200 000 rubles. and 1 300 000 rubles. respectively, with the need for 12 and 13 packs of the drug per year. The average annual cost of treatment with bosentan ranges from 1 368 900 rubles. up to 1 471 644 rubles. respectively, with the need for 13 and 14 packs of the drug. The results of the “cost minimization” analysis, carried out on the assumption of equal effectiveness of ambrisentan and bosentan, showed that per one patient for one year, the preparation of Volibris (ambrisentan) in comparison with the preparations of bosentan (Traklir and Bozeneks) 175 760 to 178 504 rubles. The values of the “cost-utility” coefficient for ambrisentan in the treatment of pulmonary arterial hypertension II and III of the functional class varied depending on the dosage (5 or 10 mg) from 1,831,563 rubles. up to 2 012 040 rubles for QALY and 2 667 711 rubles up to 2 787 728 rubles. for QALY. At the same time, similar averaged values for bosentan amounted to 2 480 073 rubles and 3 271 174 rubles for QALY for II and III functional class pulmonary arterial hypertension, respectively. The “budget impact” analysis based on the estimated number of patients with pulmonary arterial hypertension in the Russian Federation, which is 2936 people, showed that the transfer of this number of patients treated with the bosentan in the form of original (Tracler) and reproduced (Bozeneks) 1: 1, for treatment with the drug ambrisentan (Volibris), will allow for 2 years to save 853.2 million rubles, which is 9.7% of the budget required for the treatment of bosentan.

The results of comparative analysis of different methods of anesthesia pharmacoeconomic efficiency (total propofol-based intravenous anesthesia, low- flow sevoflurane- and desflurane-based anesthesia), used in minimal invasive surgery, are presented in this article. By counting of 1 minute of anesthesia price, using different methods of anesthesia, and, moreover, accounting a rate of drug load on organism, duration of anesthesia and a risk of anesthetic complications, it has been shown earnestly, that the optimal method is low-flow sevoflurane-based anesthesia coupled with supraglottic airduct I-gel.